Unhealthy Weight in Indian Families: The Role of the Family Environment in the Context of the Nutrition Transition

India faces a dual burden of increasing obesity and persistent underweight as it experiences the nutrition transition—the dietary and lifestyle changes that accompany globalization, economic development, and technological change. Yet, the nutrition transition is not solely a top-down process; rather, global forces converge with local practices at multiple levels of the social ecology. The family environment, a key site for the transmission of local customs and norms, remains largely unexplored in India. We examined the extent to which opposite-gender siblings and mother–child pairs were concordant or discordant in body weight, and whether domains of the family environment, specifically, food practices, food-related gender norms, and household resources, were associated with patterns of unhealthy weight within and between families. Multilevel dyadic analysis and logistic regression were conducted using survey data from a representative sample of 400 families in a Southern Indian city. We identified substantial clustering of weight among opposite-gender sibling pairs (ICC = 0.43) and mother–child pairs, as well as important patterns of discordance, including 11% of families experiencing a dual burden of underweight and overweight. Household resources, including mother’s education and income, were salient in explaining the distribution of body weight within and between families. Importantly, less examined domains of the family environment were also relevant, including food practices (e.g., grocery shopping frequency), and food-related gender norms (e.g., mother’s control of food served at home). Continued exploration of how global and local practices converge in households will be necessary to develop programming that effectively addresses India’s dual burden of unhealthy weight.