India facing undernutrition and obesity: Nutrition expert says country needs to look within for answers

India is facing a dual challenge of undernutrition and obesity, according to a global report which looked at 140 countries and found significant burdens of three important forms of malnutrition used as an indicator of broader trends. These include childhood stunting, anaemia in women of reproductive age, and overweight adult women.

Representational image. Reuters

Representational image. Reuters

The 'Global Nutrition Report 2017' said that 51 percent women in India are underweight, while 22 percent are overweight.

According to the report, while India has addressed "stunting" among children aged less than five, it has made no progress or presents even worse outcomes in the percentage of reproductive-age women with anaemia.

The Global Nutrition Report 2017 calls for nutrition to be placed at the heart of efforts to end poverty, fight disease and tackle climate change.

Firstpost spoke to Purnima Menon, part of an independent expert group on the report and a senior research fellow in the International Food Policy Research Institute (IFPRI)'s South Asia Office in New Delhi, to know more about the challenges and the steps to tackle the problem.

Why does such a dichotomy exist in India, where such a large proportion of overweight women live next to a large number of underweight anaemic women?

India is such a large country. The areas with a large number of overweight women are not the same as the areas with high numbers of underweight women. There are state and even district-wise discrepancies. So looking at national averages is misleading. Many of the dichotomies one sees are spatial variabilities.

Why have successive governments failed to address this issue effectively? What do they need to do?

I wouldn't quite say we've failed. India's nutrition policy framework is quite robust, and the real differences—the spatial differences that exist within India—are driven by implementation, execution, accountability and a focus on equity (or lack thereof) at local levels.

This is why some states within India are progressing faster than others, and why some districts are doing so well while others so poor off. Just stunting ranges from 12 percent in the best off district to 65 percent in the worst off district means there's a more than a five-fold difference within India.

So, a serious focus on execution, on addressing the drivers of malnutrition as they play out on a local level, and a focus on equity across the board is really important looking forward. The nutrition situation in India is too important to be left to one programme—the Integrated Child Development Services—as it has been in the past.

Our understanding of what causes poor nutrition is much better now than it used to be: India has many relevant policies in place.

This understanding and policy framework needs to come together as action at the district, block and village/town level across the country.

How exactly does climate change play a role in nutrition?

There is emerging research on climate change and nutrition. I don't work in this area and so I don't think that I have the all answers.

People have written about shifts in food production, increases in natural disasters, changing health issues and risks, limited water availability, and other such manifestations of climate change.

All these have an impact on—and implications for—nutrition.

What can India learn from practices followed elsewhere?

It's time for India to learn from India. There have been many exemplars around the world, but I find the diversity in change within India quite exciting to examine. We are studying some states that did well on stunting reduction. There are different pathways and approaches to addressing these problems within India.

This is all happening within the same national policy framework too, which means that learning from states could help more than looking outside.

Nevertheless, countries such as Brazil, Mexico, Thailand, Peru, Ghana, Vietnam offer interesting lessons.

If I could distill one common feature of many of those exemplars, it is that they seriously tried to address social, economic issues and health equity and in many cases brought into their strategies a nutrition lens.

Without an equity lens, and without addressing key determinants such as gender-related factors, sanitation and poverty, alongside health services, it is going to be difficult to move the needle faster.

Updated Date: Nov 24, 2017 16:22 PM

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