Last week, Women and Child Development Minister Annapurna Devi stated in the Lok Sabha that 17% of children in the age group of 0–5 years in India are underweight (low weight for age), while 36% are stunted (low height for age), and 6% are wasted (low weight for height) — all key indicators of malnutrition.
Malnutrition, as defined by the World Health Organisation (WHO), refers to deficiencies or excesses in nutrient intake, an imbalance of essential nutrients, or impaired nutrient utilisation. The double burden of malnutrition consists of both undernutrition, overweight, and obesity, as well as diet-related noncommunicable diseases, the WHO says.
India has struggled with malnutrition for decades, and despite several strides made in this area aided by many programmes by both Central and State governments, it continues to remain a significant challenge, contributing to the disease burden of the country — 56.4% of the total disease burden in India is attributed to unhealthy diets.
The Dietary Guidelines for India, developed by the Indian Council of Medical Research (ICMR)-National Institute of Nutrition (ICMR-NIN), Hyderabad, and brought out earlier this year, said a large proportion of children suffered impaired nutritional status while concurrently battling the rising prevalence of overweight, obesity, and pre-diabetic symptoms, creating a dual burden of malnutrition where both undernutrition and overweight and obesity coexist within the same communities and even within households.
How do we combat the diabesity (obesity and type 2 diabetes) pandemic? A recent comment in The Lancet by Chittaranjan S. Yajnik, director, diabetes unit, KEM Hospital, Pune, says: “The hope of shooing away the diabesity pandemic by controlling the lifestyle of adults and using biologics is tantamount to closing the door after the horse has bolted. Only promoting adolescent and female health in the reproductive years will help primordial and primary prevention in future generations.”
Indians, says Nihal Thomas, senior professor, department of endocrinology, diabetes, and metabolism, Christian Medical College, Vellore, like many in other Asian and African countries, start with a disadvantage: they already have a nutritional backlog of 150 odd years, which has had an impact on transgenerational growth.
Over a period of time, malnourishment leads to the thrifty phenotype, where more adipose tissue and fat are stored, even when fewer calories are consumed, at the cost of lean body muscle, he explains. This leads to changes in the pancreas and liver, and, as a result, when exposed to times of plenty, Indians put on weight easily, especially intra-abdominal fat, making them more susceptible to insulin resistance and therefore diabetes.
An article on why childhood obesity is on the rise even in underdeveloped countries
In addition, says independent development economist and food researcher Dipa Sinha, new challenges to food security compound the already existing burden of large deficits in the nutritional levels of people. These deficits, she says, are not just in terms of the amount of food available, but the right kind of food: a diverse diet, sufficient proteins, and micronutrients.
“Take price volatility with food, for instance — it is linked to multiple factors such as climate crises, which India is seeing more of with droughts and unseasonal rain, as well as fluctuations in global prices. This makes availability and access to a nutritious diet even more difficult. We know that pregnancy and the first two years of life are very important. But when prices go up, families reduce the number of expensive food items they buy, and the variety of their diet decreases. And almost always, if there isn’t enough to go around, the woman will be the one who gets the least.”
The targets of government programmes should be children and young people, especially young women, to actively promote better diets and physical exercise, Prof. Thomas recommends. As Dr. Yagnik also notes in The Lancet: Governments and policymakers need to prioritise young women’s health. “A ‘double-duty’ approach to prevent tipping into obesity while treating undernutrition is crucial,” he says.
(zubeda.h@thehindu.co.in)
