New Delhi:
As India moves forward with its vision of becoming Viksit Bharat (Developed India), a stark reality is emerging from one of the country’s most vulnerable sections. Children, especially from economically weaker sections, are being hit by a double crisis. They are undernourished in early life and then face obesity even before they reach their teenage years.
A new study from Vellore tracking children from birth to the age of nine years, provides a deeply worrying picture.
It shows that malnutrition in India is no longer just about hunger. It is also about excess weight, poor diet and changing lifestyles — all happening in a single childhood.
The study by the researchers at the Advanced Research Unit of Metabolism, Development & Aging at TIFR and CMC-Vellore has been published in The Lancet Regional Health journal.
The study — led by Dr Beena Koshy of Christian Medical College, Vellore and Dr Birsen Yilmaz of the Tata Institute of Fundamental Research, Mumbai — followed 251 children growing up in an urban slum.
It found that most children started life with normal growth patterns, but things changed rapidly after the age of five. By the age of seven, more than a quarter of the children were thin, but a smaller but worrying proportion had already become overweight.
By the age of nine, the problem intensified. About 21.6 per cent of children were still underweight, but at the same time nearly 14.6 per cent were overweight or obese.
This coexistence of undernutrition and obesity in the same community, and sometimes even in the same child over time, is what experts call the double burden of malnutrition.
“Our findings show that children in low-income urban communities are now facing both thinness and emerging obesity before they even enter their teens,” said Dr Beena Koshy. “Malnutrition in India is no longer just about underweight toddlers, but about the entire childhood years.”
The study identifies a crucial turning point. It is the primary school age. Between seven and nine years, both thinness and obesity begin to rise sharply, suggesting that this is a neglected window in India’s nutrition policies.
“Our findings clearly hint at the importance of child growth beyond the first 1000 days,” said Prof Ullas Kolthur and Mahendra Sonawane of Advanced Research Unit on Metabolism, Development and Ageing (ARUMDA) at TIFR.
“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.”
The roots of this crisis lie deep, even before a child is born. The study shows that children born with low birth weight or to undernourished mothers are far more likely to remain thin throughout childhood.
At the same time, children born with normal weight are more likely to become overweight later, reflecting changing diets, reduced physical activity and easy access to unhealthy foods in rapidly urbanising environments.
Dr Nihal Thomas of CMC Vellore explains these two contrasting but equally dangerous pathways.
“Undernutrition in early life can lead to defects in insulin secretion and even diabetes in lean individuals. Over nutrition, coupled with sedentary lifestyles, can lead to rapid weight gain and increased risk of diabetes, hypertension and cardiovascular disease,” he said.
The Vellore findings gain greater significance when seen alongside the latest National Family Health Survey (NFHS) data released just last week.
The NFHS survey presents a mixed picture.
On one hand, there has been progress — child stunting, a measure of long-term undernutrition, has declined to 29.3 per cent. Severe wasting has also fallen to 5.2 per cent.
Yet the scale of the problem remains daunting. Nearly one in three Indian children is still underweight, with underweight prevalence estimated at around 31.8 per cent.
At the same time, obesity and lifestyle diseases are rising rapidly across the country. The NFHS report flags this as a growing public health concern, signalling that India now faces a dual burden where undernutrition and obesity coexist.
This is exactly what the Vellore study captures at a more granular level. It shows how this transition plays out in real lives and over time, particularly among children from poorer households.
For families in low-income urban settings, this is a double whammy. Limited access to nutritious food leads to undernutrition in early years. Later, cheap calorie dense foods, low physical activity, and changing lifestyles push children toward overweight and obesity.
The consequences are long term and far reaching. Children who are undernourished early in life may face stunting, poor cognitive development and reduced immunity. Those who become obese later are at higher risk of diabetes, heart disease and other chronic illnesses.
What makes the problem even more complex is that both conditions can exist within the same child across different stages of life.
The researchers say this calls for a complete rethink of India’s nutrition strategy. The current focus has largely been on the first 1000 days of life, which is pre-school nutrition. While that remains critical, it is no longer sufficient.
Nutrition interventions must extend into the school years. India does have a school based mid-day meal scheme to address this challenge. Maternal health must be strengthened before and during pregnancy. Schools must become spaces where children receive both nutritious food and opportunities for physical activity.
As India aspires to be a developed nation, the message from this research is clear. The future of the country depends on its children. Ensuring they are well nourished throughout childhood is not just a health priority, it is a national imperative. Without addressing this double burden, the dream of a Viksit Bharat risks being built on a fragile foundation.
