Among 800 Nepalese women in Bhaktapur tracked from early pregnancy through 12 months postpartum (2017–2021), mean BMI climbed from 23.7 kg/m² in early pregnancy to a peak of 26.1 kg/m² at 6 months postpartum, settling at 25.2 kg/m² by 12 months. Cross-cohort comparison across four population-based studies spanning 2,400 women from 2001–2021 reveals a dramatic secular trend: postpartum overweight rose from 11.4% to 44.6%, while obesity jumped from 1.8% to 10.9% — increases of roughly 4-fold and 6-fold respectively. Using Asia-specific BMI cut-offs, which lower overweight thresholds to account for elevated cardiometabolic risk at lower body fat percentages in South Asian populations, prevalence figures were even higher.
These findings arrive at a critical inflection point for South Asian public health. Nepal has long been framed primarily as a country burdened by undernutrition, yet this longitudinal evidence documents a rapid nutrition transition mirroring trends seen in urban India and Bangladesh. The postpartum window represents a particularly consequential period — retained gestational weight is a known independent predictor of long-term obesity, type 2 diabetes, and cardiovascular disease in women. Practical implications include the need to integrate postpartum weight management into routine maternal healthcare in low-income South Asian settings, not merely prenatal monitoring. Limitations include single-city data from Bhaktapur limiting generalizability to rural Nepal, and observational design precluding causal inference on drivers. As a preprint not yet peer-reviewed, findings require independent validation before informing policy.
