Understanding the dynamics of malnutrition dichotomy in India: Trends and insights from the National Family Health Surveys

Abstract

Purpose: India is confronted with a multifaceted malnutrition landscape, characterized by the coexistence of stunting, underweight, and escalating overweight and obesity rates. Current programs predominantly target undernutrition, overlooking the surging prevalence of overweight and obesity. These trends carry substantial economic ramifications, with obesity-related costs expected to rise significantly. Addressing these challenges requires enhanced policy execution and strategic collaboration. This article seeks to help overcome policy inertia in addressing the other end of the malnutrition spectrum-overnutrition.

Methods: The National Family Health Survey (NFHS), a large-scale survey conducted by the Ministry of Health and Family Welfare, Government of India, provides high-quality data on population dynamics and health indicators. Data for relevant health indicators were extracted from NFHS-3 to NFHS-5 to identify trends and shifting paradigms in malnutrition profiles. Data from the latest NFHS (NFHS-5) were briefly analyzed to highlight the malnutrition dichotomy and perform linear regression analysis.

Results: The data revealed a declining trend in stunting and underweight prevalence alongside a rise in overweight prevalence. Linear regression analyses on NFHS-5 data showed a positive association between literacy and obesity in both men and women. The findings also indicated that children fed with minimum dietary diversity were more likely to be overweight, and revealed a significant association between elevated random blood glucose levels and obesity in women.

Conclusions: By implementing the necessary interventions and strategies, India can establish a holistic approach to addressing both undernutrition and overnutrition effectively, thus contributing to Sustainable Development Goal-2 and paving the way for a healthier and more productive future for India's population.

Keywords: Dietary diversity; Malnutrition; Nutrition policy; Nutritional status; Obesity; Undernutrition.

Fig. 1

Trends in malnutrition indicators in India (NFHS-3 to NFHS-5). This figure illustrates the trends in various malnutrition indicators from the National Family Health Surveys (NFHS-3: 2005–2006, NFHS-4: 2015–2016, and NFHS-5: 2019–2021). Overnutrition (overweight/obese) prevalence has nearly doubled in both genders, rising from 12.6 % to 24 % in women and from 9.3 % to 22.9 % in men between NFHS-3 and NFHS-5 while underweight prevalence has almost halved in both genders, declining from 35.6 % to 18.7 % in women and from 34.2 % to 16.2 % in men during the same period. Undernutrition indicators in children under age 5 show declining trends but the decrease is modest.

Fig. 2

Heatmaps representing the percentage of underweight and overweight individuals across different states in India, based on the NFHS-5 survey data. A. Prevalence of underweight children under 5 years of age, with the highest rates observed in central and eastern states. B. Prevalence of overweight children under 5 years of age, which is relatively low across most states, but higher in northern and northeastern regions. C. Prevalence of underweight adults, predominantly affecting states in central and southern India. D. Prevalence of overweight adults, which is most pronounced in urbanized and southern states, demonstrating a rising trend of overnutrition. Data source: International Institute for Population Sciences (IIPS) and ICF. 2021. National Family Health Survey (NFHS-5), 2019–21: India. Mumbai: IIPS. Refer to supplementary data sheet 1.

Fig. 3

Malnutrition dichotomy in major Indian states and union territories. This figure illustrates the percentage of underweight children under 5 years of age (blue), overweight children under 5 years of age (orange), underweight adults (gray), and overweight adults (yellow) across various Indian states and union territories. Regions such as Central and South India, including Delhi, Chandigarh, Puducherry, and Tamil Nadu, exhibit notably high overweight prevalence in adults. Conversely, Jharkhand has the highest prevalence of underweight children under 5 years of age. Other states, including Madhya Pradesh, Uttar Pradesh, and Chhattisgarh, follow with elevated rates of underweight children in that order. Data source: International Institute for Population Sciences (IIPS) and ICF. 2021. National Family Health Survey (NFHS-5), 2019–21: India. Mumbai: IIPS. Refer to supplementary data sheet 2.