This is a post I’ve been meaning to write for a while, and a recent article “Counting Our Chickens” in Indian Express prompted me to finally get down to it.
A couple of years ago, when researching food consumption trends in India, I had come across national level data on reduction in consumption of cereals in rural India and an increase in demand for fruits and vegetables. The reduction cut across all income bands, though it was more pronounced in the higher income groups.
I had mistakenly assumed that this reduction in cereals was clearly a good thing – a shift in diet towards more nutritious foods, and that it also reflected increase in incomes that is enabling people to buy more nutritious food. However, when I read up more literature on the subject and talked to more experts, I realized that things were not as straightforward as it seems. I had applied the logic of the overnourished to the situation of those who are undernourished.
There are a minimum amount of calories that any human body needs. While the recommended amount is set at 2400 calories per day, 2100 calories are considered minimum and 1800 calories are believed to be the absolute minimum required for human bodies to function properly.
Per national data, the average per capita consumption of calories in rural India stands at 2050, with 40% of the population at levels below 1800 calories per day and 75% below 2100 in rural areas. So this went against my original assumption that a shift towards more nutritious foods meant that basic needs (in terms of calories at least) had been met.
What was worse is that there has actually been a DECLINE in calories consumption over the past 25 years. Average total calorie consumption in rural India was about 10% lower in 2004-05 than in 1983. This, to me, was shocking. How can a country with increasing GDP, increasing per capita income, and increasing per capita expenditure (in real terms) be eating less and less.
Apparently the calorie decline has been confirmed by multiple surveys and the experts believe that it does reflect reality. Another way to look at this is to note that while people are spending more per capita (in real terms), they are not increasing their spending on food, despite increase in food prices (in real terms).
The decline is also evident in reduced intake of proteins and other nutrients (besides total calories) with the exception of fat, which has increased steadily.
The above data is from a seminal paper on the topic by Angus Deaton and Jean Dreze in 2009. The authors pointed out that
“It would be difficult to attribute the decline in calorie consumption to declining per capita incomes, or to changes in relative prices. Indeed, the evidence points to rising per capita incomes (especially – but not exclusively – among the better-off), with little change in the price of food – or calories – relative to other commodities.
Thus, the main point is that per capita calorie consumption is lower today at a given level of per capita household expenditure, and this applies across the expenditure scale, at low levels of per capita expenditure as well as high.”
While it is possible to argue that due to lower activity levels, the population requires fewer calories per capita, it is difficult to be sure since there is an absence of activity level data to support this hypothesis.
And, while calories are obviously not the only food intake indicator we should consider in the context of nutrition, it is an important contributor to overall nutritional intake especially for populations that are under-nourished.
Therefore it is no surprise that undernourishment is an alarming problem in India, with close to 50% of children and ~40% of women nationally being reported as being undernourished in terms of standard height for age and BMI measures. The prevalence of undernourishment in India is among the highest in the world, higher than sub-Saharan Africa.
At a nutrition related workshop I attended recently, a nutritionist displayed a body scan of a woman who is underweight and undernourished, yet with 30% body fat. Think about that for a moment. Most of us who worry about fat, are over-nourished, with too much intake of calories and fat. It is difficult to imagine a person who is simultaneously underweight and has too much fat. The nutritionist pointed out that this happens due to a cereal heavy diet and that this person was not an exceptional case.
So we have a bizarre situation: on the average, the majority of Indians are not eating enough calories, and whatever calories they are eating are the wrong kind (in the sense that they are almost exclusively cereals).
It also turns out that the prevalence of malnutrition in India is more enduring than elsewhere: there has been lower than expected decline in malnutrition India despite economic growth, compared to other countries which have undergone similar periods of economic growth.
So while we can “celebrate” the increased presence of more nutritious foods such as fruits, vegetables, milk and eggs in the Indian thali in recent years, we cannot ignore the equally important question of quantity of calories (and proteins) being consumed.
To confound it all, there are surveys which show that people’s own stated degree of “hunger” as measured in terms of number of meals skipped has gone down — it seems dramatically.
To conclude, perhaps as an oversimplification we can say that while the content of the modern Indian thali may be more varied than two decades ago, perhaps it is still very far from ideal and perhaps lighter in weight?