Dual burden of malnutrition in India's wealthy households
Dr Maitra’s research, funded by an India Development Fund award from the Office of Global Engagement at the University of Sydney, investigated the ‘triple burden of malnutrition,’ - the simultaneous existence of overnutrition, undernutrition and micronutrient deficiency in the same community or household, or even in the same individual.
“Obesity and the multiple burden of malnutrition is a relatively new phenomenon in India and hence relatively under-researched. This project was one of the first formal attempts to investigate this question,” Dr Maitra said.
A key feature of the project was a workshop in Mumbai, organised with India’s International Institute for Population Sciences, which brought together academics, NGOs and representatives from the Ministry of Health and Family Welfare.
“We were able to provide robust evidence that problems caused by multiple burdens of malnutrition already exist in India, an area of particular concern is rising obesity in rural residents,” Dr Maitra said.
We also discovered to our surprise that obesity is more of a rich person’s problem, being more prevalent in middle- to upper-income households.
"In developed countries, we find the opposite to be true, with increasing levels of obesity in people from low income households. India has not reached the tipping point where the pattern reverses."
The workshop report found, in 2015-16, only six percent of women and five percent of men in the lowest wealth quintile were obese, whereas 36 percent of women or 33 percent of men in the highest wealth quintile were obese.
The problem of malnutrition in India is very complex. In one household, there can be both stunted children from undernutrition with mothers who are overweight from overnutrition.
Research by Professor JV Meenakshi from the University of Delhi, one of the keynote speakers at the project workshop, found that in 2015 - 2016 one-third of urban Indian households with a stunted child had an overweight mother. This analysis was performed, using a lower body mass index cut-off for obesity to account for Asian populations.
The findings from the workshop have been submitted to India’s Ministry of Health, Family and Welfare.
Dr Maitra said: “It has opened up new lines of thought and posed new research questions, such as why we see obesity in richer households in emerging economies such as India, but in poorer households in developed countries such as Australia.”
"More research is required on the potential causes of multiple burden of malnutrition, particularly in relatively affluent households. It is not caused by lack of access to food, rather inequality within a household in allocation of food might matter more."
Impact of COVID-19 on malnutrition in India
Dr Maitra, an Academic Fellow in the School of Economics, has previously worked as a consultant to the United Nations and UNICEF. She is concerned about the impact of COVID-19 on India’s malnutrition problem.
“The loss of livelihoods driven by lockdown and reverse migration from city to rural areas, coupled with the loss of earnings, results in loss of access to food. More specifically, loss of access to healthy food,” she said.
“The problem of micronutrient deficiencies is also exacerbated. Anaemia in women and wasting in children, which are indicators of undernutrition, were bad already. They are likely to get worse with COVID-19.
“With supply chains affected by lockdown, the availability of fresh food is also affected, causing greater reliance on processed food, add on the physical inactivity and stress caused by the lockdown, and the risk factors for obesity increase.”
Dr Maitra plans to continue her work by looking to design nutrition-sensitive value chain interventions to tackle the problem of triple-burden malnutrition in different countries, and by gathering evidence about the intergenerational consequences of malnutrition.
“There’s a need for research in developing economies such as India and in developed OECD countries. Different aspects of malnutrition predominate in different settings,” Dr Maitra said.
"Potential risk factors for dual burden of stunted child and overweight mother in the same household, for example, could be shorter maternal stature, older maternal age, mothers’ mental health, sedentary lifestyles and inequality in allocation of food. Macro factors, such as disease environment, diet transition, cultural factors related to food habits and women’s status in the society in general, are also relevant."
This project is sponsored by the Office of Global Engagement at the University of Sydney.