India's burden of malnutrition and obesity: where diet makes or breaks

For the past eight years or so Sobha, who is in her 50s and works as a domestic help, has been diabetic.

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Apart from religiously taking her metformin tablets, she did not think too much about her condition. Recently, however, constant fatigue, swollen ankles, and vision problems made her go back to her doctor. She was shocked when she was told that her blood sugar levels were too high, her haemoglobin and vitamin D levels were dangerously low, and that she was borderline obese. "But I eat a normal diet and I do not indulge in sweets often. I do not know why my sugar is high or why I seem to be putting on weight, despite not eating much. The doctor wants me to eat more vegetables and fruits and switch from rice to ragi. But I work as a domestic help and mostly eat the food provided by my employers. Also, I cannot afford to buy fruits and vegetables on my income. Even fish has become so expensive. We also do not get pulses or legumes at subsidised rates from ration shops anymore," she says. Sobha's story is being played out across the country. People like her are among the millions of malnourished, obese, persons with diabetes in the country, who will, over time, develop serious complications of diabetes such as renal failure because basic lifestyle changes-- especially dietary changes -- that are required to keep non-communicable diseases (NCDs) under control are beyond their means.