Indian slum children face both thinness & obesity: Study highlights double burden of malnutrition

Mumbai: Children growing up in India’s urban slums are no longer battling just undernutrition. By the time they reach primary school, many are becoming overweight or obese, creating a dangerous “double burden of malnutrition” that could fuel future epidemics of diabetes and heart disease.

That is the key finding of a new study published last week in The Lancet Regional Health. Researchers from Christian Medical College (CMC), Vellore, tracked 250 children born in an urban slum between 2010 and 2012 until they turned 9 years old and found that while many began life undernourished, a growing number developed obesity during their early school years.

“Our findings show that children in low-income urban communities are now facing both thinness and emerging obesity before they even enter their teens, which means malnutrition in India is no longer just about underweight toddlers, but about the entire childhood years,” said lead researcher Dr Beena Koshy.

The study, conducted jointly by CMC and the Advanced Research Unit on Metabolic Disorders (ARUMDA) at Tata Institute of Fundamental Research (TIFR), found that although most children maintained a normal body mass index (BMI) during their first 5 years, problems emerged in mid-childhood, leading to obesity in some children.

Public health experts describe this as the “double burden of malnutrition” — the coexistence of undernutrition and overnutrition within the same population, household or even individual. It has serious implications for their future risk of diabetes, heart disease and other chronic conditions.

Co-authors Prof Ullas Kolthur and Mahendra Sonawane from ARUMDA-TIFR said the findings highlight the need to extend nutrition interventions beyond infancy. “Our findings clearly hint at the importance of child growth beyond the first 1,000 days. Extending nutrition, growth monitoring and healthy food and activity initiatives into the primary school years is essential, because this is when children’s metabolic profiles are being shaped for life,” they said.

The researchers suggested that changing diets and sedentary lifestyles in rapidly urbanising environments are altering growth trajectories within a single decade of life.

Brinelle D’Souza from the Centre for Health and Mental Health at Tata Institute of Social Sciences, Deonar, said urban poverty is increasingly accompanied by unhealthy food choices. “Urban malnutrition is rampant, but it is no longer just undernutrition but even overnutrition that we need to worry about,” she said.

She pointed out that working parents often have no time to prepare traditional meals, while inexpensive packaged foods are widely available. “Moreover, they have enough disposable cash in slums in Mumbai to let the child buy a fast food packet for Rs 5. It’s a combination of urban poverty, advertising and aspirations for people in slums to be eating packaged foods.”

She added that local govts should undertake awareness campaigns in urban slums to educate families about the link between packaged foods and non-communicable diseases later in life.