Opinion: From hidden hunger to NCDs, rethinking malnutrition in India  

Tackling malnutrition holistically is not just about meeting caloric needs but breaking the cycle of poverty and non-communicable diseases

By Dr Vanishree Joseph

Current approaches to measuring and addressing malnutrition focus more on anthropometric indicators such as stunting, wasting and underweight. These indicators are used widely across lower — and middle-income countries but often fail to capture the emerging nutritional challenges.

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Hidden hunger, or micronutrient deficiencies, affects over 2 billion people globally, many of whom reside in these regions. Poor-quality diets that meet caloric needs but lack essential nutrients are a significant factor in the rise of non-communicable diseases (NCDs), which account for 70% of deaths worldwide, according to the World Health Organization. Despite this, only about 2% of global health spending is allocated to NCDs, highlighting a critical gap in addressing the broader implications of malnutrition.

Nutrition and NCD

Right from foetal development to early childhood to the adolescent stage, nutrition shapes the organ development and physiology of an individual. Studies have shown that poor maternal nutrition will alter the metabolism and organ development of the foetus. This serves as a predisposition to non-communicable diseases when the baby is born.

Foetal adaptations to conserve energy in undernourished environments can lead to fat accumulation and obesity when exposed to caloric abundance in postnatal life. Hence, low birth weight is highly associated with the risk of insulin resistance, diabetes and hypertension in adulthood.

Life-cycle Approach

Dietary transitions have also led to the coexistence of undernutrition and overnutrition within the same population. One reason for this is interventions that fail to address nutrient deficiencies and caloric excess, which has led to the double burden of malnutrition. Therefore, policies should adopt a life-cycle approach that emphasises the interconnectedness of nutrition across all stages of life, from foetal development to old age.

To some extent, Poshan Abhiyaan has incorporated the interconnectedness between mothers’ and children’s nutritional condition. Addressing nutritional needs during key periods such as pregnancy, infancy, adolescence and adulthood helps break intergenerational cycles of malnutrition and reduce the risk of NCDs. Integrating this perspective into all policies that address malnutrition ensures a continuous, preventive focus on health rather than reactive interventions. Rethinking how we address malnutrition and its connection to NCDs should be the priority now.

Composite Measures

Traditional metrics should be supplemented with composite measures that can provide a better method to understand the issues and consequences of malnutrition. This can guide policymakers in designing interventions that address undernutrition, overnutrition and shared root causes. Comprehensive healthy eating and living should be a part of the nutritional measure. The measures should interconnect the broader determinants of nutrition and its interconnection with NCDs. This will help develop a more holistic framework to address malnutrition and its links to NCDs.

The double burden of malnutrition and rising NCDs emphasises the need for a preventive, data-driven strategy that bridges gaps in healthcare, technology and social equity

Nutritional literacy is a critical component often overlooked when addressing malnutrition. People may have access to sufficient calories but lack the knowledge of dietary diversity and balance, which leads to micronutrient deficiencies and poor health outcomes. Awareness campaigns and school-based nutritional education can play a pivotal role in creating lifelong healthy eating habits. This approach is especially relevant for adolescents, a demographic that often experiences a rapid increase in nutritional needs.

Food Systems, Policy Integration

India’s limited progress toward diet-related NCD targets highlights the need for policy reform. Currently, 6.2% of adult women and 3.5% of men are obese, and diabetes affects 9% of women and 10.2% of men. This reflects a broader challenge seen globally, where 75% of the 537 million adults with diabetes are from low- and middle-income countries. Addressing these trends requires integrating nutritional value and public health into food systems.

Current food systems often prioritise production and availability over nutritional value. Policies should incentivise producing and consuming nutrient-rich crops like fruits, vegetables, legumes and millets. These policies must integrate sustainability, food security and public health to reduce the prevalence of energy-dense but nutrient-poor foods. For example, fortification programmes for staples like rice, wheat and salt have shown potential in addressing hidden hunger but should be expanded and monitored rigorously for effectiveness.

Malnutrition cannot be tackled in isolation from its social determinants. Poverty, gender inequality, lack of education and limited access to healthcare services exacerbate both undernutrition and overnutrition. Women and girls often have limited decision-making power over household food distribution, leading to inequities in nutritional intake. Gender-sensitive policies, such as improving women’s access to income-generating opportunities and education, can significantly impact household nutrition dynamics.

Innovative use of technology can improve monitoring. Mobile health applications can help individuals track their dietary intake and provide tailored advice. Similarly, big data analytics and artificial intelligence can identify population trends and vulnerabilities, enabling targeted interventions. Predictive models can identify regions prone to a double burden of malnutrition, guiding the allocation of resources.

Healthcare Integration

Primary healthcare systems should integrate nutrition-specific and nutrition-sensitive interventions to address malnutrition and its connection to NCDs. Routine health check-ups can include nutrition assessments and counselling to ensure early detection and management of nutritional imbalances. Monitoring blood glucose levels and body mass index (BMI) at an early age can help identify and mitigate risk factors for diabetes and cardiovascular diseases.

Community engagement plays a vital role in addressing malnutrition at the grassroots level. Initiatives such as community kitchens, local farmer collectives and self-help groups can ensure the availability of nutritious food and promote collective action.

Programmes like ‘Tithi Bhojan’ in India have demonstrated the effectiveness of community participation in improving the nutritional status of vulnerable groups. Scaling these up with the support of local governments can amplify their impact.

Cultural and Regional Nuances

Nutrition policies should respect cultural and regional food practices while addressing malnutrition. Promoting the consumption of locally available and culturally acceptable superfoods, such as millets, can help address both undernutrition and NCDs. Tailored interventions that resonate with local customs and food habits are more likely to succeed.

The evolving situation of malnutrition demands an integrated approach that goes beyond anthropometric indicators to address its links with NCDs. Hidden hunger and poor-quality diets fuel a public health crisis that necessitates innovative, cross-sectoral solutions. Policies must be reoriented to adopt a life-cycle perspective, prioritise nutrient-rich food systems and empower communities through education and grassroots initiatives.

The double burden of malnutrition and rising NCDs emphasises the need for a preventive, data-driven strategy that bridges gaps in healthcare, technology and social equity. Tackling malnutrition holistically is not just about meeting caloric needs but nurturing resilience and breaking the cycle of poverty and disease. India must lead by example, rethinking nutrition as a pillar for long-term public health and sustainable development.

(The author is Head, Centre for Gender Studies and Development, National Institute of Rural Development and Panchayati Raj, Hyderabad)