Overweight, obesity & NCDs group presentation - IFPRI-NITI workshop on "A Common Vision for Tackling Malnutrition in India: Building on Data, Evidence and Expert Opinion" - 29-30 March 2019

1. Common vision for NCDs
Srinath Reddy, Shweta Khandelwal, Purnima Menon, Shuchita Gupta,
Supreet, Manita, Anjali

2. NCDs
A Global Threat To Health And Sustainable Development
• 40.5 Million Deaths In 2016
• 71% Of Global Deaths
• 78% Of NCD Deaths In LMICs
• High Proportion Of LMIC Deaths In Middle Age
• Global Economic Cost Of NCDs & Mental Illness
= 47 Trillion Dollars (2011-2030)
• NCDs Cause Poverty, Lost Productivity, High Healthcare Costs
• Between 2010 & 2025, deaths from 4 main NCDs will rise from 28.3 million to 38.8 million; of the
10.5 Million Additional Deaths, 9.5 Million will be in LMICs.
Kontis et al, Lancet; 2014

3. ‘Obesity’ Trends in India 2005-6 to 2015-16
data analysed
from the NFHS
http://rchiips.org/
NFHS/about.shtml
‘Obesity’
includes
overweight
(BMI 25)>
Prevalence in Adults %

4. Steep Rise In Prevalence On ‘Obesity’
1998-99- 2005-2006-2015-17- Women
data analysed from the NFHS
http://rchiips.org/NFHS/about.shtml
NFHS-2 : 1998-1999
NFHS-3 : 2005-6
NFHS–4- 2015-16
20.7%
NFHS- 4
10.6%
NFHS-2
12.6%
NFHS-3
‘Obesity’ includes overweight
4

5. Adults With With Diabetes, 2017 And 2045
Source: IDF Diabetes Atlas 2017
 2000 = 151 million
2017 = 425 million
2045 = 629 million
 US$54 billion more spent
on treatment globally than in 2015
 Diabetics 2-3x more likely
to develop CVD

6. A Systems Perspective Can Help Guide Effective
Policies For Agriculture, Food And Nutrition
6
Food
supply
Food
marketing
Food
transformation
and retail
Food
demandFood
choices

7. Drivers for food choices
• Conscious
• Health literacy
• Access to information (right/wrong)
• Conditions
• Cultural
• Market
• Peers
• Constraints
• Availability
• Affordability
• Time

8. Determinants (nutrition lens)
• Food environment
• Overweight obesity- unhealthy foods (HFSS), reduced physical activity, breastfeeding
• Unhealthy diets
• Salt- hypertension
• Developmental origins of NCDs (Thin fat diabetes, catch up growth, visceral obesity)
• Cancers due to pesticides, carcinogens
• Microbiome alteration
• Non alcoholic fatty liver disease (mainly due to poor nutrition) – diabetes
• Alcohol and tobacco
• Pollution
• Mental health

9. Areas identified for action
I. Food systems/environment (private sector and public food
programs)
II. Active and healthy lifestyle and improved physical activity
III. Early prevention by addressing the developmental origins of adult
disease during pregnancy
• Maternal nutrition
• Low birth weight
• Cognitive function
• Breastfeeding
• Stunting
• Catch up growth (adiposity rebound)

10. I. Food environment /systems
• Implement economic measures to reduce the consumption of unhealthy foods
through taxes, and to increase the consumption of healthy foods through
subsidies. (Taxation/Finance, Niti)
• Existing public financed programs can be improved – eg reformulation of diets in
MDM, ICDS and diversify foods available under PDS; prison, railways etc
• Encouraging the marketing and promotion of high quality diets whilst restricting
advertising and promotion of unhealthy foods. (MoHFW, FSSAI, WCD)
• Reformulating, labelling and processing foods in ways that increase their
nutritional value and safety. (FSSAI)
• Influencing food supply chains to pay more attention to nutritious crops such as
fruits and vegetables, pulses, seeds and nuts. (MoFPI, MofAg)
• Focus: climate smart ag
• Promote access/affordability to high-quality foods everywhere like hospitals,
airports, schools and workplaces. (HRD, WCD)
• Collecting better data on the quality of food environments (NSSO, NFHS, others)
http://glopan.org/sites/default/files/Downloads/FoodEnvironmentsBrief.pdf

11. II. Active lifestyle
• Better urban design
• Improved workplaces supporting active lifestyle and better food
• Social advocacy – aspirational models, peer pressure
• Creating demand for healthier options via Nutrition literacy and
health promotion at all levels (including at schools)
• Swachh Bharat and other platforms can be leveraged for better
messaging around appropriate nutrition

12. III. DoHAD
• Focus should be on life-course approach
• Maternal nutrition should be improved (THR, screening, guidelines for
FWW, action strategy to be drawn up)
• Low birth weight prevention
• Breastfeeding promotion
• Stunting
• Catch up growth (adiposity rebound

13. Summing Up – What Needs To Be Done?
• Sustainable, resilient food systems for healthy diets.
• Aligned health systems providing universal coverage of
essential nutrition actions.
• Social protection and nutrition education.
• Trade and investment for improved nutrition.
• Safe and supportive environments for nutrition at all
ages.
• Strengthened governance and accountability for
nutrition.
• Prioritising research at all levels for robust action
Enabling environment critical to support nutrition
policy regulation vs choice...empower the consumer
but strengthen public policy with double duty lens for
fighting against obesity, NCDs