India’s new urban worry — rising overnutrition Premium

UIrban India faces the risk of a nutrition-driven public health crisis

A recent article in Nature that studied the prevalence of Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD) among IT employees in Hyderabad had alarming findings: 84% of the participants had fatty liver, indicating MAFLD, and 71% were obese. This striking statistic underscores a larger, more insidious public health crisis that is emerging in tandem with the growth of India’s urban economy. The underlying drivers are chronic stress, excess salt intake, disrupted sleep patterns, and prolonged sedentary routines, particularly among those in the technology sector. IT companies often tether employees to their desks by offering free kiosks stocked with snacks that fall short of nutritional standards.

India is grappling with a paradoxical nutritional landscape. While undernutrition remains a concern in many regions, overnutrition is now rapidly escalating in urban centres. In 2021, India ranked second globally in overweight and obesity prevalence. The trend is particularly evident in metropolitan IT corridors, where professionals are unwittingly becoming the face of a silent metabolic crisis. India’s double burden of malnutrition — rampant undernutrition coexisting with overnutrition — is reflected in its low ranking on the Global Hunger Index.

According to the World Health Organization (WHO), noncommunicable diseases (NCDs) were responsible for 74% of global deaths in 2019 (it was 61% in 2000). These diseases disproportionately affect low- and middle-income countries, including India. WHO’s 2024 World Health Statistics warns that NCDs and obesity are increasingly prevalent in the most economically productive segment of society. Without substantial policy interventions, regions such as South-East Asia are unlikely to meet the 2030 Sustainable Development Goal (SDG) targets to reduce premature mortality from NCDs.

In Tamil Nadu, the 2023-24 STEPS Survey paints a stark picture: over 65% of deaths in Chennai are attributable to NCDs. While the NCD cascade of care has shown improvement, there are significant gaps.

Among those receiving treatment for hypertension, only 16% have achieved blood pressure control, and for individuals aged 18-44, this drops to just 9.3%. Among diabetics in the same age group, only 9.8% manage to maintain glycaemic control. The prevalence of overweight and obesity stands at 31.6% and 14.2%, respectively. Additionally, 94.2% of respondents reported inadequate fruit and vegetable consumption, while 24.4% reported insufficient physical activity.

Tamil Nadu’s Makkalai Thedi Maruthuvam (MTM) programme, deserves mention for its multisectoral approach to NCD control. From January 2024, 3,79,635 employees have been screened through workplace interventions. The eight-kilometre health walk and the “Eat Right Challenge” were introduced to encourage behavioural change and nutrition awareness. However, the unchecked growth of fast food outlets in metros remains a formidable obstacle.

The National Family Health Survey-5 shows that obesity steadily rises with age, from 7% among men (15-19 years) to 32% among those aged 40 to 49 years. The prevalence of overweight or obesity rises from 10% in the lowest wealth quintile to 37% in the highest wealth quintile.