Diabetes, obesity and malnutrition: NFHS 6 data flags India's growing health crisis

India is facing a growing nutritional paradox. New data from the National Family Health Survey (NFHS-6, 2023-24) show that while obesity and diabetes are rising rapidly nationwide, undernutrition remains a serious concern, particularly in rural India.

In certain states and union territories, the findings show a double burden as underweight and overweight populations coexist, often within the same communities.

Obesity and undernutrition

According to the survey, 30.7 percent of women and 27.3 percent of men between the ages of 15-49 are now overweight or obese. This is a sharp rise from 24 percent among women and 22.9 percent among men, according to NFHS 5 (2019 to 21).

The rise is especially high in urban areas. Nearly 43 percent of urban women are overweight or obese, compared with 25,5 percent in rural areas.

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Among men, the urban-rural divide is equally stark: 36.3 percent in urban India and 23 percent in rural areas.

At the same time, despite efforts, undernutrition has not disappeared. Almost one in five adults in the above age group remains underweight. The numbers have in fact grown. While there is a sharp increase among men from 16.2 percent to 19.7 percent , women also showed a slight rise of one percent from 18.7 percent to 19.7 percent compared to NFHS -5.

Diabetes warning bells

The survey has also highlighted the worrying rise in blood sugar and diabetes.

Among women aged 15 years and above, 17.8 percent had blood sugar levels above 140 mg/dl or were taking medicines. The rise is from 13.5 percent in NFHS 5. In this group, 9.1 percent had very high blood sugar levels exceeding 160 mg/dL, while 7 percent had levels above 140 mg/dL.

In men, 20.9 percent had elevated blood sugar and were taking medicine, meaning one out of every five adult men is taking diabetes medication. The number has sharply risen from NFHS-5, which was 15.6 percent. The data also show 10.9 percent, or one in every 10 adult men, had very high blood sugar levels of 160 mg/dl.

Urban populations are more affected than their rural counterparts. 21.9 percent of urban women and 23.9 percent of urban men are on diabetes medicine. The numbers are not very low for the rural population as well, with almost 20 percent of men in rural areas and 16 percent of women in urban areas taking treatment for diabetes.

Hypertension remains a major threat

The survey also offers a mixed picture on blood pressure. Among women, the prevalence of elevated blood pressure prevalence and use of medication for hypertension fell slightly from 21.3 percent to 19.4 percent; the same happened for men, as there was a decline from 24 percent to 22.1 percent.

However, the fact remains that one in five adult Indians continues to live with high blood pressure, which is a major risk for heart disease, stroke, and kidney disease.

States and union territories: A report card

Delhi: Adults on diabetes medicines have shown a sharp rise, from 12 to 19 percent among women and 14 to 22 percent among men, with even a decrease in obesity from 38 percent to 34 percent. However, there is an increase in malnutrition from 10 to 12 percent in women and 9 to 14.9 percent among men.

Maharashtra: Obesity increased from 23 to 31 percent among women and 24.7 to 32 percent among men. There is also an increase among adults taking diabetes medicine.

West Bengal: Sharp increase in obesity among women from 22.7 to 34.6 percent, and among men from 16 percent to 24 percent. The rise is the same for diabetes as well: from 17.5 percent to 22.7 percent on treatment among women; for men, it has increased to 26.8 percent from 21.3 percent.

Uttar Pradesh: Increase in malnutrition — 19 to 22 percent in women, while 18 to 23 percent among men. Obesity is also increasing from 21 to 26 percent among women and 18 to 21.8 percent among men. Among women, those on diabetes treatment have increased from 10 to 15 percent, and from 11.6 to 19.5 percent among men.

Bihar: Increase in underweight among men from 21 to 24.5 percent. Increase in obesity among both men and women.

Punjab: Major increase among diabetics from 14.7 percent; among women on treatment in NFHS 5, the number is 21 percent now. Similarly, for men, it increased from 14.7 to 22.3 percent.

Kerala: Increase in malnutrition among men-10 to 15 percent. Obesity increased in women from 38 to 46 percent.

Karnataka: Increase in obesity from 30 to 41 percent among women and 30 to 36 percent among men.

Gujarat: Sharp increase in obesity-22 to 32 percent among women and 20 to 29 percent among men.

Tamil Nadu: Increase in obesity among women and also increase in people with diabetes — 20 to 25 percent among women, 22 to 26 percent among men.

Jharkhand, Himachal Pradesh, Chhattisgarh, Rajasthan, Chandigarh, Assam and Madhya Pradesh also showed a sharp increase in malnutrition levels.

What do the experts say

Experts say the data suggests India has not solved its traditional nutrition problems even as new lifestyle-related health challenges emerge.

Dr Anoop Misra, eminent physician and Chairman of Fortis C-DOC Hospital for Diabetes and Allied Sciences, Delhi, calls it a 'double-edged health crisis'.

“The latest NFHS-6 data shows that India is facing a double-edged health crisis. On one hand, nearly 1 in 5 adults in rural areas is still underweight and facing undernutrition. On the other hand, obesity and high blood sugar are rising rapidly, especially in our cities, where more than 40 percent of women are now overweight,” Dr Misra says.

“We are dealing with too little nutrition and too much of the wrong kind of food at the exact same time. This is a major wake-up call. We cannot just focus on feeding people more calories; we must focus on providing healthy, balanced food to everyone,’’ he added.

Says Dr K Srinath Reddy, Founder President of the Public Health Foundation of India and former head of Department of Cardiology at AIIMS, “Rise in obesity levels is a matter of concern because of the increased risk it poses for diabetes and cardiovascular disease, which are rising due to demographic and nutritional shifts at the population level. It must also be recognised that even at ‘non-obese’ levels of body mass index (BMI), the risk of cardiovascular and metabolic diseases increases with high abdominal fat deposition. A waist-to-height ratio of more than 0.5 spells danger for diabetes, cardiovascular and renal disorders."

He adds, “While controlled hypertension levels appear to be steady, high blood pressure increases the cardiovascular and renal disease risk associated with diabetes at even lower levels than140/90. We need to ensure that persons with diabetes maintain blood pressure levels which stay below 130/85 mm Hg.’’

Dr Aijaz Ilmi, Senior Consultant – Preventive Wellness & Metabolic Health

Pacific One Health Media, says, "The latest NFHS-6 data highlights a concerning shift in metabolic health in India. While obesity, diabetes, and hypertension continue to rise, the true burden may actually be underestimated. Globally, and particularly in Europe and the United States, blood pressure thresholds for defining hypertension have progressively moved lower because cardiovascular risk begins much earlier than previously believed. As diagnostic cut-offs evolve, a larger proportion of the population is recognised as being at risk, meaning the actual burden of blood pressure-related disease is substantially higher than traditional estimates suggest.”

International guidelines, such as those from the World Health Organization and the American Diabetes Association, generally use fasting blood sugar levels of 126 mg/dL or HbA1c of 6.5 percent.

Experts believe diabetes cannot be measured by a single metric. Similarly, many experts believe a BMI of 23 is considered obese for the Indian population.

Why data is important

Dr Ilmi explains, "These conditions are not isolated diseases but manifestations of a broader metabolic crisis driven by obesity, insulin resistance, poor sleep, stress, ultra-processed foods and sedentary lifestyles. “The focus must shift from disease treatment to early metabolic screening, prevention and lifestyle intervention if we are to reverse this trend."

At the same time, persistent levels of malnutrition show that food security, poor diet quality and health inequalities remain unresolved.

The challenge for policymakers is to ensure people get nutritious food, while preventing diabetes, obesity and hypertension.