The Double Burden of Malnutrition
Public health experts call it the "double burden of malnutrition": the coexistence of undernutrition alongside overweight and obesity. Recent findings from the National Family Health Survey (NFHS-6), conducted in 2023-24, paint a clear picture of this
dual challenge. While India has made progress in reducing child stunting, the data also shows a sharp rise in obesity among adults. Among women, the prevalence of being overweight or obese jumped from 24% to 30.7%, while for men it rose from 22.9% to 27.3%. This reveals a rapid nutritional transition, where economic growth and urbanisation are creating a complex public health crisis that old policies, focused solely on hunger, are ill-equipped to handle.
The Lingering Shadow of Undernutrition
Despite economic progress, a significant portion of India's population remains underfed. The latest NFHS-6 data shows that while stunting (low height for age) among children under five has declined from 35.5% to 29.3%, nearly a third of Indian children are still affected. The prevalence of wasting (low weight for height), an indicator of acute malnutrition, remains stubbornly high at around 19%. These issues are deeply connected to poverty, food insecurity, and poor sanitation. The poorest 5% of rural households, for instance, consume far fewer calories than recommended, while their diets often lack essential micronutrients, leading to high rates of anaemia, particularly among women.
The Rise of Overnutrition and Lifestyle Diseases
On the other side of the divide is a burgeoning crisis of overnutrition. The shift towards processed, calorie-dense foods, especially in urban areas, is fuelling a rapid increase in obesity. Among urban women, a staggering 42.8% are now classified as overweight or obese. This dietary transition is directly linked to a surge in non-communicable diseases (NCDs). According to NFHS-6, diabetes prevalence has risen significantly, affecting 17.8% of women and 20.9% of men. This trend is no longer confined to the wealthy; as processed foods become cheaper and more accessible, these lifestyle diseases are affecting a broader cross-section of society.
An Urban-Rural and Economic Fault Line
The nutrition divide is starkly visible across geographic and economic lines. Undernutrition remains more prevalent in rural areas, where 22.5% of women have a below-normal Body Mass Index (BMI), compared to 13.2% in urban areas. States like Jharkhand and Bihar continue to report the country's highest rates of child stunting. Conversely, urban centres are the epicentre of the obesity crisis. In cities, the consumption of fat and processed foods is higher, contributing to a greater prevalence of overweight individuals and related health issues. Economic inequality is a primary driver; the wealthiest households consume nearly double the calories of the poorest, highlighting a profound disparity in access to not just food, but nutritious food.
The Path Forward: From Food Security to Nutrition Security
Addressing this widening divide requires a fundamental policy shift from focusing merely on food security (ensuring enough calories) to achieving nutrition security (ensuring access to a healthy, balanced diet). Experts argue that existing programmes, while successful in improving some metrics like child stunting, must now be redesigned to tackle the dual challenges of undernutrition and obesity. This involves promoting dietary diversity, making healthy foods like fruits and pulses more affordable, and implementing policies to curb the marketing and consumption of unhealthy, ultra-processed products. Without an integrated approach that addresses both ends of the malnutrition spectrum, India risks undermining its public health and future development.
