The current study explores the spatial patterns of underweight and overweight among adult men and women in districts of India and identifies the micro-geographical locations where the risks of underweight and overweight are simultaneously prevalent, after accounting for demographic and socio-economic factors.

We relied on BMI (weight (kg)/height squared (m2)), a measure of nutritional status among adult individuals, from the 2015–2016 National Family and Health Survey. Underweight was defined as <18·5 kg/m2 and overweight as ≥25·0 kg/m2.

We adopted Bayesian structured additive quantile regression to model the underlying spatial structure in underweight and overweight burden.

Men aged 15–54 years (sample size: 108 092) and women aged 15–49 years (sample size: 642 002).

About 19·7 % of men and 22·9 % of women were underweight, and 19·6 % of men and 20·6 % of women were overweight. Results indicate that malnutrition burden in adults exhibits geographical divides across the country. Districts located in the central, western and eastern regions show higher risks of underweight. There is evidence of substantial spatial clustering of districts with higher risk of overweight in southern and northern India. While finding a little evidence on double burden of malnutrition among population groups, we identified a total of sixty-six double burden districts.

The current study demonstrates that the geographical burden of overweight in Indian adults is yet to surpass that of underweight, but the coexistence of double burden of underweight and overweight in selected regions presents a new challenge for improving nutritional status and necessitates specialised policy initiatives.