The Dual Disease Burden in India
India has long grappled with the spectre of hunger. However, the recent NFHS-6 by the Ministry of Health and Family Welfare (MoHFW) in collaboration with the International Institute for Population Sciences (IIPS) across 6.79 lakh households and 715 districts in 2023-24, brings an uncomfortable news for the nation asit is now battling two wars of nutrition. Chronic undernutrition and rapid rising levels of obesity in the same communities, and sometimes families, is what public health experts are now describing as India's “double burden of malnutrition”.
The Numbers That Tell Two Stories
One end of the spectrum is that child undernutrition is entrenched and stubborn. The stunting among children under five decreased from 35.5% to 29.3% in NFHS-6 compared to NFHS-5, and the rate of severe wasting decreased from 7.7% to 5.2%, while underweight children saw a slight decrease from 32.1% to 31.8%. The Government's own Poshan Tracker data also backs this grim picture when it comes to children under the age of five who were measured for growth parameters in Anganwadis; 17% were found to be underweight, 5.2% wasted and 38.9% stunted, proving that the NFHS-level improvements have not yet reached ground reality for the most vulnerable.
At the other extreme, the proportion of adults with obesity has rapidly increased. The proportion of overweight or obese women rose from 24% in NFHS-5 to 30.7% in NFHS-6 and among men from 22.9% to 27.3%. At the same time, the percentage of men with less than normal BMI has got worse, from 16.2% to 19.7%, while the percentage of women with less than normal BMI improved slightly from 19.7% to 15%.This simultaneous divergence of men getting heavier and thinner at the level of a population reflects the paradox India is facing today.
The Metabolic Epidemic
Obesity is not arriving alone. About one in five adult Indian men is now metabolically compromised as NFHS-6 found that 20.9% of them had high blood sugar or were on blood sugar treatment, compared to 17.8% of women. The nation is facing a significant epidemiological transition with blood pressure trends adding to the alarm - 19.4% of women and 22.1% of men aged 15 years and older have elevated blood pressure. The macro dimension was highlighted in the Economic Survey 2023-24 that Indiahas seen a threefold increase in non-communicable diseases (NCDs) since 1995, over 100 million people may now be diabetic, and 56.4% of the total disease burden can be traced back to unhealthy diets.
A Geographic Fault Line
The double burden is not evenly distributed across the varied geographical landscape of India, with aclear north-south divide. Stunting and undernutrition are still a problem in the northern and central states, while diabetes and obesity are now a growing issue in the southern states. With in states, the rise is stark, with the prevalence of diabetes in women rising from 14% to 22.3% in Karnataka and obesity increasing from 30.2% to 41.2% in the state. Mean while, Kerala has the highest prevalence of diabetes in India, with 31.9% of men and 28.9% of women diagnosed with high blood sugar or taking diabetes medication, and almost half(46.7%) of Kerala's women are also overweight or obese. Even this urban-rich association is waning obesity and diabetes is not just a problem in metropolitan cities; smaller towns and rural India are seeing the same trend and lifestyle diseases are becoming a national phenomenon.
The Root Causes of a Paradox.
How can a country with millions of children who go to sleep stunted have the second largest population of diabetics in the world? This is due to India's fast but uneven development and the answers lie there. The middle class and the poor are now able to access both ultra-processed, poor-quality, high-calorie foods and the lack of physical activity that accompanies them in urban environments. Now, in urban settings, ultra-processed, nutrient-poor, high-calorie foods are available to both middle-class and poor consumers, and physical activity is lacking. The results of the linear regression analyses with the NFHS data indicated a positive relationship between literacy and obesity, and children who consumed minimum dietary diversity were more likely to be overweight, indicating that dietary transitions out of poverty may be more likely to be toward excess than balanced. Meanwhile, the low-income families are stuck between two extremes - not enough micronutrients and too much refined carbohydrates result in bodies that are both underfed and overfed.
The anaemia crisis isa third dimension. In India, NFHS-5 data (which was not part of NFHS-6) revealed that 57% of women and 67.1% of children were anaemic, a condition which could also coexist with obesity among those with high intakes ofcalories, but low intakes of iron and micronutrients.
Policy Caught in the Middle
The structural framework of India's nutrition policy continues to be skewed towards undernutrition. The focus of current programmes is mainly on undernutrition, and they do not consider the growing incidence of overweight and obesity and the associated economic implications, which is likely to increase rapidly. The government's flagship schemes POSHAN 2.0 and Mission POSHAN Abhiyaan have made tangible progress in the areas of institutional delivery, immunisation and antenatal care. However, current high obesity rates and continued undernutrition necessitate focused, integrated, and balanced interventions and policy changes,including the integration of food regulation, urban planning and primary healthcare.
Experts have recommended a tax on high-fat, high-salt and high-sugar (HFSS) foods, front-of-pack labelling and making primary health centres and schools more effective at promoting nutrition literacy. The NFHS-6 data is clear: there are not more supplemental asks or extra urgent asks.
At DevInsights, our nutrition evaluation work across states including Uttar Pradesh, Rajasthan, and Madhya Pradesh continues to inform how India's malnutrition challenge is understood and measured.
NFHS-6 is a reflection on acountry in nutritional transition. Data shows a double burden of malnutrition in the same communities, and often in the same families, with undernutrition and obesity. A stunted child in Bihar and an obese, hypertensive adult in Bengaluru aren't two separate issues, they are two sides of the same broken food environment, broken public health system, and ineffective policy response. Combating India's double burden requires an integrated nutrition policy that nourishes the hungry and mitigates the over-nourished at the same time.
References
1. Chaudhuri,S., Kumar, Y., Nirupama, A. Y., & Agiwal, V. (2023). Examining theprevalence and patterns of malnutrition among children aged 0–3 in India:Comparative insights from NFHS-1 to NFHS-5. Clinical Epidemiology and GlobalHealth, 24, 101450. https://doi.org/10.1016/j.cegh.2023.101450
2. Dhoop,P., & Dhoop, V. (2024, January). Another hole in India's data tapestry. DeccanHerald. https://www.deccanherald.com/opinion/another-hole-in-india-s-data-tapestry-1236439.html
3. Edunovations.(2026, June). NFHS-6 report 2024: Key findings on health, nutrition andimmunisation in India explained. Edunovations Current Affairs. https://edunovations.com/currentaffairs/national/nfhs-6-report-2024/
4. Forumon Open Food Facts. (2024). Economic Survey 2023–24 flags obesity as a major threatto India's health. https://forum.openfoodfacts.org/t/economic-survey-2023-24-flags-obesity-as-a-major-threat-to-indias-health/627
5. Ministryof Health and Family Welfare, Government of India, & InternationalInstitute for Population Sciences. (2026). National Family Health Survey-6(NFHS-6), 2023–24: India fact sheet. IIPS. http://rchiips.org/nfhs/
6. Modi,B., Sheth, A., & Panchani, R. (2024). Decoding malnutrition trends inIndia: A comprehensive analysis using National Family Health Survey data forinformed strategies and interventions. NMO Journal, 17(2), 68–71. https://doi.org/10.4103/jnmo.jnmo_8_23
7. OutlookIndia. (2026, May). NFHS-6: Southern states lead India's diabetes and obesityrankings. Outlook India. https://www.outlookindia.com/national/nfhs-6-southern-states-lead-indias-diabetes-and-obesity-rankings
8.PressInformation Bureau, Government of India. (2022). Malnourished children[Press release]. Ministry of Health and Family Welfare. https://www.pib.gov.in/PressReleasePage.aspx?PRID=1806601
9.Preethi,V., Hemalatha, V., Arlappa, N., Thomas, M. B., & Jaleel, A. (2024). Trendsand predictors of severe and moderate anaemia among children aged 6–59 monthsin India: An analysis of three rounds of National Family Health Survey (NFHS)data. BMC Public Health, 24, Article 2875. https://doi.org/10.1186/s12889-024-20328-9
10. ORF(Observer Research Foundation). (2025, January 9). Anaemia in India: A silentpublic health crisis. ORF Expert Speak. https://www.orfonline.org/expert-speak/anaemia-in-india-a-silent-public-health-crisis
11. Siddiqui,M. Z., Donato, K., & Bhagat, R. (2025). Understanding the dynamics ofmalnutrition dichotomy in India: Trends and insights from the National FamilyHealth Surveys. SSM – Population Health, 29, 101938. https://doi.org/10.1016/j.ssmph.2025.101938 (ScienceDirect/ PMC)
12. Singh,J. K., Chiero, V., Kriina, M., Alee, N. T., & Chauhan, K. (2022).Identifying the trend of persistent cluster of stunting, wasting, andunderweight among children under five years in northeastern states of India. ClinicalEpidemiology and Global Health, 18, 101158. https://doi.org/10.1016/j.cegh.2022.101158
13. TheFederal. (2026, May). 'Anaemia mukt' to 'data mukt': How health survey NFHS-6hides the truth. The Federal. https://thefederal.com/category/health/anaemia-mukt-india-health-survy-nfhs-6-fact-sheet-245037
14. ThePrint. (2026, May). NFHS finds India trapped between obesity &undernutrition. The Print. https://theprint.in/health/gaining-weight-losing-health-national-survey-finds-india-trapped-between-obesity-undernutrition/2945717/
15. TheWeek. (2026, June 1). High blood pressure surge in India: NFHS-6 data revealsalarming adult health trend. The Week. https://www.theweek.in/news/health/2026/06/01/high-blood-pressure-surge-in-india-nfhs-6-data-reveals-alarming-adult-health-trend.html
