India is undergoing rapid urbanisation and economic growth, which have brought profound changes in lifestyles and dietary habits. While the country continues to grapple with undernutrition in many regions, a parallel but often overlooked challenge is the rising prevalence of overnutrition—a form of malnutrition resulting from excessive intake of calories and unhealthy nutrients. Overnutrition in urban India is emerging as a major driver of non-communicable diseases (NCDs), threatening public health, economic productivity, and social wellbeing.

Understanding Overnutrition:

Overnutrition refers to the condition where calorie consumption persistently exceeds the body's energy requirements. Unlike traditional malnutrition, which is associated with deficiencies, overnutrition is characterized by an imbalance where excess calories—often from unhealthy sources—lead to overweight, obesity, and related metabolic disorders. This condition may also coincide with micronutrient deficiencies, creating a double burden of malnutrition.

The key manifestations of overnutrition include:

·         Excess body fat, particularly visceral fat around the abdomen

·         Increased risk of chronic diseases such as type 2 diabetes, cardiovascular diseases, and certain cancers

·         Micronutrient deficiencies despite high caloric intake, such as anaemia and vitamin D deficiency

Data on the Scale of Overnutrition in Urban India:

·         The National Family Health Survey (NFHS-5, 2019-21) indicates that approximately 33% of urban women and 29% of urban men are overweight or obese (BMI ≥ 25), a significant increase from around 20% in NFHS-3 (2005-06).

·         The ICMR-INDIAB study (2021) reports obesity prevalence rates exceeding 40% in urban centres like Delhi, Kerala, and Tamil Nadu. Urban diabetes prevalence is reported between 12-14%, roughly twice the rate seen in rural populations.

·         The WHO Global Obesity Observatory (2023) warns of rising childhood obesity rates in Indian cities, indicating a disturbing trend that could burden future health systems.

·         Tamil Nadu’s STEPS Survey (2021) reveals that 60% of Chennai’s adult population is overweight or obese, with 41% suffering from hypertension and 22% diagnosed with diabetes, underscoring the interconnectedness of overnutrition with NCDs.

Causes of Overnutrition in Urban Settings:

The increasing prevalence of overnutrition in urban India is driven by a complex interplay of dietary, lifestyle, socio-economic, and environmental factors.

Dietary Transition

Urban populations have shifted from traditional diets rich in whole grains, fruits, and vegetables to diets dominated by:

·         Ultra-processed foods high in refined sugars, saturated fats, and salt

·         Frequent consumption of fast foods, sugary beverages, and snacks

·         Increased portion sizes and snacking habits, often influenced by marketing and availability

This shift is exacerbated by the growth of food delivery services, advertising campaigns, and the convenience culture prevalent in cities.

Sedentary Lifestyle

The urban environment often promotes inactivity due to:

·         Sedentary office jobs requiring long hours of sitting

·         Increased screen time from computers, smartphones, and entertainment devices

·         Lack of accessible public spaces for exercise, safe walking paths, and parks

·         Reduced physical activity during commuting due to reliance on motorized transport

Socioeconomic and Cultural Factors

·         Urban populations tend to have greater disposable income to spend on food, but often lack awareness about healthy choices.

·         There is often a cultural perception equating overweight with prosperity and health.

·         Nutritional education is limited, and many urban dwellers are unaware of the health risks posed by overnutrition.

Marketing and Accessibility

Aggressive marketing of unhealthy food products, particularly targeting children and youth, contributes significantly. Urban markets are saturated with cheap, calorie-dense foods that are more affordable than healthier alternatives like fresh produce.

Vulnerable Populations Within Urban Areas:

·         Children and Adolescents: Exposure to junk food marketing, increased screen time, and reduced physical activity contribute to early onset obesity.

·         Working Professionals: Sedentary work environments, stress, irregular meals, and reliance on processed foods increase risks.

·         Women: Postpartum weight retention, hormonal factors, and limited physical activity exacerbate the problem.

·         Elderly: Reduced mobility and dietary monotony increase vulnerability.

·         Urban Poor: Despite limited income, reliance on cheap, calorie-dense foods combined with poor nutrition education leads to paradoxical overweight/obesity with micronutrient deficiencies.

Health and Economic Consequences:

Health Risks

·         Increased incidence of cardiovascular diseases, stroke, type 2 diabetes, hypertension, and certain cancers.

·         Conditions like non-alcoholic fatty liver disease (NAFLD), sleep apnea, and osteoarthritis become more common.

·         Mental health challenges arise, including depression, anxiety, and low self-esteem linked to body image issues.

Economic Burden

·         Rising healthcare costs to treat chronic diseases linked to obesity place a heavy financial strain on individuals and government health programs.

·         Loss of productivity through increased absenteeism, disability, and premature mortality.

·         Greater demand on urban health infrastructure, insurance systems, and social welfare schemes.

Government Interventions and Their Limitations:

·         POSHAN Abhiyaan addresses malnutrition comprehensively but has limited focus on adult obesity and urban lifestyle diseases.

·         The Eat Right India movement (FSSAI) promotes healthier eating, including food labelling and reduction of trans fats, but faces challenges in implementation and enforcement.

·         The School Health Programme under Ayushman Bharat integrates nutrition education but requires scaling to reach all urban schools effectively.

·         National Health Policy 2017 recognizes the rising burden of NCDs but lacks a dedicated strategy targeting urban overnutrition specifically.

Key challenges include:

·         Insufficient nutrition education and public awareness campaigns targeting adults.

·         Weak regulatory mechanisms on junk food advertising, especially near schools.

·         Limited urban-specific programs addressing lifestyle modification and physical activity promotion.

·         Urban poor populations remain underserved in nutritional interventions.

Strategies to Address Urban Overnutrition:

Public Awareness and Education

·         Conduct large-scale campaigns to improve nutrition literacy and promote healthy eating habits.

·         Use mass media and community outreach to encourage portion control and balanced diets.

·         Integrate nutrition education into school curricula and workplace wellness programs.

Urban Planning and Infrastructure

·         Promote development of pedestrian-friendly infrastructure, parks, and recreational spaces.

·         Encourage policies that make healthy foods affordable and accessible through urban markets.

·         Limit the density of fast-food outlets near schools and residential areas.

Regulatory and Fiscal Measures

·         Impose taxes on sugar-sweetened beverages and ultra-processed foods.

·         Subsidize fruits, vegetables, and traditional healthy foods.

·         Enforce stricter regulations on marketing of unhealthy foods, especially to children.

·         Mandate clear, front-of-pack nutritional labelling for packaged and restaurant foods.

Health System Strengthening

·         Implement routine screening for overweight and obesity in urban health facilities.

·         Provide counselling services for diet, physical activity, and weight management.

·         Train healthcare providers in managing lifestyle diseases linked to overnutrition.

Research and Monitoring

·         Establish urban nutrition surveillance systems to monitor trends and risk factors.

·         Conduct studies on urban dietary behaviours and physical activity patterns.

·         Evaluate effectiveness of interventions and policies to guide future actions.

Conclusion:

Overnutrition in urban India represents a silent but escalating public health crisis. While much focus remains on undernutrition, ignoring the rise of overweight and obesity threatens to overwhelm the health system with costly chronic diseases. Addressing this challenge requires immediate, sustained action encompassing awareness, regulation, urban design, and healthcare interventions.

India must adopt a balanced approach that recognizes malnutrition in all its forms and prioritizes prevention and management of overnutrition alongside undernutrition. Only through coordinated efforts across government, civil society, and communities can India ensure healthier urban populations and sustainable development in the coming decades.