Little knowledge about healthy food choices, poor diet diversity and emphasis on fatty, sugary & salty foods have a dire impact on nutritional status

The fifth round of the National Family Health Survey (NFHS-5) data depicts a holistic picture of India's health status thereby giving us some reasons to celebrate and others to think. Data on India's nutritional status highlights the triple burden of malnutrition (undernutrition, micronutrient deficiencies, and obesity) faced by the country even before the onset of the COVID-19 pandemic. As required, the focus for the past year and a half was on the immediate threat of the virus followed by immunizing the population. India now enters a new phase wherein true resilient recovery can only take place if we pledge to focus on nutrition, especially of the young population collectively.

The second phase of NFHS-5 conducted in 2019-2021, shows that the percentage of children who are stunted, wasted and underweight has gone down only marginally. There is, however, a slight increase in the percentage of severely wasted and overweight children. Concomitantly, there has been a steep increase in anaemia among all age groups. The percentage of overweight or obese (BMI —25.0 kg/m2) women and men between ages 15-49 has also increased.

The Comprehensive National Nutrition Survey for 2016-2018 reveals that every second Indian adolescent suffers from some form of malnutrition. About a quarter of adolescents are thin for their age while five per cent are overweight (BMI-for-age >+1 SD). Under half of preschoolers, a fourth of school-age children, and close to a third of adolescents were anaemic.

An often-overlooked aspect of malnutrition is the lack of proper dietary habits. Lack of adequate knowledge and awareness about healthy food choices, poor diet diversity, and emphasis on high fat, sugar, salt (HFSS) foods have a dire impact on the nutritional status. The existing underlying nutritional challenges have been further exacerbated with the collateral impact of the fight against COVID-19. With the disruption in food and nutrition services such as in Integrated Child Development Services (ICDS) and mid-day meal (MDM) and Weekly Iron Folic Acid Supplementation (WIFS) in schools, the malnutrition challenge has further been compounded. The prolonged closure of schools and extended online classes has not only impacted eating habits but also decreased the physical activity levels of children, increasing the susceptibility to obesity.

Micronutrient deficiency during early childhood can often transverse into adolescence which if not addressed can lead to long-term effects on health, cognition, education, and productivity. Hence, adolescence can be considered as a second window of opportunity to improve the nutritional status of the individual. India is home to almost a fifth of the global adolescent (10-19 years) population. Nutritional requirements increase substantially and peak during this period with a 15-25 per cent increase in height, attainment of 40-60 per cent of peak bone mass, and up to 50 per cent of adult body weight — as well as blood loss due to the onset of menstruation among girls.

Adopting a lifecycle approach, by ensuring good nutrition to our children and adolescents will go a long way in ensuring the good health of future generations.

To strengthen the health of the future of the country, we need to ensure the optimal nutritional and health status of our children and young people today. To understand the state of nutrition in different population segments and the target areas which need to be focused on for effective, immediate as well as sustained interventions, research in the form of a rapid assessment should be conducted. 

Dietary factors are associated with increased risk of chronic diseases and undernutrition, national and international dietary guidelines recommend improving the diversity of diet to achieve a balanced diet. This requires that the macro and micronutrients requirement and sources, are understood and accessible by all, especially growing children and adolescents. By enabling and empowering the present and future generation through the access and knowledge of a healthy diet and its sources, India enables subsequent economic and development goals as well.

Given the scale and size of India, in order to achieve this goal, all stakeholders must take conscious measures. Public-private partnerships across sectors can enable congruence of efforts toward common goals to address malnutrition and boost immunity. Food technology and logistics expertise of the private sector can be leveraged to strengthen and scale-up government initiatives like Poshan Abhiyaan and Anemia Mukt Bharat. Convergence of efforts would enable the maximization of impact while optimizing resources across nutritional outcomes for India.

(The writer is Associate Professor, Department of Food and Nutrition, Institute of Home Economics, University of Delhi. The views expressed are personal.)