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A staggeringly large number of Indians in 15 states are either overweight or underweight, and suffer from anaemia, according to the latest release of National Family and Health Survey (NFHS 4). These states make up about 44% of the country's population. The survey was done in 2015.
Abnormal weight was measured by working out the body mass index (BMI), which is a measure of how much a person weighs relative to his/her height. A BMI less than 18.5 kg per square metre makes you underweight, while over 25 means you are overweight. Both conditions are caused by bad nutrition and result in bad health parameters.
An abnormal BMI is strikingly common among women across the 15 surveyed states, and it ranges from 24% in Meghalaya to a shocking 51% in Andhra Pradesh and Telangana. Even in Tamil Nadu, which otherwise shows better health parameters, 46% women report abnormal BMI. Among men, the same pattern is visible in these states but the proportions are slightly lower.
In poorer states like Bihar, the share of underweight population — 30% women and 25% men — is far higher than overweight people — 12% to 13%.
Conversely, in better off states like Haryana, 16% women and 11% men have low BMI, but 20% are overweight. There is a sharp urban-rural divide too, with higher numbers of overweight people living in urban areas.
Despite slight dips compared to the last survey in 2005-06, the proportion of adults in the 15-49 years age group suffering from anaemia is still very high among women, ranging around 45% in Karnataka to as high as 63% in high-income Haryana, among the big states.
Among men, it ranges from 15% in Telangana to 30% in West Bengal.
According to Anura Kurpad, professor of nutrition at St John's Research Institute, Bengaluru, the two problems are interlinked.
"A low BMI usually reflects energy deficiency. If all food intake is low, it is reasonable that the intake of micronutrients, like iron, will be low. This is compounded by the fact that Indian diets are already poor in diversity and consequently low in micronutrients anyway, and further, even inhibitory to their absorption. Eating lower amounts of this poor diet magnifies the risk of anaemia," he says.
"On the other side, a high BMI usually implies high body fat. Fat can release inflammatory signals that increase the level of hepcidin, which in turn inhibits iron absorption. In effect, anyone with a chronic inflammatory condition is at risk of low iron stores and fat mimics this," he adds.
Two types of issues — structural and income related — are causing this nutritional double whammy, according to Hemal Shroff, a public health specialist at the Tata Institute of Social Sciences (TISS), Mumbai.
health specialist at the Tata Institute of Social Sciences (TISS), Mumbai. "Some of these structural issues are — excessive focus on wheat and rice production, increased availability of processed foods and sugary drinks, reduction in physical activities in urban areas, lack of government intervention in improving access to healthy foods, etc." she says.
Poor incomes lead to people not having access to healthy foods, although many would argue that poor people make non-nutritive food choices, Shroff points out. She is also critical of the government for only "planning" interventions and not implementing them.