Diets, Nutrition, and Poverty - The Oxford Topic of Food, Politics, and Society - page 341

adults within the same household differently. Children may use up the excess energy and
still remain underweight whereas adults are more likely to gain weight. Intrahousehold
food-allocation biases between adults and children, on the one hand, and, between
males and females, on the other, compound these effects.
Over half the disease burden (55% including injuries) in India is now attributable
to NCDs, a larger share than communicable diseases and maternal- and child-health
(MCH) issues. Ischemic heart disease is the leading cause of both deaths and forgone
disability adjusted life years (DALYs) in working age adults (15-69 years).38 But commu-
nicable diseases (e.g., tuberculosis, respiratory infections, and water- and vector-borne
disease) are still prominent in the total population, reflecting a “double disease burden.”
Although India lags behind other developing countries in the epidemiological tran-
sition—decline in infectious disease mortality compensated for increasingly by higher
mortality from chronic degenerative NCDs—there is some evidence of this transition
taking place. The estimated deaths from NCDs are projected to rise from 3.78 million in
1990 (40.46% of all deaths) to 7.63 million in 2020 (66.70% of all deaths).39
NCDs constitute a major economic burden in India, entailing high levels of out-of-
pocket spending by households with members suffering from NCDs, the limited levels
of insurance coverage (including subsidised public services), and the income losses that
befall affected households. Associated with these costs are risks of catastrophic spend-
ing and impoverishment, and, of course, macro impacts in terms of lower GDP (Mahal,
Karan, and Engelan 2009).
Analysis of the prevalence of NCDs can throw new light on the underlying causes,
including socioeconomic, demographic, and locational characteristics of households.
Of particular importance are the links among aging, obesity, growing affluence, expan-
sion of the middle class, urbanization, and NCDs.40 We present here a summary of the
findings on the prevalence of overweight and obesity among the adults (older than
22 years), based on body mass index (BMI).41
About 9.5% of the adult males were overweight and about 2.5% were obese. The cor-
responding rates among adult females—12.65% and 3.18%, respectively—were higher.
Although overweight and obesity are largely a core urban phenomenon—about 22%
of the urban adults were overweight and about 7% were obese—these disorders are
observed in urban slums and rural areas too. Specifically, the proportion of overweight
in urban slums (about 15%) was lower but not markedly so. In the rural areas, however,
the proportion of overweight (above 9%) was a little less than half that in the urban
areas, and that of obese (about 2%) was just over one-fourth of the figure in urban areas.
Overweight and obesity are not confined to relatively affluent households. Although
lower among the poor, their proportions are non-negligible. Our analysis shows that,
among the nonpoor, the proportions of overweight and obese were about 14% and
just under 4%, respectively. Among the poor, the shares were 7% and about 1.25%,
respectively.
Disaggregation of the overweight and the obese by caste and tribe further suggests
that even socially and economically deprived sections are not immune to such disor-
ders. Among the Scheduled Castes, the proportions of overweight and obese were about