India's nutrition story has two parallel realities. One reflects lack. The other is excess. Both exist simultaneously, frequently within the same households, and increasingly within the same individuals at different points in their lives. But the problem still receives only one-sided attention in the public eye.
It has happened gradually. Over the years, India has moved from a calorie-deficient to a calorie-sufficient country. Food availability grew, supply chains extended and processed foods became commonly available. But the nutritional adequacy did not improve at the same pace. This imbalance has led to a double burden of malnutrition.
Undernutrition Still Exists in Large Numbers
Undernutrition remains a major public health problem. Many populations still suffer from poor dietary diversity, micronutrient deficiencies and insufficient protein intake. Iron deficiency anaemia, vitamin deficiencies and stunted growth patterns continue to appear across socio-economic groups.
The report of the State of Food Security and Nutrition in the World (2024) notes that around 55 per cent of India's population cannot afford a healthy diet. Nearly 40 percent do not get enough nutrition. This suggests a structural gap between the availability of food and its nutritional quality.
The quality of the diet remains uneven. Large segments of the population live on carbohydrate-heavy meals with little protein, fruits and vegetables. In many countries, food prices usually trump the nutritional value of what people can afford to eat.
Undernutrition in childhood has consequences for growth and development outcomes. Poor early nutrition increases susceptibility to infections, hampers cognitive development and affects long-term productivity. The effects are long-term and influence disease risk in adulthood.
Obesity is Growing Along with Deficiency
At the same time, obesity has become a major health burden. The NFHS-5 (2019-21) estimates that almost one in four adults in India are obese. One in three adults has abdominal obesity and one in four has generalized obesity (ICMR, Lancet Diabetes & Endocrinology, 2023).
This has been driven by urbanisation, sedentary lifestyles and increased consumption of ultra-processed foods. High fat, salt and sugar foods are widely available and inexpensive, making it easier to overconsume calories than to achieve nutrient adequacy.
According to a World Health Organization report, nearly 50 percent of Indians fail to meet the recommended physical activity levels. Less activity and more food calories cause weight to go up faster.
The Double Burden in One Population
India's nutrition challenge is not group-wise. It goes over. Undernutrition in the early years and obesity in later life can coexist in the same population. This transition is more and more common.
Undernutrition in childhood followed by adult obesity creates a metabolic mismatch. Nutritional deficiency in early life impacts muscle growth and metabolic programming. Then, if you eat a calorie-dense diet later, you will gain fat, often in the abdominal area.
The consequence is a population vulnerable to both ends of the spectrum of malnutrition and metabolic disease.
Dual Pattern in Childhood Nutrition
India has over 14.4 million children living with obesity, among the highest in the world. Meanwhile, undernutrition and micronutrient deficiencies remain widespread.
Children are consuming increasing amounts of processed snacks, sugar-sweetened beverages and fast foods. These diets are calorie-rich, nutrient-poor. The end result is that the person gains weight but is nutritionally deficient.
Health outcomes are not limited to childhood. Obese children are at risk for type 2 diabetes, hypertension, respiratory disorders and long-term cardiovascular disease. Psychological effects including depression and low self-esteem also appear early on.
Why the Two Problems Coexist
The coexistence of undernutrition and obesity is linked to dietary transition. Processed, energy dense alternatives are slowly replacing traditional diets based on whole foods. They're cheaper, more accessible and heavily marketed.
Urbanisation has led to a decline in physical activity. The working patterns have changed from manual work to sitting work. Screen time increased among age groups. These lifestyle changes magnify the effects of poor dietary choices.
Food insecurity is also a factor. When affordable nutrient-rich foods are not available, households opt for cheaper calorie-dense foods. This sets up a cycle where both undernutrition and obesity are the result of the same structural constraints.
Metabolic Consequences of The Double Burden
Both undernutrition and obesity share overlapping metabolic consequences. Both make you more likely to develop chronic diseases such as diabetes, hypertension and cardiovascular diseases.
Abdominal obesity especially drives insulin resistance and systemic inflammation. On the other hand, lack of nutrients harms immune response and metabolic resilience. This combination raises long-term health risks.
Health System Focus Still Uneven
Historically, public health messaging has emphasized undernutrition. Supplementation programs, maternal nutrition programs and child feeding programs have improved outcomes in many areas.
Prevention of obesity has been relatively neglected in primary care. Metabolic risk screening, dietary counseling and early lifestyle intervention are still not consistent across regions.
A Common Approach to Nutrition
A combined strategy is needed to address both types of malnutrition. Nutritional adequacy and calorie balance must be tackled together rather than separately.
Diet quality improvement is still central. Higher intakes of protein, fibre and micronutrients are beneficial for both undernourished and overweight populations. Cutting back on ultra-processed foods is good for metabolic health across the board.
It is equally important to promote physical activity. Regular movement improves insulin sensitivity, helps maintain muscle mass and decreases the accumulation of fat in the abdomen.
Healthcare systems need integrated screening for undernutrition and obesity at primary care level. Early identification allows for intervention before long-term complications occur.
India's nutrition challenge is two sides of the same coin. Deficiency and excess exist within the same population, frequently shaped by the same environmental and economic forces. Focusing on one side alone does not address the root problem. Nutrition policy, clinical practice and public awareness must capture the full picture.
(By Dr. Ashish Gautam, Principal Director, Robotic and Laparoscopic Surgery, Max Super Speciality Hospital, Patparganj, New Delhi)
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