Even 30 years ago, obesity was not considered a public health issue. Even as late as 1990s, obesity was only seen as a western concern, whereas undernutrition or malnutrition was more of a problem for developing nations such as India. But the fact of the matter is, obesity and excess weight is rising worldwide and people globally struggling with being overweight or obese.
According to Dr. Mira Shekar, Global Lead for Nutrition at The World Bank, in the last few decades, obesity has gone up by at least three times. Today 44% of adults across the world are either overweight or obese and for kids under five years, almost 80% who are obese or overweight live in the lower and middle-income economies of the world, which includes India.
Fast food consumption among rural adolescents increasing risk of obesity
The problem is closer to home than one thinks or cares to admit. As per the findings of NFHS 5, 33 states have reported an increase in obesity since NFHS 4 results among children aged 0-5 years [2.1% in NFHS 4 has increased to 3.4% in NFHS 5]. The problem is even more acute among adults. Traditionally, the prevalent sedentary lifestyle means higher obesity in urban India than in rural. Nevertheless, obesity among rural women aged 15-49 years has increased to 19.7% in NFHS 5 from 15% in NFHS 4, and to 19.3% among rural men in NFHS 5 from 14.3% in NFHS 4.
Mira Shekar further states that there are several reasons responsible for this rising problem, principal among them being changes in lifestyles leading to a decline in access to healthy food systems. Lower and middle-income countries need to improve their food systems, and as a starting point, policy planners need to recognise the fact that more and more women are now going out to work, which in itself is a good thing, but it also means less time to cook from scratch at home. This leads to healthy foods being replaced by unhealthy foods or snacks, especially in the diets of children and adolescents, who usually do not cook for themselves.
To explore this further in the context of rural India, Sambodhi Panels, in collaboration with Transforming Rural India Foundation (and under its Rural ThinkInsights series), have conducted a pan-India (rural) telephone-based survey covering 4174 adolescent boys and girls aged 10-19 years (coverage of 2117 aged 10-14 years and 2057aged 15-19 years). The survey specifically looked at frequency of consumption of unhealthy (junk) food by rural adolescents, the source of procurement, and location of consumption.
Consumption of 'fast food' items at least once in the past 7 days
The most consumed ‘fast food’ item among adolescents is chips/Kurkuretype of snacks with 87% having consumed the same about three times in the past 7 days. This is followed by biscuits (usually flour-based), which were consumed by every three in four adolescents around 3.5 times in the last 7 days. While sliced bread (commonly flour-based) is yet to make major inroads in a rural diet, surprisingly, over 40% of adolescents do consume instant noodles (primarily Maggi), which seems to have made heavy inroads as an alternative snacking option in rural India. This was consumed around two times in the last 7 days.
Sugar-based sweet items, be it traditional sweets, chocolates, hard-boiled candy, or ice cream, were being consumed by one in two adolescents around 2-3 times in the past 7 days. Contrary to popular perceptions, carbonated and non-carbonated (local) soft drinks were also consumed by nearly 30% of adolescents, around twice a week.
Frequency of consumption
Apart from quantum of consumption, it is also important to present the source of procurement and consumption. The survey found that for all these ‘fast foods’, home is the primary source of procurement (where the adolescent had been given the item). Further, for biscuits, instant noodles, sliced bread, namkeens like chips, and sweet treats like chocolates, candy, and ice cream were also bought from a local store, or bought from a local hawker/vendor/thelawala (in combination ranging between 10-45%). Soft drinks and sweets, to a lesser extent, are offered at a friend’s or relation’s home and consumed there as well.
Regarding the place of consumption, overwhelmingly for 4 out of the 7 ‘fast food’ items, the major share of the consumption took place at home. Namkeens (in the form of chips and other salty snacks) are consumed primarily outside of school or home or within the school. Similar trends were reported for both sweetened soft drinks as well as chocolates/candy/ice cream.
Given that home is a principal point of consumption, a concentrated awareness campaign targeting parents is the likely way forward.
The obesity problem is not just a personal problem -it can have a huge effect on the local and global economy. Obesity can lead to non-communicable diseases, like cardiovascular cancers and diabetes. It also means higher healthcare costs, higher absenteeism from work, and lower productivity. The World Bank has been prescribing several means to address this problem, including taxation on unhealthy foods, namely sugar-sweetened items like soft drinks and high-fat foods, and front-of-package labelling, especially on processed foods. Perhaps it is time for India to sit up and listen.