Report on Double Burden of Malnutrition in India: Causes and Effects

This report provides a comprehensive analysis of the double burden of malnutrition in India, a critical public health issue characterized by the co-existence of undernutrition and overweight/obesity. It explores the etiology and epidemiology, highlighting the challenges faced by India due to factors like poverty, urbanization, and population growth. The report delves into the determinants of malnutrition, including intergenerational perpetuation, poor maternal nutrition, and socioeconomic disparities. It examines the national dietary patterns, which are often high in carbohydrates and lacking in essential nutrients, contributing to insulin resistance and weight gain. Furthermore, the report discusses the impact of food production and wastage, as well as the need for improved food security. The report concludes by examining the challenges and need for strategies to address the double burden of malnutrition effectively, emphasizing the urgent need for evidence-based interventions and preventive healthcare initiatives.

Running head: DOUBLE BURDEN OF MALNUTRITION
DOUBLE BURDEN OF MALNUTRITION
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Introduction
The double burden of nutrition can be defined as the characteristics of a country where
there is a co-existence of under nutrition along with the disorders of overweight and obesity or
also other diet-related non communicable diseases not only in the personal level within
individuals but also among households, population and across he life courses (Ramachandran,
2016).. It has been found from a statistical analysis conducted by WHO (World Health
Organization) that in the year 2014, approximately 1.9 million adults were found above the age
of 18 an older who were overweight. At the same time, it was also found that 462 million people
were found underweight. . Again, 600 million people were found to be obese. It has been found
that poor nutrition continues to cause death in children out of which half the population of
children are under the age of 5. Low and middle income countries are facing such these
consequences for about 30% faster than the high income countries and therefore, it has become
one of the primary concerns of the nations about how to handle the condition strategically to
reduce the double burden of malnutrition and give a proper quality life (Shankar et al., 2017).
Etiology and epidemiology
India is one of the south east countries which are facing the consequences of double
burden of malnutrition in spite of a huge number of initiative been taken at a national level as
well as an international level. However, there is a requirement to discuss the entire scenario that
had contributed to the occurrence of such a situation in India. After the independence of India,
policy makers and politicians have identified the importance of India as a developing country to
recognize the importance of planned growth as well as economy emphasis on the on human
resource development (Kosaka & Umezaki, 2017). However India has not yet been successful in

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overcoming the problems of poverty, communicable diseases as well as under nutrition. Besides,
it is also facing additional challenges which remain related to the affluence of industrialization,
urbanization an economic betterment. Last two decades have seen the rate of obesity and
overweight to increase along with prevalence of diabetes and cardiovascular issues in the urban
areas (Mastorci et al., 2017). These disorders vary between urban and rural areas as well as in the
different states and socio-economic strata. Case fatality rates are reported to be higher in the poor
as well as rural population mainly because of the poor health care and delayed diagnosis and
treatment or disorders in such classes.
The population of India has been seen to increase from 934 million in the year 1996 to
that of 1264 million in 2016 although there has been no effective strategies to tackle the
population increase effectively. This is leading to failure of the strategies as the strategies are not
being able to provide intervention at the similar case of exponential increase in population.
Moreover, the technological advantage and increases access to healthcare have caused reduction
in crude birth rate from 24.10 to 21.41. Crude death rate from 8.99 to 7.48 as well as natural
growth rate from 1.51 to 1.39 percent, infant mortality rate from 63 to 38 per 1000 live birth for
males and 64 to 39 for females. All these had resulted in steady growth of population but
managing resources to provide food, education and helter to these increase number of population
had not been conducted properly which had contributed to poor quality living, lack of access to
quality food, proper education for maintaining lifestyles and maintain a steady health and well
being (Bohman, 2015). Moreover population is also growing because the present generation has
the highest number of the reproductive age groups, high fertility due to lack of contraception.
Due to the vast increase in population number, government is facing he issues to tackle the
situation as financial development of the nation though developing steadily but is not sufficient

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for providing good food and lifestyle resources to this huge population increase. As a result
while the urban areas are getting cases of obesity and the rural areas are facing underweight
issues. Lack of financial power in rural areas leads to compromised women health and
sequentially to their babies, that result in compromised health and poor nutritional status.
Moreover lack of education, developing healthcare services (incapable for treating huge number
of patients) have also resulted in poor condition of rural areas. All these lead to child mortality
and even though they survive, they carry on the trend in a generation wise manner affecting the
health of the nation.
Determinants in this scenario
Statistical analysis and researches conducted in India by eminent researchers have helped
us to look deeper in the issue and has helped in pointing out some of the main determinants that
had resulted in the present condition. India has been facing huge number of deaths in the under
five children cohort. The main cause of malnutrition as well as death in the children has been
contributed to three important reasons (Thow et al., 2016). The intergenerational perpetuation of
malnutrition is first because often underweight pregnant women increases the likelihood of
giving birth to low weight babies which in turn becomes a strong predictor of the underweight in
infancy as well as in early childhood. Secondly, malnutrition in the different lactating mothers
raises the incidence of the children receiving reduce micro-nutrient consumption during feeding
on breast milk. This again affects infant growth. The third reason is that malnourished women
are always sick and weaker and therefore they are less able to care for their children, effectively.
These children often grow up on minimum nutrients which result them in stunted growth,
wasting and poor quality lives. The low socioeconomic people also cannot afford privatized
healthcare due to its high financial demands and the governmental hospitals remain overcrowded

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and effective treatment is delayed (Florentino 2014). The governmental healthcare although trust
to provide the best care but lack of resources in order to meet the huge demands cut off their best
attempts to give good lives to people (Ramirez et al. 2014). Low socioeconomic people also
cannot afford education and financial stability required for maintenance of lifestyles and
therefore they are not being able to afford proper quality food which becomes an addition
indicator to poor nutritional status in addition to their low birth weight conditions (Shankar et al.,
2017). However in the middle and higher classes, digitalized life and high tech life have affected
in bad health in urban areas where huge pressures of work in office given people less scope for
exercises and make people indulge in high calorigenic fast food which results in obesity. Static
lifestyles, unhealthy diets, excessive pleasure in using gazettes, little sleep, little exercises and
indulgence in luxurious lives all result in individuals being overweight. Lack of knowledge about
health maintenance and better financial stability are the determinants of obesity in India (Thow et
al., 2016). One of the another important findings of the researchers working on this topic in
India have found out that the healthcare systems in India has lack of preventive health care
assistant and is more based on curative. Hence making people educated about their health,
making them aware of the wrong practices and the consequences are not promoted at a higher
rate than it should have been. However, the present government has recently taken the issue of
maternal nutrition strategies and missing the voices reach to rural areas as well. More rapid and
evidence based strategies are require on an urgent basis to handle the dual burden of malnutrition
effectively (Victoria & Rivera, 2014).
Food production statistics of that area
India having a population of above 1.2 billion has seen huge growth in last two decades
where the gross domestic product has increased 4.5 times two times per capita consumption had

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increased thrice (Shankar et al., 2017). Food production in India has also increases about two
times but in spite of producing sufficient amount of food to feed it population. India is unable to
provide access to food to a larger section of people with the women and children being in the
forefront of the danger. The FAO estimates have shown in the “The State of Food Insecurity in
the World, 2015” , 194.6 million people are undernourished in the nation with 48% of women
being underweight and 44% of the children under 5 being underweight. India is also ranked at 97
out of 118 countries in the world in the Global Hunger index of 2016 and showed three
important indicators (Thow et al., 2016). This are prevalence of wasting and stunting children
under 5 years, under 5 child mortality rate and proportion of undernourished children in
population. Researchers have found out that one third of the food produced in the nation gets
wasted or just gets lost due to corrupt stakeholders in management. about 40% of the fruits and
the vegetable and 30% of the cereals which are produced by the farmers of the nation are lost due
to inefficient supply chain management and do not reach the consumer markets. The farmers are
forced to sell their harvests in lesser amounts to the stakeholders who often exploit their efforts
and pay them less even when the government is paying a good amount to farmers. It is the
middle men who undertake corruptions. A significant level of food losses are seen to occur
upstream, during harvest and also during post harvest handling. A lot of food is lost or wasted
even during distribution and consumption stages. Some of the food also gets wasted in the
shelves and in warehouses of food business either due to excess production, introduction of new
products, labeling errors and also due to shorter remaining life cycle (Tzioumis et al., 2016). The
food which can be easily salvaged by timely withdrawal from the networks of distribution,
proper aggregation of the food and then redirecting it to people of need get wasted due to
inefficient workforce, inefficient knowledge of proper management, present of absenteeism,

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corruption and not being responsible with the duties of management workers. Therefore although
green revolution had made India greener, the poorer class ha still been the sufferers (Mastorci et
al., 2017). The middle and high income people are wasting food at a higher level and no proper
strategies of renewal of food sources are present.
Source: (Mastorci et al., 2017)

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Source: (Thow et al., 2016)
Source: (Thow et al., 2016)

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Source: (Tzioumis et al., 2016)
National dietary pattern of Indian food habits
The Indian dietary pattern is very high on carbohydrates which cause their predisposition
to different insulin resistances and diabetes, blood derangement and weight gain. Milled rice,
pulses, table sugar, milk products and others all lead to heavy carb diet. Moreover as most the
diet is vegetarian therefore it lacks certain important nutrients like B12, long chain omega 3 fatty
acids, vitamin A and Iron. Indians have less protein in their diets due to their dietary patterns
more curbs increases their chance to develop obesity and weight gain (Tzioumis et al., 2016).
They have cereals and oilseeds dominate diet, which does not provide them enough protein but

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lots of calories. Moreover static lifestyle in the upper socio-economic classes is mostly affected.
Due to les financial stability, low socioeconomic classes cannot afford food two meals a day
even and even if they can afford of they are carb rich rather than proteins. Meat and fish are
higher in cost and therefore cannot be afford by people on a daily basis which is very important
for children during their growing years. All these had lead to the dual burden of malnutrition in
India.
Strategies
The action plan is the framework or strategies that are implemented for building the
strategic directions for creating or enabling the environment to provide nutrition to the
individuals. However, some basic strategies are used for mapping the associations between the
policy actions, the global form of nutrition, the relevant form of the indicators and the actions for
making the various policies to improve the conditions of the health and the nutrition levels of the
population. Therefore, some of the strategic plans are discussed in the section below
Strategy A: The improvement of the governance by enhancing the political form of
commitment informed evidences and the context that are specific to the policies of the
sectors
The good form of the governance can be unexpected phenomenon upon a very strong
form of leadership, the will of setting the administration and the commitment towards the
government. However, nutrition, in today’s world has become the most prioritized as the most
important factor for developing the agenda of the country (Thow et al., 2016). It should be
ensured that the healthcare system of the nation incorporates the maternal and the child health.
The nutrition is an essential and primary package of the healthcare. With the increasing rate of

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malnutrition that are reflecting the poor condition of health of the population, the country’s
healthcare have implemented various effectual packaging interventions to reduce the rates of
interventions. The establishments of the high levels of coordination of the mechanisms are due to
the nutritional actions that are needed in the multisectors (Mastorci et al., 2017). The government
should also ensure the policy that provides the adequate form of financing for providing proper
nutrition to the population.
Strategy B: Developing and adopting the guidelines that are relevant and regulatory that
can help in the implementation of the interventions that are based on the evidences
The development of guidelines, regulatory form of the frameworks and the legislations
are very much essential for the instruments that are essential for doubling the burden of the
malnutrition. The guidelines that are evidence based are always available at the globalized level
and should be adopted by the countries that are based on the context to the country.
The national guidelines for the dietary that are generally food based often helps to
promote the nutritious form of the diet that emphasizes on the diversities of the high form of
intake of the fibres and low sugar, salt and fat (Ramachandran, 2016). The national policies have
limited the intake of the fatty acids and they tend to virtually eliminate the partial form of the
hydrogenated vegetable oils in the supply of the food. The promotions of the fiscal policies are
being practiced to overcome the unhealthy form of diets and enhancing the access of the healthy
form of food. This phenomenon ensures that the guidelines are practiced all over the country for
the supplementation of the macronutrient and for the fortifications of the products that are
suitable for the population of the country (Shankar et al., 2017). However, it is very essential to

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review and develop the better form of national guidelines for the prevention and the treatments to
provide care for managing the common form of diseases.
Strategy C: For addressing the double burden of malnutrition the there must be a
development to strengthen the health systems by adding sufficient resources, strengthening
the capacity and monitoring the community.
To achieve proper nutrition it is important to maintain the availability of the nutrition
services so that it can be afforded easily. It is essential to arrange an evidence based development
process that will incorporate latest technology, research and learning tools. For the primary
healthcare some packages has been developed which ensure that a proper system is incorporated
for nutrition of mother and child (Haddad, Cameron & Barnett 2014). To follow this policy an
essential package of nutrition was developed by the health care system, which can reflect the
double burden of malnutrition. Adequate resources were funded to fulfill the requirements for
proper nutrition. Some qualified professionals are appointed to access and evaluate the nutrition
programs implemented to reduce the double burden of malnutrition. Healthcare facilities were
promoted that offer nutrition services in clinical condition to prevent and provide proper
treatment for serious acute malnutrition problems. Food laboratories are being upgraded to
ensure the safety of food and for supporting the implementation for healthy diet of mother and
child (Shrimpton et al. 2016). Safe management of water was also established and access of the
proper sanitation facility at different communities. Some actions were initiated for the
development of nutrition and identification of the indicators to inform, evaluate and monitor the
actions that are suitable for tracking the double burden of malnutrition.

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Strategy D: For promoting healthy diets and formation of strategic alliances the
communities must empower and strengthen the knowledge of nutrition.
The promotion of community empowerment depends on the development of the policies
that are established to reduce the double burden of malnutrition. It is also important to form
partnership with the food sector for promoting healthy diets which can help to reduce the double
burden of malnutrition. Some action groups have been formed by the civil society organizations
which helps to promote physical activity and healthy diets used to support the promotion of
education campaigns of nutrition (Tebekaw, Teller & Colón-Ramos, 2014). Engagement of
academic institutions is maintained for monitoring the evaluation of research to reduce the
double burden of malnutrition. Advocating the resources for nutrition, support the partnerships
policies and coordinating the mechanisms of health and various sectors for promoting healthy
diets and safe nutrition. Supporting the targets to develop the National policies, action plans as
well as the strategies which to reduce the double burden of malnutrition (Tzioumis et al., 2016).
Community advocacy plan were developed and implemented for providing healthy diet. These
plans execute the strategies of social marketing and also help in teacher training to improve the
nutrition education in schools. The society must engage with the private sectors for the reduction
of obsesogenic environment to reduce overweight obesity and dietary risks. On the other hand
healthy lifestyles were also created in communities to reduce different forms of malnutrition.
Healthy diets and lifestyle is also being promoted at workplaces to reduce the overweight and
encourages in proper nutrition of the workers.

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