- India's NFHS-6 survey shows progress in maternal health but rising obesity and diabetes risk
- Childhood insulin resistance often starts early, linked to obesity and sedentary lifestyles
- Abdominal obesity is a key diabetes risk factor, more than overall body weight or BMI
India has struggled with the dual challenge of undernutrition and infectious diseases for a long time. But the just released National Family Health Survey (NFHS-6) points towards a big change in the health landscape of the country. The survey shows positive progress on several maternal and child health indicators, but also shows a troubling rise in obesity, overweight and high blood sugar levels across many states.
Diabetes is thought of as an adult disease, but the risk factors that lead to diabetes often start much earlier in life. As childhood obesity, sedentary lifestyles, and unhealthy eating habits along with screen time are increasing, we are paving the way for a future spike in diabetes cases in our younger generations.
NFHS-6 is not only a snapshot of India's current population health but also a red flag for the country's metabolic health crisis in the coming decades.
The Diabetes Journey Often Begins Before Adulthood
Diabetes type 2 does not appear suddenly. It usually starts with insulin resistance, which is when the body 's cells become less responsive to insulin. Blood sugar levels begin to increase over time, and eventually you have prediabetes and diabetes.
One of the biggest concerns is that insulin resistance can start in childhood, years before symptoms occur. Many of the children with early metabolic abnormalities may look well and lead their daily lives without any apparent warning signs.
Factors contributing to this trend include:
- Increasing rates of childhood overweight and obesity
- Reduced physical activity
- Excessive screen time
- Frequent consumption of sugary beverages
- Increased intake of ultra-processed foods
- Poor sleep habits
- Family history of diabetes
Children may have an increased risk of metabolic disease as they grow older due to the accumulation of these risk factors.
Also Read: High Blood Sugar, Obesity On The Rise, Says NFHS-6 Data: Here's Why Health Insurance Is Crucial Now
Why Abdominal Obesity Matters More Than Weight Alone
Not all fat is the same. More and more doctors are concerned about abdominal obesity, when too much fat piles up around the waist. Unlike fat stored elsewhere in the body, abdominal fat is metabolically active and strongly associated with insulin resistance, inflammation and future diabetes risk.
Even a child who does not seem very overweight can have unhealthy levels of fat around the stomach area. That is why waist circumference and waist-to-height ratio are becoming important tools to assess metabolic health along with body weight and body mass index (BMI).
In terms of preventing diabetes, screening for abdominal obesity may be more useful than just focusing on the number on the scale.
The Double Burden of Malnutrition
One of the important messages that have come out of NFHS-6 is that India continues to suffer from double burden of malnutrition. Some areas are still fighting undernutrition, but at the same time obesity and other lifestyle-related disorders are on the rise.
Research has shown that children who experienced undernutrition in the womb, infancy or early childhood, are potentially more vulnerable to obesity and diabetes later in life, particularly in terms of calorie-dense foods and sedentary lifestyles.
This means that diabetes prevention is not just about reducing obesity. It also includes providing adequate nutrition at critical stages of growth and development. A healthy start in life may be an important factor in determining future metabolic health.
How Modern Lifestyles Are Changing Children's Health
Today's children are growing up in a very different environment than previous generations.
Many people spend hours on phones, tablets, computers and gaming devices. Many urban settings have seen an increase in academic performance demands, screen-based entertainment and a reduction in outdoor play.
These lifestyle changes contribute to:
- Reduced calorie expenditure
- Weight gain
- Poor cardiovascular fitness
- Sleep disturbances
- Increased snacking behaviour
- Higher consumption of sugary drinks
Long periods of sedentary behaviour have consistently been associated with obesity and insulin resistance, both of which are associated with increased future risk of diabetes.
The Hidden Impact Beyond Diabetes
The impact of childhood obesity extends well beyond blood sugar levels. Before the onset of diabetes, excess body fat can affect various organs and systems in the body. Children with obesity are more likely to develop non-alcoholic fatty liver disease and liver inflammation which are appearing more frequently in younger children. Extra weight can also affect heart health by contributing to high blood pressure, abnormal cholesterol levels and early changes in the blood vessels that increase the risk for future heart disease.
Hormonal health can also be affected leading to problems such as puberty-related disturbances, menstrual irregularities in girls and other hormonal imbalances. In addition, sleep disorders, low self-esteem and emotional and psychological problems that can affect general well-being have been linked to childhood obesity. Critically, many of these complications can develop years before a diagnosis of diabetes, highlighting the importance of early identification and intervention.
Should Children Be Screened Earlier?
Children with significant diabetes risk factors should undergo targeted screening. Children who may need early evaluation include those who:
- Are Overweight or obese
- Have Family history of diabetes
- Suffer from abdominal obesity
- Display symptoms of insulin resistance
- Have abnormal cholesterol levels or high blood pressure
Early diagnosis enables the implementation of lifestyle changes before irreversible metabolic damage occurs. The goal is not to diagnose disease in children, but to detect risk early enough to prevent disease.
What Can Be Done Now?
A coordinated effort at several levels is necessary to prevent diabetes in the future. Parents also have an important role to play in promoting healthy eating, physical activity, adequate sleep and limiting screen time from an early age. Schools can help by promoting sports, physical education and better food choices in the school environment.
Early risk assessments, routine monitoring and counselling for children and families at risk can help. More broadly, public health policies can help build healthier communities by running awareness campaigns, nutrition programmes and improving access to nutritious food. Above all, preventing diabetes must not begin in adulthood but rather in childhood, when lifelong health habits are first developed.
NFHS-6 points to a changing health profile for India. There has been progress in many health indicators, but the increase in obesity and metabolic risk factors poses new challenges ahead.
India's future diabetes burden may be shaped not only by what adults eat and how they live today, but also by the health habits formed during childhood. Early recognition of these risks and investment in prevention may help to mitigate the long-term impact of diabetes and other lifestyle-related diseases. As India advances in its health transition, protecting children's metabolic health will be key to creating a healthier generation for the future.
(By Dr. G. Krishna Mohan Reddy, Senior Consultant Physician and Diabetologist, Yashoda Hospitals, Hyderabad)
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