Challenges in addressing the rising dual burden of nutrition in India

India is home to almost one-fifth of the world’s population and undergoing nutritional transition, with the dual burden of nutrition affecting her populace. This dual burden is characterized by co-existence of overweight-obesity (O-O) and under nutrition both at individual and population level. The increasing proportion of children with overweight-obesity places them at greater risk of non-communicable diseases such as diabetes and cardio-vascular diseases. Nutrition-related risk factors are attributable to nearly half (45%) of the mortality of children under five years, many of which are preventable through effective nutrition interventions. There has not been any major improvement in the nutritional status of women and girls over the last decade. Anaemia burden in the country has only reduced marginally from 55.3% as reported in National Family Health Survey (NFHS) in round-3, 2005-06 to 53% in 2015-16 (NFHS 4). Further, one-third (33%) of the children under-five years are underweight, 34% stunted, 17% are wasted and 2% were overweight or obese; while almost one-third adolescent are anemic (28%).

Recognizing the importance of food supply, nutrition, safe water and basic sanitation, the Government of India has designed programmes to tackle these determinants of undernutrition. As a result, several programmes such as Integrated Child Development Services (ICDS), National Health Mission (NHM) including Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH + A), Swachh Bharat including Sanitation and the National Rural Drinking Water Programme, MatritvaSahyogYojana, Rajiv Gandhi Scheme for Empowerment of Adolescent Girls (RGSEAG) Sabla for adolescent girls, Mid-Day Meals Scheme (MDM), Targeted Public Distribution System (PDS), National Food Security Mission, Mahatma Gandhi National Rural Employment Guarantee Scheme and the National Rural Livelihood Mission are implemented. In the early 2019, the Government of India started an ambitious programme titled, Prime Minister’s Overarching Scheme for Holistic Nourishment (POSHAN) Abhiyan under the National Nutrition Mission. POSHAN aims to reduce stunting (2%), underweight (2%), anemia (3%) among young children, women and adolescent girls and to reduce low birth weight (2%) per annum. The NHM also envisaged achievement of universal access to equitable, affordable & quality health care services.

In order to address the critical challenges afflicting nutritional status of Indians, a multipronged approach is needed. Over the years, reviews conducted of the nutritional programs have identified several gaps. These include infrastructural problems, poor utilization due to low awareness about the programmes, faulty supervision and monitoring mechanisms, inadequate community participation and too much dependence on the government. It is time to redesign these programs with appropriate strategies to strengthen the implementation at the primary level of care by integrating various approaches. The process of redesigning can be guided by principles of primordial and primary prevention in addition to the existing interventions. These include promoting nutritious diets with focus on but not limited to reduction of salt, sugar intake, promoting breastfeeding and supplementation and fortification of foods. Ensuring qualified and skilled personnel to develop, deliver and evaluate populationbased nutrition services will help this process. In order to accomplish a healthy and nutritious future for Indians, it is important to create awareness and engage schools, children and youth in creating healthy food environment. Identifying the disparities within and between states, districts, and local communities isneeded to act and ensure adequate financing for nutrition through a separate budget for nutrition-related activities.