India is currently facing a complex nutritional paradox. While millions still struggle with hunger and undernutrition, there’s a fast-growing problem of obesity and lifestyle-related diseases. These opposing issues exist simultaneously across the country, even within the same household. This phenomenon is known as the double burden of malnutrition.
It is no longer just about not getting enough to eat. Many people are consuming enough or even too many calories, but still lack essential nutrients. Others are battling obesity and related illnesses due to high-calorie but poor-quality diets. This double burden is now one of the most pressing public health challenges in India.
Despite decades of intervention, undernutrition remains widespread in India, especially among children and women. According to the National Family Health Survey (NFHS-5, 2021):
These numbers reflect the scale of undernutrition that still persists in both rural and urban areas. Poverty, poor sanitation, lack of healthcare, and gender inequality are some of the key drivers that continue to affect the nutritional status of millions.
On the other end, India is seeing an alarming rise in overweight and obesity rates, particularly in urban areas but increasingly in rural communities as well.
In 2022, over 12 million Indian children aged 5 to 19 were classified as overweight
Among adult women, obesity rose from just 1.2 percent in 1990 to nearly 10 percent in 2022
Among men, obesity increased from 0.5 percent to over 5 percent in the same period
This transformation is largely due to changes in diet and lifestyle. As people move away from traditional foods to processed and packaged items, and become more sedentary, the risk of developing conditions like diabetes, hypertension, and heart disease increases significantly.
One of the most visible signs of the double burden is the increasing number of families where the parent, often the mother or father, is overweight or obese, while the child is undernourished. This is known as intra-household malnutrition.
Between 2006 and 2021, the number of such cases grew rapidly:
This mismatch occurs when families have enough calories, often from rice, wheat, or processed food, but lack the diversity and nutrition that fruits, vegetables, and proteins provide.
Malnutrition in India follows patterns of inequality. Urban non-slum households are increasingly obese, while rural and poorer families continue to struggle with undernutrition. Yet, overnutrition is also growing among the poor, creating a new kind of nutritional inequality.
In rural India, double burden prevalence grew from 13 percent in 2006 to 26 percent in 2021
In urban areas, the increase was more gradual, from 20 to 27 percent
Among poorer households, the rate of increase was faster than in wealthier ones
This means that India’s poorest are now not only underfed but are also becoming overweight due to poor-quality diets and limited access to health education.
India is currently experiencing a “nutrition transition.” Traditional diets that included coarse grains, seasonal vegetables, and homemade meals are being replaced by packaged snacks, sugary drinks, and fast food. These items are cheap, accessible, and aggressively marketed, especially to young people. The shift is faster in urban and semi-urban areas, but rural India is not far behind.
This trend has led to a sharp rise in energy-dense, nutrient-poor diets. People are consuming enough or even too many calories but not enough essential vitamins, minerals, and proteins. This is a classic recipe for both obesity and hidden hunger, also known as micronutrient deficiency.
India’s flagship food distribution programs such as the Public Distribution System (PDS) primarily focus on calories. They supply rice, wheat, and sometimes sugar or oil—but not enough nutrient-rich foods like pulses, vegetables, or fortified items. School meals and Anganwadi services under the Integrated Child Development Services (ICDS) are meant to improve child nutrition, but quality varies and often lacks dietary diversity.
While these programs have played a key role in addressing hunger, they are not designed to tackle the growing burden of overnutrition or non-communicable diseases. Most interventions are still focused on undernutrition alone.
Malnutrition in India is deeply gendered. Girls and women often eat last in the family and may get smaller portions, especially in food-insecure households. Cultural norms and lack of decision-making power further limit their access to nutritious food and healthcare.
Early marriage, frequent pregnancies, and limited prenatal care weaken women’s health. An undernourished mother is more likely to give birth to a low-birth-weight child, continuing the cycle of malnutrition into the next generation. Thus, women’s health is not just an individual concern—it is central to breaking the intergenerational cycle of malnutrition.
With increasing urbanization and rising incomes, food habits have changed rapidly, but awareness about balanced nutrition and healthy lifestyles has not kept pace. Families may choose deep-fried snacks or sugary drinks out of convenience, habit, or the belief that they are more ‘modern’ or ‘tasty.’
Physical activity has also declined, particularly in urban areas. Children spend more time indoors with screens than playing outside. Adults, especially those with desk jobs, may get little to no exercise. These lifestyle factors are driving a rise in overweight and obesity, even as nutritional deficiencies persist.
Stunted Growth and Poor Learning in Children
Undernourished children, especially in the first thousand days of life, suffer from stunted growth, weaker immune systems, and impaired brain development. This affects their performance in school, limits their job prospects, and reduces earning potential as adults. The effects are long-term and often irreversible.
Rising Rates of Obesity and Lifestyle Diseases
Overnutrition, on the other hand, leads to excess body weight and increases the risk of diseases like type 2 diabetes, hypertension, and heart conditions. These are no longer diseases of the rich. They are now widespread even among low-income and middle-income groups. India is already the diabetes capital of the world, and rates of childhood obesity are climbing steadily.
A Vicious Intergenerational Cycle
Perhaps the most damaging consequence of the double burden is how it feeds itself across generations. Undernourished girls often become undernourished mothers. Their children are born with low birth weight and weak immunity. At the same time, those same children may be exposed to junk food early and gain excess weight later. The result is a population that is simultaneously undernourished and overweight—suffering the worst of both worlds.
India has implemented several national-level schemes to fight malnutrition. Some of the most important include:
These programs have shown some success in reducing hunger and improving school enrollment. However, they are often fragmented, underfunded, and poorly monitored. Importantly, most do not address overnutrition or the health risks associated with obesity and poor dietary habits.
Public food schemes must expand their offerings. Instead of only supplying rice and wheat, the PDS should include pulses, fortified foods, vegetables, and millets. This would ensure that beneficiaries get more than just calories—they get complete, balanced nutrition. School meals and Anganwadi food should also follow similar standards.
Awareness campaigns about the importance of balanced diets, reading food labels, and limiting sugar and salt are crucial. Nutrition education should be part of school curricula. Marketing of unhealthy foods to children needs strict regulation. Celebrity endorsements of junk food also need scrutiny.
Frontline workers like ASHAs, Anganwadi staff, and women’s self-help groups should be equipped with the tools to spread awareness about maternal nutrition, breastfeeding, complementary feeding, and healthy cooking practices. Empowered women can transform household eating habits and ensure that the next generation grows up healthier.
Since nutritional challenges vary between states and even districts, data-driven, locally tailored interventions are vital. Real-time dashboards at the village or block level can help policymakers identify problem areas and target resources more efficiently. Technology and digital tools should be used to track progress and identify gaps.
The double burden of malnutrition is one of the most urgent public health challenges facing India today. It is not just about food—it is about inequality, healthcare, education, and awareness. It is a social issue, an economic issue, and above all, a moral issue.
Solving this crisis requires a new approach. One that recognizes that undernutrition and overnutrition are not separate problems but two sides of the same coin. One that ensures food security does not come at the cost of food quality. One that empowers communities while holding systems accountable. And one that puts people—especially women and children—at the center of all policies.
If India can meet this challenge with clarity, compassion, and commitment, it will not only improve health outcomes but also secure a brighter, stronger future for all its citizens.