Rising Overnutrition: India’s New Urban Worry 

Syllabus: GS2/ Health

In Context

• India is witnessing a paradoxical nutrition crisis, with undernutrition persisting in rural regions even as overnutrition sharply rises in urban centres.
• This dual burden means the country simultaneously battles problems of hunger and micronutrient deficiency alongside obesity and diet-related non-communicable diseases (NCDs).

Dual Burden: Urban Overnutrition vs Rural Undernutrition

• Undernutrition remains a serious issue, especially in rural India. Over one-third of Indian children under five are stunted (low height-for-age) due to chronic undernourishment and child malnutrition indicators are consistently worse in rural areas than in urban areas.
  • For instance, states like Bihar and Meghalaya report rural stunting rates exceeding 40%, significantly higher than their urban counterparts.
• On the other hand, rates of overweight and obesity have surged, particularly in cities. The prevalence of overweight or obesity among adults doubled between 2005 and 2022,  rising from 13% to 24% in women and 9% to 22.9% in men.
  • Nearly 43% of urban women and 46% of urban men are now overweight or obese, compared to about 32% of rural women and 35% of rural men: (STEPS Survey, 2023–24)
• India’s paradox is also evident globally, the country ranked second worldwide in the number of overweight/obese individuals as of 2021, even as it struggles with high levels of hunger (as highlighted by its persistent challenges on the Global Hunger Index).

Factors Driving Overnutrition in Urban India

• Sedentary Lifestyles and Work Culture: Modern urban work is largely desk-bound. For example, a study among young IT professionals in Hyderabad found 71% were obese and 84% had fatty liver disease, underscoring the metabolic risks of sedentary jobs.
• Chronic Stress and Sleep Disruption: City life and high-pressure jobs contribute to chronic stress and irregular sleep patterns.
• Dietary Shift to Processed Foods: Urban diets have shifted toward inexpensive, energy-dense processed foods. There is greater consumption of packaged snacks, fast foods, and sugar-sweetened beverages that are high in fat, sugar, and salt (HFSS).
• Social and Behavioral Factors: Increasing incomes and changing aspirations have made overeating and rich diets more common. In cities, food is part of socializing and convenience.
• Emerging “Nightlife Culture”: As urban economies expand, so does a nightlife culture, often associated with late-night eating and consumption of unhealthy foods and beverages.
• Biological and Genetic Factors: South Asians are more prone to abdominal obesity and diabetes at lower BMIs.

Factors Driving Undernutrition in Rural India

• Limited Access to Nutritious Food: Economic constraints prevent rural households from affording diverse and nutrient-rich diets, leading to reliance on calorie-dense but nutrient-poor staples.
• Inadequate Sanitation Facilities: Lack of clean water and proper sanitation leads to repeated infections like diarrhea, which impair nutrient absorption.
• Intergenerational Undernutrition: Undernourished mothers are more likely to give birth to low birth weight babies, perpetuating a cycle of malnutrition.
• Leakages and Corruption: Issues in the Public Distribution System (PDS) and other welfare schemes lead to inadequate delivery of food and nutrition services.

Implications of this Double Burden of Malnutrition

• 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.
• Strain on Healthcare System: The escalating NCD burden places immense pressure on an already stretched healthcare system, requiring long-term care and increasing healthcare expenditures.
• Economic Strain: Increased healthcare costs, reduced productivity, rising Out-of-Pocket Expenditure (OOPE).
• Intergenerational Impact: Childhood obesity has surged dramatically and is projected 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.
• Exacerbation of Health Inequalities: While undernutrition disproportionately affects the poor, overnutrition is increasingly prevalent across wealth quintiles, indicating a widespread health crisis in the making, with potential for further widening health disparities.
• Failure to Meet SDG Targets: Without substantial policy interventions, India is unlikely to meet the 2030 Sustainable Development Goal (SDG) targets to reduce premature mortality from NCDs.

Government Steps to Tackle Undernutrition and Overnutrition

• POSHAN Abhiyaan (National Nutrition Mission): Launched in 2018, this flagship mission aims to reduce child stunting, underweight and anemia, and improve maternal nutrition.
• National Nutrition Strategy (NITI Aayog): Kuposhan Mukt Bharat by 2022; addresses both under- and overnutrition.
• Tamil Nadu’s Makkalai Thedi Maruthuvam (MTM) Programme: This multisectoral approach to NCD control includes workplace screenings, health walks, and the “Eat Right Challenge” to encourage behavioral change and nutrition awareness.
• Eat Right India Movement (FSSAI): Led by the Food Safety and Standards Authority of India (FSSAI), this initiative promotes safe, healthy, and sustainable food.
• Front-of-Package Labelling (Health Star Rating Proposal): To help consumers make informed choices, FSSAI in 2022 proposed a new Indian Nutrition Rating (INR) – a health star rating system for packaged foods.
• 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

• Unchecked Growth of Fast Food Outlets: The rapid proliferation of fast food chains in urban metros remains a formidable obstacle, making it difficult to shift dietary habits.
• Market Saturation with UPFs: The market is flooded with convenient but unhealthy ultra-processed foods, offering consumers limited nutritious choices.
• Debate on Labelling Effectiveness: The proposed HSR system has sparked debate among medical practitioners and nutrition experts regarding its actual effectiveness in influencing consumer choices.
• Insufficient Consumer Awareness: While nutrition awareness is growing, it remains insufficient to counter aggressive marketing of unhealthy products.
• Weak Enforcement: Existing regulations often lack stricter enforcement mechanisms, allowing non-compliant practices to persist.
• Behavioral Change Resistance: Deep-seated dietary habits and preferences, coupled with the convenience offered by unhealthy options, make behavioral change a slow and challenging process.

Saudi Arabian model

• Saudi Arabia is among the few nations meeting WHO’s sodium reduction best practices and recognised for eliminating trans fats. 
• As part of its Vision 2030 initiative, Saudi Arabia has embedded NCD prevention into its national policy framework. 
• It enforces calorie labelling in restaurants, imposes a 50% excise tax on sugar-sweetened beverages, and levies a 100% tax on energy drinks. 
• Its success lies in the coherence of its strategy — integrating health, regulatory oversight, industry compliance, and civic engagement.

Way Forward

• Mandatory Front-of-Package Warning Labels: Implement clear, concise, and prominent warning labels (e.g., traffic light system or warning symbols) on HFSS foods, rather than potentially ambiguous star ratings.
• Strict Marketing and Advertising Regulations of unhealthy foods, especially those targeting children.
• Fiscal Measures (Health Taxes): Impose significant excise taxes on sugar-sweetened beverages (SSBs), energy drinks, and highly processed foods.
• Incentivize Healthy Food Production and Distribution: Provide incentives (subsidies, tax breaks) to manufacturers producing nutritious, traditional, and minimally processed foods.
• Nutritional Literacy: Incorporate comprehensive nutritional education into school curricula from an early age.
• Regular Audits: Conduct regular and transparent audits of food manufacturers, restaurants, and catering services.

Source: TH