Successfully tackling undernutrition and obesity will require a push for healthier behaviours anchored by a change in agricultural policy that empowers people to eat better
By Prabhu Pingali, Shubh Swain & Andaleeb Rahman
India’s National Family Health Survey (NFHS) just released vital indicators for 22 states. The data reveal a new challenge for public health in the country. The rise of obesity in India is nothing new, but India’s latest NFHS casts the problem in a different light. Not only the obesity is rising fast in the country overall, but far from the “urban problem” most Indians have considered it, obesity is now increasing faster in rural parts of the country, bringing with it a host of related diseases. Looking at the NFHS round 5 data for 22 states, most of the states have around a third or more of their populations classified as obese, a considerable increase in just a few years.
For example, looking at the women’s obesity rates in 15 major states broadly representing the eastern, western, northern and southern parts of the country, all but three—Maharashtra, Gujarat and Assam—show a high rise in women identified as obese. Looking closely at the rural and urban distribution in those states, in all but one—Assam—the obesity gap between rural and urban women narrowed because of the huge jump in obesity among rural populations. The story is the same for rural men.
This trend is borne out in the rising rates of obesity-related diseases. For example, all of the states show a significant increase in women with very high blood sugar, but in many states, the jump is greater in rural areas.
What is driving this convergence? Growing income opportunities in nearby urban centres, the increase in non-farm wages, a decline in cultivators, and a rise in sedentary lifestyles driven by improved infrastructure have all played a role. So too has the unmet need for the diversification in the food system.
Turning the tide against obesity and related morbidities like high blood sugar in both urban and rural areas requires a restructuring of India’s food systems to ensure that healthy foods are available and affordable for all. A helpful first step would be moving away from the heavy focus on calorie-dense food crops by reforming policies that incentivise staple grain production even as the overall calorie requirement in India is declining. Farmers should instead be incentivised to grow a diverse array of nutritious crops, and the government must ensure that a robust infrastructure, including market access, is created to make such foods available and affordable to people in rural areas.
Recent policy changes have aimed to expand market access to farmers in order to increase the availability of agricultural products in more areas, but it remains to be seen if these reforms provide the right incentives to create a more diversified and nutrition-sensitive food system.
As demonstrated by increased sales of coarse cereal-based products and multigrain breads, demand for nutrient-rich foods already exists, but it is mostly among the urban middle class. Making such products affordable for impoverished and rural Indians requires them to be produced in much greater numbers. Increased production of fruits and vegetables is also needed, along with a strong network of refrigerated supply chains that can transport perishable foods to remote, rural areas. That should be the focus of the agricultural policy going forward. Behavioural interventions akin to the Fit India campaign or the egg promotion campaign of the 1990s would be useful to nudge communities towards healthier lifestyles, even in rural areas.
India is urbanising, and a large share of people—even those in rural areas—are adopting urban-like behaviours due to their proximity to cities. As a result, efforts to address malnutrition must increasingly focus on obesity as well as undernutrition. Successfully tackling both challenges will require a push for healthier behaviours anchored by a change in agricultural policy that empowers people to eat better.
Pingali is founding director, Swain is gender & nutrition specialist and Rahman is a post-doctoral associate, Tata-Cornell Institute. Views are personal