Overnutrition: Current scenario & combat strategies

Abstract

Large population-based surveys by the Government of India and several other regional studies have reconfirmed the coexisting burden of over- and undernutrition. While time trends from the 2^nd, 3^rd and 4^th rounds of the National Family Health Survey show declining trends in the prevalence of the underweight, it also highlights increasing rates in the overweight/obesity. Dose-response relationships with different micro- and macronutrient consumption with overweight/obesity prevalence have been established. In this context, it was attempted to identify the specific diet pattern and socio-behavioural determinants of overnutrition along with its combat strategies. This review highlights that while the proportion of chronic energy deficiency is decreasing in India, the intake of micronutrients and food groups continues to be below the recommended dietary allowance set by the Indian Council of Medical Research. Distal factors that determine the nutritional imbalance among Indians are presented under (i) household contextual factors, (ii) peer and socio-cultural influencers, and (iii) business and neighbourhood environment. Accumulation of such factors increases the density of obesogenic environment around individuals. Further, the review offers action points at individual, society and policy levels, presented in a 'logframe matrix' for bringing convergence actions across sectors in consultation with programme managers from different ministries/departments.

Keywords: Childhood obesity; dietary pattern; dual burden; non-communicable diseases; nutritional imbalance; whole of society.

Fig. 1

Consumption of macronutrients and overnutrition; a dose-response relationship.

Fig. 2

Consumption of food groups and overnutrition in the 3^rd Round of the National Nutrition Monitoring Bureau survey; a dose-response relationship.

Fig. 3

‘Path to Convergence’ for grading and preventing obesogenic environment in India - a log frame approach based on common themes emerged from the discussion with different stakeholders (working groups, programmes and ministries). ASHA, Accredited Social Health Activist; AWW, Anganwadi Worker; ANM, auxiliary nurse midwife; SSBs, sugar-sweetened beverages; NCDs, non-communicable diseases; OW/Ob, overweight/obese; NPCDCS, National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular diseases and Stroke; NCW, National Commission for Women; RMK, Rashtriya Mahila Kosh; PA, physical activity; PTA, Parent Teachers Association; RKSK, Rashtriya Kishor Swasthya Karyakram; RBSK, Rashtriya Bal Swasthya Karyakram; VHNSCs, Village Health Nutrition and Sanitation Committee; MoWCD, Ministry of Women and Child Development.