Context
India is experiencing an ironic nutrition crisis, with undernutrition persisting in rural regions and overnutrition drastically rising in urban areas. These two sides burden show the country simultaneously fighting problems of hunger and micronutrient deficiency, besides obesity and diet-related non-communicable diseases (NCDs).
Urban Overnutrition vs Rural Undernutrition
(i) Undernutrition remains a serious issue, especially in rural India. More than one-third of children below five are stunted because of chronic undernourishment and child malnutrition.
(ii) On the flip side of the coin, rates of overweight and obesity have increased, particularly in cities. The prevalence of overweight or obesity among adults reduced between 2005 and 2022, increasing from 13% to 24% in women and 9% to 22.9% in men.
(iii) Both around 45% of urban men and women are overweight or obese, compared to about 33% (average) of rural women and of rural men: (STEPS Survey, 2023–24)
(iv) India’s situation is also evident globally; it stood second worldwide in the number of obese individuals, even as it struggles with high levels of hunger.
Factors Driving Overnutrition in Urban India
(i) Sedentary Lifestyles and Work Culture: Today’s urban work is mostly desk-bound. For eg, MOre than half of the employees in Hyderabad and Bangalore are suffering from fatty liver disease. It underscores the metabolic risks of sedentary jobs.
(ii) Chronic Stress and Sleep Disruption: City lifestyle and intense-pressure jobs contribute to chronic stress and irregular sleep cycles.
(iii) Dietary Shift to Processed Foods: Urban diets have inclined towards cheaper, energy-dense ultraprocessed foods. There is greater consumption of packaged snacks, which are loaded with high fat, sugar, and salt.
(iv) Social and Behavioral Factors: Rising incomes and altering aspirations have made overeating and rich diets more common. In cities, food acts as a socializing and convenience agent.
(v) Emerging “Nightlife Culture”: Urban economies’ expansion is directly proportional to nightlife culture. Late-night eating and unhealthy foods and beverages have become their dependence, or we can say a norm.
(vi) Biological and Genetic Factors: South Asians are more vulnerable to abdominal obesity and diabetes at lower BMIs.
Factors Driving Undernutrition in Rural India
(i) Limited Access to Nutritious Food: Economic restrictions prevent rural households from getting diverse and nutrient-rich diets. As a result, dependency on calorie-dense but nutrient-poor diets is there.
(ii) Inadequate Sanitation Facilities: Inadequate clean water and sanitation lead to repeated infections like diarrhea, which impair nutrient absorption.
(iii) Intergenerational Undernutrition: Undernourished mothers most probably give birth to low-weight babies. Consequently, perpetuating a cycle of malnutrition.
(iv) Leakages and Corruption: Challenges in the Public Distribution System and various welfare schemes make inadequate delivery of food and nutrition a general thing.
Implications of this Double Burden of Malnutrition
(i) Increased NCD Burden: Overnutrition is directly fueling the surge in NCDs like Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD), hypertension, diabetes, and cardiovascular diseases. This is evident in findings such as 84% of IT employees in Hyderabad having fatty liver and over 65% of deaths in Chennai being attributable to NCDs.
(ii) Strain on Healthcare System: The rising NCD burden puts a lot of pressure on an already burdened healthcare system, demanding long-term care and increasing healthcare expenditures.
(iii) Economic Strain: Increased healthcare costs, reduced productivity, rising Out-of-Pocket Expenditure (OOPE).
(iv) Intergenerational Impact: Obese children have surged drastically and are estimated to climb further, setting the stage for a future generation burdened with NCDs from an early age. This can perpetuate a cycle of ill-health and reduced human capital.
(v) Failure to Meet SDG Targets: Unless substantial policy interventions are made, it is difficult for India to meet the 2030 Sustainable Development Goal (SDG) targets to decrease premature mortality from NCDs.
Government Steps to Tackle Undernutrition and Overnutrition
(i) POSHAN Abhiyaan (National Nutrition Mission): Being a flagship mission, it aims to reduce child stunting, underweight, and anemia, and ameliorate maternal nutrition.
(ii) National Nutrition Strategy (NITI Aayog): Kuposhan Mukt Bharat by 2022; addresses both under- and overnutrition.
(iii) Eat Right India Movement (FSSAI): Led by the FSSAI, this initiative works for ensuring safe, healthy, and sustainable food.
(iv) Anemia Mukt Bharat” and Micronutrient Programs: Given rampant micronutrient deficiencies (like ~57% of women being anaemic, NFHS-5), the government runs targeted programs for Iron and Folic Acid supplementation (especially for pregnant women, adolescents) and Vitamin A supplementation for children.
Challenges in Implementation
(i) Unchecked Growth of Fast Food Outlets: The rapid expansion of fast food in metro cities is a dangerous obstacle. It is making it tougher to shift dietary habits.
(ii) Market Saturation with UPFs: The market is inundated with easy-to-cook, cheaper but unhealthy ultra-processed foods, leaving consumers with limited nutritious choices.
(iii) Debate on Labelling Effectiveness: The proposed HSR system has initiated debate among medical practitioners and nutrition experts about its actual effectiveness in influencing consumer choices.
(iv) Insufficient Consumer Awareness: While nutrition awareness is growing, it remains ineffective in countering aggressive marketing of unhealthy products.
(v) Behavioral Change Resistance: Deep-seated dietary habits and preferences, along with the convenience offered by unhealthy options. It makes behavioral change a slow and challenging process.
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Way Forward
(i) Mandatory Front-of-Package Warning Labels: Implement clear, concise, and prominent warning labels on HFSS foods.
(ii) Strict Marketing and Advertising Regulations of unhealthy foods, particularly those targeting children.
(iii) Fiscal Measures (Health Taxes): Impose huge excise taxes on sugar-sweetened beverages (SSBs), energy drinks, and ultra-processed foods.
(iv) Incentivize Healthy Food Production and Distribution: Ensure incentives are given to manufacturers producing nutritious, traditional, and minimally processed foods.
(v) Nutritional Literacy: Incorporate comprehensive nutritional education into school curricula from an early age.
(vi) Regular Audits: Conduct regular and transparent audits of food manufacturers, restaurants, and catering services.
Conclusion
India’s nutrition discourse needs an update from calorie sufficiency to dietary quality. Tackling the urban overnutrition wave requires the same whole-of-government urgency that the country collated for digital payments or COVID-19 vaccination, supported by smart taxes, aggressive reformulation, community-based campaign pushes, and evidence-powered governance.