India's rapid economic advancement is paralleled by a concurrent transformation in dietary habits, impacting both urban and rural communities. The contemporary scenario witnesses a continual abundance of high-energy food coupled with diminished physical activity. In this same time frame, there has been a remarkable rise in the occurrence of overweight and obesity in both urban and rural population of India, surpassing 60% in the most recent data (NIN). Even a minor positive energy imbalance of 50 kcal/day can result in a monthly weight gain of up to 1 kg.
Urban data from NIN indicates that the average daily consumption of packaged foods, including sweets and savories, is around 100 grams, providing over 500 kcal/day per individual. The hyperpalatable nature of processed foods makes it easy to overconsume. This transformation in the Indian food landscape is linked to a rise in diet-related non-communicable diseases (DR-NCDs) such as non-alcoholic fatty liver disease (NAFLD), diabetes, and cardiovascular diseases (CVDs). CVDs, including hypertension, heart attacks, and strokes, manifest at a younger age in the Indian population, with a mortality rate higher than the global average. Additionally, one in three adults in India is affected by NAFLD. The epidemic has transcended socioeconomic boundaries, affecting both urban and rural regions without regard to class or dwelling areas.
A recent report highlights that the market is predominantly dominated by chocolate and sugar confectionery, followed by convenience foods and beverages. Sweet biscuits alone constitute over 45% of the ultra-processed food (UPF) market. The continuous surplus of energy in the body disrupts hepatic insulin signal transduction, leading to insulin resistance, inflammation and features of metabolic syndrome (MetS), contributing to the escalation of DR-NCDs.
Globally, various countries have adopted policy measures to curb the consumption of unhealthy foods, such as increased taxes on unhealthy items and reduced taxes or subsidies for healthier alternatives. Some nations have implemented comprehensive nutrition labelling, awareness programs, and regulations restricting the advertising and marketing of highly processed foods, targeting both food processors/manufacturers and consumers.
The National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS) focuses on early diagnosis and management. In response to the growing burden of NAFLD, the Government of India has recently incorporated NAFLD into the NPCDCS program. Additionally, in June 2022, the Central Consumer Protection Authority (CCPA) introduced guidelines under the Consumer Protection Act, 2019, aimed at preventing misleading advertisements and endorsements. While restrictions on unhealthy food advertising are evolving, a comprehensive strategy incorporating various interventions is imperative.
Implementing nutrient-based taxes on High in Fat, Salt, and Sugar (HFSS) foods and taxes based on processing levels, coupled with incentives for wholesome foods, will encourage the food industry to develop healthier options. Clear food labelling is crucial for public health communication, requiring easily understandable labels due to consumers' limited attention span and nutrition literacy. Intelligible labelling that aids people in swiftly identifying HFSS and processing levels, such as ultra-processed foods (UPF), will significantly contribute to reducing the production and consumption of unhealthy foods.
Given the complexity of nutrition science, the diverse nature of food products, and consumption patterns, comprehensive diet and nutrient intake data are urgently required to guide evidence-based public health nutrition policy formulation and prevent the mounting epidemic of overweight/obesity and DR-NCDs.
The ICMR-NIN has initiated a survey to map diet, nutrition, health status, and biomarkers among urban and rural populations across India. The data will inform nutrient gaps, consumption patterns across India, and the level of intake of packaged foods, UPFs, carbonated beverages, fruit juices, and other unhealthy food habits. The survey data will aid in developing appropriate data-driven policies to mitigate the rising DR-NCDs in India.
It is also time to leverage AI technology tools for addressing obesogenic environments and behaviours both at the institutional and individual levels to combat the obesity epidemic and DR-NCDs. A team of scientists at the National Institute of Nutrition (NIN) is actively involved in crafting a 'School/College Overweight & Obesity Risk Surveillance System.' This endeavour will enable the development of intervention modules geared towards creating a favourable food environment, with the potential for widespread replication. The primary focus is on food environment to alleviate the mounting epidemic of obesity and DR-NCDs in India.
By implementing a combination of strategies such as curbing predatory marketing and advertisement, subsidies for healthier options, food labelling and behaviour change communication, India can foster a health-promoting food environment and address obesity and diet-related non-communicable diseases.
