The prevalence of obesity in India is increasing rapidly — faster than the world average, even. A new study explores the reasons behind its rise in a bid to help policymakers design programs factoring them in.

Published in Economics and Human Biology, the study used data from National Family Health Surveys to find that contributors of obesity between men and women vary — for the former, obesity was linked to the use of technology, like motorized transportation, that reduces physical activity; for the latter, “increasing age and diminishing reproductive stress (when a woman stops having children)” was a major factor.

Moreover, besides sex, whether an individual resides in an urban or a rural area also has a role to play. For women, decreased reproductive stress was the biggest driver of obesity in rural areas, whereas, in cities, age played a bigger role. For men, on the other hand, access to motorized transport was one of the largest contributors to obesity in rural areas. At the same time, a sedentary lifestyle, primarily due to increased television watching, was a bigger factor in cities.

“Biological differences, along with intrahousehold differences in behavior and access to technology, explain how obesity has emerged differently across genders in India… Understanding the circumstances behind these trends can help policymakers identify which factors should be prioritized in efforts to reduce obesity,” Sunaina Dhingra, an assistant professor in the Jindal School of Government and Public Policy in India, who co-authored the study, said in a statement.

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Past research has cited a multitude of reasons behind the rise of obesity in the country. While sedentary lifestyle and the lack of physical activities are commonly discussed as factors contributing to the problem, researchers point to lifestyle-related stressors like increased workload and lack of sleep at night as other possible contributors.

Some believe parenting practices, too, are adding to India’s obesity burden — especially among children. “There cannot be so much academic pressure that they can’t take out half an hour, one hour, for exercise… The parents also find it very convenient — when they see their child sitting with books… or that the child is on the computer because then they’re less troubled by the child,” Madhulika Sen, the principal of Tagore International School in Delhi, told CNN in 2017.

Unfortunately, India’s notoriety for malnutrition has overshadowed its obesity problem. “For developing countries like India, morbid obesity has not yet become a public health priority… Probably, India is, in our own eyes, still a country of poverty, hunger, and malnutrition. Yet, statistics suggest otherwise,” according to a 2012 study published in the Indian Journal of Endocrinology and Metabolism.

However, amid this ignorance, India has emerged as “one of the capitals of diabetes and cardiovascular diseases,” according to the 2012 study; both of these health conditions are often attributed to obesity. In fact, the prevalence of the conditions in India is so high that the country’s diabetic population is estimated to be almost 70 million by 2025 and 80 million by 2030. Simultaneously, according to another study from 2012, the prevalence of heart diseases in the country was projected to rise from 2.26 million to 4.77 million in just two decades.

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Despite the rise of obesity in the country, malnourishment continues to be in the picture — a 2019 study found the proportion of children under five who died due to malnutrition in India had decreased by just 2% since 1990. And just last month, one of the country’s High Courts put the onus on the state to prevent deaths due to malnutrition.

Experts often refer to India’s tryst with malnourishment on the one hand and obesity on the other as a “double burden.” But even though the conditions may seem antonymous, the key to addressing them is the same: a healthy diet.

However, the easy availability, and often low cost, of processed and junk food to advertisements promoting their consumption on TV, to people choosing them because they’re tastier — have all paved the path for unhealthy eating, and subsequently, obesity in India.

Diet, however, is a difficult problem to fix in India, say experts. “Interpretation of nutrition research is as complex as the cooking in India where the dialect and the diet change every 100 miles,” Dr. A.B. Dey from the AIIMS in Delhi told The Indian Express. Yet, it is one of the most viable solutions.

“Ensuring that Indians have access to a healthy diet is ultimately the key to addressing hunger, undernutrition, and obesity in the country,” said Prabhu Pingali, co-author of the present study and founder of the Tata-Cornell Institute for Agriculture and Nutrition at the Cornell University in the U.S.