Double-burden of malnutrition in India: A growing threat

Image courtesy: International Diabetes Federation

India is undergoing a rapid socio-economic, demographic, nutritional and health transition. While the country is still grappling with issues of poverty, undernutrition and communicable diseases, it is increasingly facing additional challenges related to obesity and a rise in the prevalence of non-communicable diseases like diabetes and high blood pressure, especially in urban areas.

POSHAN has launched a set of interactive district-wise maps to take stock of how India’s districts stand on the six global nutrition targets adopted by the World Health Assembly in 2012. The global nutrition targets are geared to fight the double-burden of malnutrition effectively. Along with focusing on childhood stunting (low height-for-age), wasting (low weight-for-height), low birth weight, anemia in women of reproductive age, and exclusive breastfeeding in the first six months, these targets also aim to ensure that there is no increase in the rate of children who are overweight.

The recently released 2017 Global Nutrition Report emphasizes the need to address the problems of obesity and diet-related non-communicable diseases (NCDs) alongside efforts to address stunting, wasting, anemia and other micronutrient deficiencies. According to their analysis, half of all countries have not implemented NCD management. It is crucial to have effective priority interventions that include both nutrition-specific and nutrition-sensitive investments, through an inter-sectoral approach for achieving the global nutrition targets.

Along with the maternal, infant and young child nutrition indicators, the maps launched by POSHAN present district-wise disaggregated data on the levels of overweight or obesity and blood sugar among men and women, in 2016. Based on data from the latest round of National Family Health Survey-4, conducted in 2015-16, evidence shows that obesity among adults in India is nearly as big a problem as undernutrition.

POSHAN’s Data Note on ‘How are India’s districts doing on nutrition-related non-communicable diseases?’ reveals that on average, 8 percent of men and 6 percent of women have high blood sugar, with considerable variability across districts. In 154 districts, more than 10 percent of men have high blood sugar, while the same prevalence levels for women are seen in 19 districts. In over 300 districts, between 5 and 10 percent of women and men have high blood sugar. This Data Note also gives district-wise disaggregated data on the prevalence levels of high blood pressure and overweight or obesity.

According to NHFS-4 data, the ten best and worst performing districts in terms of blood sugar levels, for men and women, are as follows:

Lowest incidence of high sugar levels, in 2016

S. No.



District/State Percentage of men with sugar level above 140 mg/dl District/State Percentage of women with sugar level above 140 mg/dl
1 Ramban (Jammu & Kashmir) 0.6 Kargil (Jammu & Kashmir) 1.0
2 Bid (Maharashtra) 0.9 Banda (Uttar Pradesh) 1.3
3 Auraiya (Uttar Pradesh) 1.3 Ashoknagar (Madhya Pradesh) 1.8
4 Cachar (Assam) 1.4 Bhind (Madhya Pradesh) 1.9
5 Dohad (Gujarat) 1.5 Jaisalmer (RJ) 1.9
6 Sirsa (Haryana) 1.6 Latehar (Jharkhand) 2.0
7 Nagaur (Rajasthan) 1.8 Cachar (Assam) 2.0
8 Chamoli (Uttarakhand) 1.8 Etah (Uttar Pradesh) 2.1
9 Leh - Ladakh (Jammu & Kashmir) 1.8 Leh - Ladakh (Jammu & Kashmir) 2.1
10 Lahul and Spiti (Himachal Pradesh) 1.9 Hamirpur (Uttar Pradesh) 2.2


Highest incidence of high sugar levels, in 2016

S. No.



District/State Percentage of men with sugar level above 140 mg/dl District/State Percentage of women with sugar level above 140 mg/dl
1 Kolkata (West Bengal) 22.2 Basti (Uttar Pradesh) 12.5
2 Wayanad (Kerala) 20.5 Krishna (Andhra Pradesh) 12.5
3 North & Middle Andaman

(Andaman & Nicobar)

19.8 North East Delhi (Delhi) 12.2
4 Kozhikode (Kerala) 19.6 Lakshadweep (Lakshadweep) 12.0
5 Churachandpur (Manipur) 19.1 Wayanad (Kerala) 11.9
6 Guntur (Andhra Pradesh) 19.0 Mumbai (Maharashtra) 11.8
7 Y.S.R./Cuddapah (Andhra Pradesh) 18.2 Kottayam (Kerala) 11.8
8 Aurangabad (Bihar) 17.6 Mokokchung (Nagaland) 11.7
9 Ernakulam (Kerala) 17.0 Cuttack (Odisha) 11.5
10 South Andaman (Andaman & Nicobar) 16.4 Bhadrak (Odisha) 11.5


On World Diabetes Day 2017, as countries around the globe look at the theme of ‘women and diabetes’ in a bid to promote the importance of affordable and equitable access for all women at risk of or living with diabetes to the essential diabetes medicines and technologies, POSHAN re-affirms the need to revisit the existing nutrition action plans to simultaneously address undernutrition and these emerging non-communicable diseases related to nutrition. India is fortunate to have these indicators included in the national health surveys, at a disaggregated enough level to initiate local actions to understand and address this major health challenge.

Written by Pratima Mathews, IFPRI.