India’s women are more likely to be obese than their male counterparts, new research shows.

There were 20 million obese women in India in 2014 compared with 9.8 million obese men, according to a study published in the British medical journal, the Lancet.

Severe obesity was observed in an additional 4 million Indian women. There were less than 800,000 obese women in India in 1975 compared with 400,000 obese men.

The study, comparing body-mass index from 1975 to 2014 from adults in 186 countries showed middle- and poorer-income countries like China, India and Brazil jumped in rankings when it came to obesity although India and China also have the most underweight citizens in the world.

Worldwide, the number of obese people rose to 641 million in 2014 from 105 million in 1975, according to the study. Global obesity rates almost tripled for men to 11% of the total from 3.2% in 1975, while among women it nearly doubled to 15% from 6.4% in 1975.

China had the most obese men and women in the world in 2014.

Still, India saw a more significant rise in obesity from its 19th position for both men and women in 1975 to rankings 5th and 3rd respectively in 2014, reflecting increasing obesity rates among women worldwide.

Obesity has been linked to a host of illnesses including diabetes, cardiovascular disease and breathing disorders. Rapid urbanization along with rising income and sedentary lifestyles have all been associated with rising levels of obesity.

Being obese is defined as having a body mass index, a measurement that relates weight to height, of 30 kilograms per meter squared.

Still, there is either too much or too little to eat in India.

Indians were the most underweight in the world in 1975 at a time when society was vastly agrarian and it would be decades before the country’s liberalized economy increased standards of living.

It remained the country with the most underweight in 2014, when 102 million men and 100 million women were considered underfed.

Even though China has the second-highest number of underweight men and women in the world, over dozens of years it reduced the number of people considered underfed to 8% for men and 13% in women in 2014 from 18.2% for men and 21% in women in 1975. In India, the number of underweight in that time increased by 8% of total global underweight.

The number of underweight people worldwide rose to 462 million from 330 million in the same period.