Syllabus
GS Paper II – Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.
Context
The Lancet study underscores a dual health challenge in India, where obesity rates have surged among both adults and children over the past three decades. Simultaneously, undernutrition remains a persistent issue, resulting in a ‘double burden’ on the country’s healthcare system.
Double Burden of Malnutrition
Introduction
The double burden of malnutrition refers to the coexistence of contrasting forms of malnutrition within the same population. On one hand, we have undernutrition, which leads to stunted growth and increased susceptibility to diseases, particularly in children. On the other hand, there’s overnutrition, characterized by obesity and diet-related noncommunicable diseases (NCDs). This global challenge affects both low- and middle-income countries, with significant economic consequences. Integrated nutrition action is crucial to address this complex issue and promote better health outcomes for all.
Highlights of the study
- Obesity Trends in India: Over a 32-year period, India has witnessed a sustained and concerning increase in obesity among both adults and children. This poses a significant public health challenge, as obesity is closely associated with a higher risk of various non-communicable diseases, including diabetes, hypertension, heart disease, and strokes.
- Processed Foods and Obesity: The study highlights the role of processed foods, which are often rich in fats, salt, and sugar, in driving the obesity epidemic in India. The link between dietary choices and public health outcomes is crucial. As people increasingly consume these processed foods, the impact on health becomes more pronounced.
- Body Mass Index (BMI) Classification: To assess obesity and underweight, health professionals rely on Body Mass Index (BMI), a widely used indicator of body fatness. The World Health Organization (WHO) provides guidelines for BMI classification, which are adopted globally by health organizations.
Report 1: Lancet Study on Underweight and Obesity Trends (1990–2022)
Report 2: NNMB Report on Nutrition and Health in India
| Report 1: Lancet Study on Underweight and Obesity Trends (1990–2022) | Report 2: NNMB Report on Nutrition and Health in India |
| Underweight and Obesity Trends | Obesity, Hypertension, and Diabetes in India |
| – Combined prevalence of underweight and obesity decreased in 11 countries for women and 17 countries for men. | – Obesity rate in India increased from 1.2% (1990) to 9.8% (2022) for women and 0.5% to 5.4% (2022) for men. |
| – Highest combined prevalence of underweight and obesity in island nations in the Caribbean, Polynesia, Micronesia, and Middle East. | – Kerala has the highest prevalence of hypertension and high cholesterol in urban men and women, while Puducherry has the highest prevalence of diabetes. |
| – Obesity prevalence higher than underweight in most countries globally. | – Only 57% of children (1–3 years) and 68% (4–6 years) consumed adequate proteins and calories. |
| – Childhood thinness and obesity trends varied across countries. | – 34% of men and 44% of women are overweight in India; 13% of men and 11% of women are underweight. |
| – India projected to have more obese than underweight children by 2022. | – 16% of urban children born with low birth weight (LBW), putting them at risk for infections and early death. |
Understanding Obesity
- Obesity refers to the abnormal or excessive accumulation of fat in the body, which poses significant health risks.
- BMI Classification
- Adults (20 years and older): Individuals are considered obese if their Body Mass Index (BMI) is 30 kg/m² or more.
- School-aged children and adolescents (5 to 19 years): Obesity is identified when their BMI is two standard deviations above the mean for their age group.
- BMI Formula: BMI = (Weight (in Kgs)) / (Height2 (in m))
- Obesity Trends
- Women
- The prevalence of obesity among women has significantly increased from 1.2% in 1990 to 9.8% in 2022.
- In 2022, approximately 44 million women were living with obesity.
- Men
- Obesity rates in men also rose by 4.9 percentage points during the same period.
- In 2022, there were 26 million men with obesity.
- Childhood Obesity
- Over the 32-year period, childhood obesity showed a substantial increase.
- In 2022, 3.1% of girls and 3.9% of boys were classified as obese.
- Millions of boys and girls were affected by obesity in 2022.
- Women
Understanding Underweight
- Underweight is one of the four sub-forms of undernutrition, indicating insufficient body weight relative to height.
- BMI Classification
- Adults (20 years and older): Individuals are considered underweight if their Body Mass Index (BMI) is less than 18 kg/m².
- School-aged children and adolescents (5 to 19 years): Underweight status is identified when their BMI is two standard deviations below the mean for their age group.
- Prevalence of Underweight and Thinness
- Overall Prevalence: Despite the increasing obesity rates, the prevalence of underweight and thinness remains high across genders and age groups.
- Women and Men: 13.7% of women and 12.5% of men are classified as underweight.
- Childhood Thinness
- Thinness in children, especially girls, is a significant concern.
- Indian girls have the highest global prevalence of thinness, with a rate of 20.3%.
- Indian boys follow closely with the second-highest global prevalence, at 21.7%.
Factors Contributing to Gender-Specific Obesity Trends in India
- Lack of Physical Activity: Women often encounter challenges in accessing or dedicating time to physical activities such as walks or gym workouts. Limited physical activity significantly contributes to weight gain and obesity.
- Prioritizing Family Nutrition: As primary caregivers, women frequently prioritize their family’s nutritional needs over their own. This may lead to dietary choices less conducive to personal weight management.
- Sleep Patterns: Disrupted sleep patterns, early waking, and late bedtimes can negatively impact metabolism and contribute to weight gain in women.
- Central Obesity: Central obesity, characterized by excess abdominal fat, is a more accurate predictor of future risks (e.g., diabetes, hypertension) than overall obesity.
- Socio-economic Factors: Socio-economic status influences women’s access to resources, including opportunities for physical activity and healthier food choices.
- Cultural and Societal Norms: Cultural expectations and societal norms shape women’s roles and responsibilities, affecting the time available for self-care activities like exercise and sleep.
Obesity and Undernutrition Patterns in India
- Shift in Obesity Trends: Traditionally associated with affluence, obesity trends in India have shifted due to economic factors. The affordability and accessibility of unhealthy processed foods (e.g., samosas, pakoras) contribute to rising obesity rates among the economically disadvantaged.
- Rural-Urban Divide: Urban areas experience higher obesity prevalence compared to rural regions. Urban lifestyles, easy access to processed and fast foods, and sedentary jobs contribute to this disparity.
- Undernutrition in Poor and Remote Regions: Despite obesity’s rise, undernutrition persists in economically poorer states’ remote areas (e.g., Bihar, Jharkhand, Odisha). Some individuals struggle to afford and access sufficient meals.
- Economic Factors and Food Choices: Economic constraints strongly influence food choices. Unhealthy processed foods are often more cost-effective and perceived as tastier than healthier alternatives.
- Global Comparison: Globally, unhealthy food tends to be more affordable than fresh, nutritious options, as seen in the comparison with Western countries.
- Public Health Implications: The coexistence of obesity and undernutrition creates a dual burden of malnutrition. Effective policies should address socio-economic determinants, promote healthier food choices, and improve access to nutritious meals.
WHO Guidelines on Nutrition and Obesity
- Height-Weight Measurement
- Purpose: Determine weight-for-height and nutritional status in children under 5 years.
- Action: Compare measurements with WHO child growth standards.
- Counselling for Overweight Individuals
- Target: Parents and caregivers.
- Focus: Nutrition, eating habits, physical activity, and breastfeeding promotion.
- Obesity Management Plan
- Identification: Assess by health worker (primary level) or trained professional (referral clinic/hospital).
- Plan: Develop an appropriate management plan for obese individuals.
- Prevention Focus
- Avoid Routine Supplementary Foods: For moderately wasted or stunted children, prioritize prevention over routine supplementation until stronger evidence exists.
- Addressing Obesogenic Environment
- Strategy: Prevent high energy intake and promote physical activity.
- Social Norms: Encourage changes related to food and physical activity.
- Public Policy and Regulation
- Taxation: Consider heavy taxation on high-salt foods (e.g., Hungary’s approach).
- Marketing Regulation: Control marketing of unhealthy foods, especially those targeting children (high salt, sugar, fat).
- Nutrient Labelling
- Role: Positive front-of-pack and standardized global nutrient labels on packaged foods can promote healthy choices and lifestyles.
Consequences of the Double Burden of Malnutrition
Individual Health Implications
- Increased Risk of Non-Communicable Diseases (NCDs):
- Individuals facing both undernutrition and obesity have a heightened risk of NCDs, including diabetes, hypertension, and cardiovascular diseases. The combination of malnutrition can lead to various metabolic and cardiovascular complications.
- Compromised Immune Function:
- Undernutrition weakens the immune system, making individuals more susceptible to infections. Conversely, obesity can lead to chronic inflammation, further compromising immune function.
- Stunted Development in Children:
- Coexistence of undernutrition and obesity in children results in stunted physical and cognitive development, leading to short-term and long-term health challenges.
- Psychosocial Impact:
- Individuals with the double burden may face psychosocial challenges, including body image issues and mental health concerns. Societal stigmas related to weight contribute to mental health issues.
Economic Burden
- Increased Healthcare Costs:
- The presence of both undernutrition and obesity strains the healthcare system. Treating NCDs associated with obesity requires significant healthcare resources.
- Productivity Loss:
- Health issues from the double burden lead to reduced workforce productivity. Absenteeism and decreased efficiency result in economic losses for individuals and the nation.
- Intergenerational Impact:
- Stunted child development perpetuates a cycle of health challenges and economic disadvantages across generations.
Public Health Challenges
- Strained Healthcare Systems:
- Addressing diverse and sometimes conflicting nutritional needs becomes complex for healthcare systems. Resource allocation and planning are challenging.
- Complicated Intervention Strategies:
- Designing effective public health interventions is more difficult when tackling both undernutrition and obesity simultaneously. Tailored approaches are necessary for different population segments.
Social Inequality and Disparities
- Socio-economic Divide:
- The double burden exacerbates existing socio-economic disparities. Vulnerable populations struggle to access healthcare, nutritious food, and education.
- Impact on Women:
- Women, disproportionately affected by undernutrition and obesity, face unique challenges related to reproductive and maternal health, as well as overall well-being.
Government Initiatives
- Integrated Child Development Services (ICDS)
- Focus: Maternal and child health.
- Services: Supplementary nutrition, healthcare, and early childhood education.
- Target: Vulnerable groups (children, adolescent girls, mothers, expectant women).
- National Health Mission (NHM)
- Objective: Improve healthcare infrastructure and provide essential services.
- Emphasis: Maternal and child healthcare.
- Midday Meal Scheme
- Purpose: Provide free meals to school children.
- Goals: Improve nutritional intake and encourage school attendance.
- Fortification Programs
- Strategy: Fortify staple foods with essential micronutrients.
- Aim: Address deficiencies on a larger scale.
- Food Security and Dietary Improvement
- Increase food grain production for security.
- Promote nutritionally rich foods.
- Enhance dietary patterns.
- Income Transfers and Public Distribution System
- Improve purchasing power for landless, rural, and urban poor.
- Expand and enhance the public distribution system.
- National Nutrition Mission
- Recent initiative to combat malnutrition and promote better health outcomes.
Way forward
- Nutrition Education and Awareness
- Objective: Raise awareness about balanced nutrition.
- Actions:
- Educate communities on the risks of both undernutrition and overnutrition.
- Promote healthy eating habits, portion control, and diverse diets.
- Promotion of Breastfeeding
- Importance: Breastfeeding provides essential nutrients for infants’ healthy growth.
- Recommendations:
- Encourage and support breastfeeding.
- Disseminate information on the benefits of exclusive breastfeeding during the first six months of life.
- Access to Nutrient-Dense Foods
- Focus: Improve access to affordable, nutrient-dense foods, especially for vulnerable populations.
- Approach:
- Enhance agricultural practices.
- Ensure a diverse and nutritious food supply.
- Public Health Interventions
- Goal: Reduce consumption of unhealthy foods and beverages.
- Strategies:
- Implement sugar taxes.
- Enhance food labelling.
- Regulate high-calorie, low-nutrient foods.
- Healthcare Services and Monitoring
- Enhancement:
- Strengthen healthcare systems to identify and address both undernutrition and overnutrition.
- Regularly monitor and evaluate nutritional status.
- Enhancement:
- Social Safety Nets
- Purpose: Provide support for vulnerable populations.
- Actions:
- Ensure access to nutritious foods.
- Address socio-economic factors, including poverty and inequality.
- Community Engagement
- Involvement:
- Engage communities in designing and implementing nutrition programs.
- Empower individuals to make informed choices for their families.
- Involvement:
- Collaboration and Partnerships
- Coordinated Response:
- Foster collaboration among government agencies, NGOs, private sector, and international bodies.
- Share best practices from successful interventions.
- Coordinated Response:
- Research and Innovation
- Investment:
- Research causes and consequences of the double burden of malnutrition.
- Promote innovation in food production and distribution.
- Investment:
- Policy Integration
- Holistic Approach:
- Integrate nutrition considerations into broader policies (health, agriculture, education).
- Ensure coherence across different policy areas for nutritional well-being.
- Holistic Approach:
Conclusion
The double burden of malnutrition—the simultaneous presence of undernutrition and obesity—poses a multifaceted challenge for India. As we strive for better health outcomes, it’s crucial to shift our focus from mere “food security” to comprehensive “nutrition security.” By raising awareness, promoting balanced diets, and integrating nutrition considerations into policies, we can address this complex issue. India’s inclusion of relevant indicators in national health surveys enables targeted local actions. These efforts align with global goals, emphasizing the need for sustainable nutrition practices. Ultimately, a holistic approach—one that ensures access to nutritious food and empowers individuals—will pave the way toward a healthier, more productive future for all.
Source: IE
Related PYQ
Appropriate local community level healthcare intervention is a prerequisite to achieve ‘Health for All’ in India. Explain. [UPSC CSE – 2018 Mains]
Practice Question
How can food subsidy programs be reformed to simultaneously address food security and encourage healthier dietary choices? Analyse. [250 words]