India is undergoing an epidemiological transformation in nutrition. But in reality, this stage is not just a ‘transition’, it is also a dangerous accumulation of risk factors from both ends of the risk spectrum. Many vulnerable people face complex scenarios. The known risks of undernutrition and inadequate dietary diversification are being met by rapid societal change in lifestyles and dietary patterns in another, but equally unhealthy space: the rise of overweight and obesity. I am facing a complicated scenario. This ‘double burden’ of malnutrition may seem like a paradox, but a deeper analysis reveals many common root causes.
According to the Multidimensional Poverty Index 2022 (MPI 2022), 16.4% of India’s population is classified as multidimensional poor and a further 18.7% are classified as vulnerable to multidimensional poverty. About 5 million in total. More than 60% of households identified as poor have undernourishment as one of their vulnerabilities.
One of the hallmarks of India today is enormous intra- and inter-state migration and explosive urbanization. This mobility, coupled with massive expansion of infrastructure, roads, internet connectivity, etc., has also led to the expansion of markets from urban areas into deep rural areas that were previously remote and inaccessible.
These factors include family fragmentation, increased labor burdens on women, increased exposure to advertising and social media, and the manufacture of a “desire” to live and eat like people wealthier than oneself. Growing awareness of nutrition, coupled with other important determinants, has led to a significant increase in consumption of pre-processed and ultra-processed foods across the country.
Ironically, not only do these contribute significantly to obesity, they also deprive healthier dietary options at the same cost, causing undernutrition, especially among children.
Huge numbers at risk
Obesity and related non-communicable diseases, primarily diabetes, ischemic heart disease, hypertension, stroke, certain cancers, musculoskeletal disorders, and increased psychological stress due to stigma and discrimination affect nearly a quarter of the population. currently well documented in India (15). -49 years) are classified as obese according to NFHS-5 (2019-20).
Currently concentrated in the urban affluent segment, the additionality of a predominantly sedentary lifestyle plays an important role. But trends are catching up with women, who appear to be particularly at risk, across all wealth quintiles and geographies.
To use diabetes as a proxy for related illnesses, the National Non-Communicable Diseases Monitoring Survey (NNMS) conducted by the government in 2017-2018 found that the prevalence of diabetes among adults aged 18-69 was 9.3. % and impaired glucose tolerance was 24.5%. Year.
in general,” highest proportion of adults Newly diagnosed or previously diagnosed diabetes with impaired fasting glycemia (sometimes called IFG or prediabetes) are between the ages of 50 and 69 years, live in urban areas, and have metabolic risk factors ( had overweight, obesity, central obesity, hypertension, elevated cholesterol)”. Importantly, however, rates of impaired glucose tolerance in urban and rural areas were about the same.
Economic cost of obesity
Human health and disease should ideally be measured in terms of the realization of human rights and the prevention of suffering. However, in a situation where resources are scarce to begin with, and where they are so unequally distributed, public health advocacy and planning must not only initiate and evaluate interventions, but gain visibility and priority. To do so, the burden of disease must be sacrificed.
Costs are generally categorized as direct (hospitalization, medication, medical expenses, travel) and indirect (lost productivity, absenteeism, disability, etc.).
a most recent quote Okunagbe et al. (Economic Impact of Overweight and Obesity: Current and Future Estimates for Eight Countries) suggests that overweight and obesity are costing India Rs. !
This is more than 1% of GDP, even after excluding long-term disability and early retirement. By 2060, this he predicts will reach Rs 6.9 lakh. About 2.5 percent of GDP!according to World Obesity ForumMedical costs account for 99.8% of direct costs, and premature death accounts for 69% of indirect costs. Indirect costs contribute the most to GDP loss.
Beyond star rating
Despite recognizing the complex nature of the problem in the face of this alarming forecast for India, there are a number of effective interventions that have great potential to mitigate this trend. Specifically, measures such as the Front-of-Pack-Labeling (FoPL) of foods high in sugar, salt and fat (HFSS) and tax increases on HFSS are a large-scale nutrition awareness campaign to combat the threat of unhealthy diets. combined with the campaign.
However, India appears to be missing a much-needed opportunity to effectively adopt these, possibly in the face of resistance by the ‘big food’ industry. Introduced a proposed regulation of the FoPL in favor of a rating (INR) (a type of star rating for health). Half to five golden star halo.
As other public health experts have noted, adopting clear is much more common sense. warning label For HFSS foods where the intention is to allow consumers to make clear choices about foods that cause obesity. Countries like Chile and Brazil have effectively used warning labels to discourage consumption of foods high in fat, sugar and salt, and while Mexico’s well-adopted soda tax, it has also reduced obesity rates. It’s too late to get on track. The negative impact on profits to industry is well offset by real savings in health and social security, and the savings in suffering are immense.
We are still battling undernutrition and communicable diseases such as tuberculosis, malaria, dengue and COVID-19, adding obesity and non-communicable diseases to the disease burden. Combined with stagnating or declining spending in the health and social sectors, the impact on future generations, especially the poor, could be disastrous. This is a price in human life that we cannot afford to pay and every attempt must be made to avoid a dire scenario.
Dr. Vandana Prasad is a public health expert and Dr. Arun Prasad is a bariatric surgeon. Views are personal and do not represent the position of this publication.
Dr. Vandana Prasad I am a public health expert. Views are personal and do not represent the position of this publication.
Dr. Arun Prasad I am a bariatric surgeon.Views are personal and do not represent the position of this publication
