Double malnutrition on the rise in India due to shift to ultra-processed foods, private sector push
India is second among the top five global markets for sugary beverage manufacturers. And, this is pushing the burden of double malnutrition — obesity and underweight — in the country. These facts have been noted in the latest Lancet series released on December 16, 2019. India is also one of the 15 countries where the double burden is on the rise, according to the series.
While the per capita sale of sugary beverages in India is low as compared to other countries, the total market sale is highest after China, Barry M Popkin, an American professor on nutrition, told Down To Earth. The per capita consumption is also rising fast.
“These countries are expected to become major markets for sugary beverages in the next decade. The speed of change is particularly important in understanding how this nutrition reality is shifting,” the four-paper series of The Lancet stated.
The overall consumption of ultra-processed foods, retail revolution which led to the emergence of large and small food retailers replacing fresh markets, and a very marked change regarding who controls the market are majorly contributing to disturbing nutrition levels.
“Case studies from China, Bangladesh, and India were the first to remark on this transformation and later research showed similar trends in Africa. These studies showed that the global and national public sectors were no longer the major influences of diets in Low-and-middle income countries (LMICs). Rather, food retailers, food agribusinesses, global food companies, and the food service sector and their domestic local counterparts have contracts directly with farmers,” the report said.
The Lancet said factors such as urbanisation, migration to cities, income growth, infrastructure improvements and trade liberalisation in LMICs, which include India, had upped private investment in the food sector. This, when put in context with the rising consumption of ultra-processed foods, made the pattern clearer.
Curiously enough, it identified another factor — working women. “Equally important is how the increase in the number of women working outside the home and the value of their time in work have shaped the demand for food that is ready to eat or ready to heat. Monteiro calls this convenience in food preparation and consumption the ultra-processed food revolution,” the paper said.
The food items sold outside schools was also exacerbating the menace as they were of poor nutritional quality. “Evidence from Brazil, Iran, Mexico, Haiti, Guatemala, India, South Africa, and the Philippines shows that foods sold by vendors in and outside of schools include chips, cookies, crackers, ice cream, fried foods, sugary drinks, hamburgers, pizza, and confectionary,” the report said.
Regarding the quality of meals served in schools, it said there was ‘surprisingly little information’ in LMICs.
In the second paper of the five-paper series, The Lancet said that malnutrition was not just a challenge in itself but was also increasing the existing burden of non-communicable diseases (NCDs). The authors of the paper drew attention to a study done in Pune in three cohorts.
Due to multigenerational exposure to energy scarcity and micronutrient deficiencies, a little less than one-third of the 663 young adults had developed pre-diabetes and 15 per cent of 100 young mothers had gestational diabetes in the rural cohort.
The same factors had a more pronounced affect in the urban cohort. As many as 21 per cent were overweight, 18.5 per cent were developing pre-diabetes and 2 per cent had developed diabetes by the age of 21 years.
“The nutritional supplementation in early life might potentially promote metabolic capacity and thus reduce the risk of NCD. Supplementation during pregnancy reduces the risk of low birthweight but propagates few beneficial effects into childhood,” the report said.
Worse, undernutrition was also appending the rate of infections. Pointing to India, the Lancet paper said the microbiota of Indian children with stunting was short of probiotic species (good bacteria beneficial to intestine) and rich in the ones causing inflammation (infections).
Incidentally, a National Sample Survey Organisation report in November noted that among all ailments, it were infections that were making Indians the most sick. These infections included malaria, viral hepatitis / jaundice, acute diarrhoeal diseases / dysentery, dengue fever, chikungunya, measles, acute encephalitis syndrome, typhoid, hookworm infection filariasis, tuberculosis and others.
In LMICs, the nutrition transition could exacerbate the inflammatory burden of malnutrition.
Malnutrition and economy
Nutrition has a clear class divide too, the Lancet report confirmed. In India, the tribal population was more affected than the rest, it said. However, this divide was not limited to India.
“In high-income countries such as Canada, Australia, and the United Kingdom, for example, First Nation, Indigenous, and ethnic minority populations, respectively, typically show higher levels of low birthweight and childhood undernutrition than do the general population, but also increased risk of obesity and NCDs in later life. Similarly, African Americans show persisting deficits in birthweight relative to people of European ancestry. Additionally, Hispanic and African Americans have greater prevalence of adult obesity than Americans of European descent,” it said.
But is the double burden of malnutrition restricted to health? No, said The Lancet. “More than two decades back, Barry M Popkin and his colleagues identified costs of 1 per cent and 2 per cent of gross domestic product from undernutrition, overweight, and associated NCDs in China and India, respectively,” it said referring to a paper authored by Popkin.
Other than India, it is the LMICs which are bearing the brunt of the double burden. The Lancet report said more than one in three of them faced both the extremes. And, shifts in food systems were to be primarily blamed for that.
“All forms of malnutrition have a common denominator — food systems that fail to provide all people with healthy, safe, affordable, and sustainable diets. Changing this will require action across food systems — from production and processing, through trade and distribution, pricing, marketing, and labelling, to consumption and waste. All relevant policies and investments must be radically re-examined,” lead author of the report, Francesco Branca, who is director of the Department of Nutrition for Health and Development, World Health Organization, said.
The report identified a set of ‘double-duty actions’ that not only reduced the risk of nutritional deficiencies leading to underweight, wasting, stunting or micronutrient deficiencies but also obesity or NCDs, with the same sets of intervention.
These range from improved antenatal care and breastfeeding practices, to social welfare, as well as new agricultural and food system policies with healthy diets as their primary goal.
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