India is clearly far along in the nutrition transition. This paper shows that there have been rapid increases in the proportion of adult women in India who are overweight and obese: these increases are seen not just in urban but in rural areas as well, and there are regional specificities. Correspondingly, diabetes and hypertension affect a large proportion of adults, even as childhood undernutrition remains a public health problem. These have important consequences for the design of public health systems, especially in rural India. At the same time, the intra-household dual burden of malnutrition is also increasing. Among other factors, households with wealthier and less educated mothers, and children born with a healthy weight, seem less vulnerable to the dual burden of malnutrition. Also significant are household expenditure (suggesting that the phenomenon is associated with affluence) and lifestyle choices, calling for better and nuanced behavior change communication strategies.