In addition, some recent evidence indicates that obesity is no longer just restricted to urban areas.

By-Jaya Jumrani, Ronald Donato & Md Zakaria Siddiqui

India, a land of diverse cultures, is home to 70% of South Asia’s undernourished population. Given its significant share in the global population, the country has a critical role in shaping the overall nutrition situation in the world. Despite being one of the rapidly growing economies in the past decade, India is now witnessing a triple burden of malnutrition, i.e., coexistence of undernutrition, micronutrient deficiencies and overnutrition. There has been a rapid emergence of overweight and obesity with as high as 20% of the population aged 15-49 years falling in this category. In addition, some recent evidence indicates that obesity is no longer just restricted to urban areas. Alongside rapid socio-economic development, India is undergoing a major transition of disease epidemiology with the share of non-communicable diseases (NCDs) in the total disease burden spiraling from 30% in 1990 to 55% in 2016.

The great Indian ‘calorie consumption puzzle’, as it is often termed, has intrigued various scholars in the past decade. Calorie consumption has been reflecting a strong positive relationship with household income (positive micro-level relationship) while it exhibits a declining trend with rising income at the macro level both overtime and across regions at a given point of time (negative macro-level relationship). This puzzle has further mystified recently with the latest available survey round for 2011-12 wherein a 4% increase is observed in the per capita caloric consumption. The domain experts, for explaining the calorie consumption enigma, have put forth various plausible explanations. These mainly include changing occupational structure, misdirected dietary diversification patterns, escalating relative food prices, rising non-food expenses (that crowd out food expenses) and inaccurate collection of data of eating out that has grown rapidly. Nevertheless, not so much focus has been given to improved public health infrastructure and disease environment—a crucial factor in defining the efficiency with which a region’s population will absorb nutrients from their food intake—that typically varies considerably across states.

In a recently published research, we evaluate the spatial nature of disease environment and health infrastructure and its likely effect on caloric needs. The disaggregated picture of calorie intake over time by rich and poor classes reveals a process of convergence, that is, slowly rising for the poor and falling for richer group. A considerable shift is observed in consumption patterns away from calories derived from carbohydrates towards those derived from fat-based products (see accompanying graphic), particularly for poor segments of the population. Thus, one can expect the NCDs to rise in the near future. The modelling exercise also demonstrates that growth in fat consumption is highest among the poorest households while for richer households it has been falling. Given that NCDs are usually not covered under public health initiatives, such consumption pattern of fat is likely to pose a growing financial burden on the poor and more vulnerable sections of the community. The study’s findings suggest that it is critical for any policy analysis pertaining to consumption patterns and nutrition transition to be undertaken at the maximum possible disaggregated level as certain dynamics might become relatively more ambiguous when evaluated at an aggregate level.

India is a subcontinent with as high as 2,000 ethnic groups with distinctive lineage and diverse lifestyles. About 10 states have more than 60 million people in 2017, and various Indian states have population sizes that are similar to sizes of large countries. Notwithstanding a wide gap in economic development across states, the socio-cultural milieu also varies significantly. Reconfirming such a pattern of regional disparity, the study indicates a considerable variation in caloric intakes across states based on the spatial differences in the epidemiological environment and associated heath infrastructure. Households residing in states where the prevalence of disease and infection is lower and consequently having better nutrient absorption rates are more likely to have lower caloric requirements in comparison to those residing in less healthy ones. This is also reflected in the prevalence of calorie deficiency—a measure of food security; a household is considered to be calorie deficient if actual caloric intake is less than the recommended norms for given age, sex and activity status of the household members. One of the charts in the accompanying graphic represents the incidence of calorie deficiency for major Indian states before and after accounting for state-level differences in epidemiological environment and public health infrastructure. Calorie deficiency among states such as Kerala, Tamil Nadu, Punjab and Andhra Pradesh is considerably adjusted downwards while it is adjusted upwards for Uttar Pradesh and Bihar once contextual factors are accounted for. This points towards the fact that continued use of uniform caloric thresholds without giving due consideration to inter-state differences and respective state-level macro factors such as disease environment is not apt and can lead to ill-advised policy responses. More careful investigation is required for comprehensively understanding the role of macro factors in defining minimum caloric needs to maintain good health at the regional level.