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Hidden by hunger

It is not enough to attain food security. The need of the hour is to get to nutritional security, argues G.M. SUBBA RAO, while taking a second look at concepts like malnutrition and under-nutrition.


IN the recent past there has been a spate of articles in the popular press on hunger and various manifestations of malnutrition, causes, effects and ways and means to tackle them. Some talked about the populist schemes, others posed straight queries questioning the policy makers on their commitment in tackling public health problems, yet others threw up some often ignored perspectives.

Michelle Mascarenhas' article "Unpalatable truth?" published in The Hindu Sunday Magazine June 22, 2003 falls into the last category. It was undoubtedly an effort to open our minds to a few often-ignored causes for obesity, a "weighty" problem that is assuming monstrous proportions even in the developing countries.

Most often, terms like hunger and malnutrition are used inter-changeably and malnutrition is often equated with under-nutrition, when pioneering nutrition scientists in this part of the world are redefining many a term indicating a paradigm shift in the way the global problems of hunger, malnutrition and food insecurity are understood and addressed.

At this juncture it is necessary to look at the terms like hunger, malnutrition and food (in)security in a new light, redefine them, revisit our policies and recast our focus, to broaden the ground for meaningful scientific endeavours, to provide a holistic perspective for the policy makers and to help people understand the scourge of these problems.

Hunger is not just a state of mind or urge to eat more, neither is it mere inadequacy of food to satisfy the call of the stomach. It means not getting enough food to meet the nutritional requirement of the body.

Researchers have been focussing on the problem of "Hidden Hunger", which is widespread, particularly in the Third World. In most of these countries, families make do with food that may not have enough micronutrients and are unable to afford fruit, vegetables and animal foods needed to provide balanced diets. A related cause often indicated is that some of the "green revolution" crops of the 1960s and 1970s created specifically to reduce starvation are often short of important nutrients.

Today, refined wheat and rice have virtually displaced coarse grains and millets as the staple cereal. This has not only led to a substantial reduction in fibre content in the diet but also, possibly, the content of micronutrients such as vitamin B-complex, zinc and chromium.


Hunger today refers not to the overt and obvious hunger of poor people who are unable to afford at least one square meal a day, but to a more insidious hunger caused by eating food that is cheap and filling but deficient in essential vitamins and micronutrients. But unfortunately, the term "hidden hunger" or "silent hunger" is seldom found outside specialist journals and is rarely seen in popular newspapers and magazines, leave alone the policy documents.

Malnutrition in the form of under-nutrition or deficiencies of essential vitamins and minerals continues to cause severe illness or morbidity among millions of people worldwide. It is estimated, more than 3.5 billion people are affected by iron deficiency and two billion are at risk of iodine deficiency and many more are affected by insufficient vitamin A. This is one side of the coin often seen and talked about.

Thus malnutrition is usually equated with under-nutrition. When plans and policies talk of measures to tackle this problem, we often fail to realise that malnutrition also manifests as over-nutrition or obesity. In many countries, health problems related to dietary excess are an ever-increasing threat. As the population goes up the socio-economic scale, cereal intake is likely to decline and the intake of sugar and fats generally increases. Convenience and fast foods find increasing acceptance leading to over-weight. Using existing World Health Organisation standards, data from 79 developing countries and a number of industrialised countries suggests that about 22 million children under five years of age are overweight worldwide (WHO 1998). Studies prove beyond doubt that obesity in childhood and adolescence is associated with various health problems, and its persistence into adulthood leads to health effects ranging from an increased risk of premature death to several non-fatal but debilitating conditions that affect productivity. These emerging problems are not just limited to developed countries; an increasing number of developing countries are confronted with the double burden of under-nutrition and chronic diet-related diseases, which arise due to over-nutrition or obesity. According to some studies, the incidence of obesity in India is 7-9 per cent mainly in urban centres. Although this number is small as compared to the United States and other countries, it is significant due to the sheer size of the population in India.

Whether in their mildest or most severe form, the consequences of poor nutrition and health result in a reduction in overall well-being and quality of life, and in the levels of development of human potential. It is the time to look at both sides of the coin called malnutrition.

Putting an end to hunger necessarily starts with ensuring that enough food is produced and made available for everyone. However, simply growing enough food does not guarantee the elimination of hunger. Access by all people at all times to food must be guaranteed. In other words, food security was the goal towards which the developing world was striving. Today, in countries like ours, foodgrain production has registered impressive progress. While sustaining it, the production of quality foods such as horticultural products, legumes and milk have to be significantly raised to ensure nutritionally adequate diets. We need to fight at both ends of the spectrum, feeding the millions and ensuring what we feed them is nutritionally adequate. The need of the hour is not just food security but ensuring Nutrition Security to the hungry millions. This is the time to rework on our objectives; we need to aim at combating Hidden Hunger and not mere Hunger, our programmes catering to malnutrition address the twin-troubles of under-nutrition as well as over-nutrition/obesity and above all talk of Nutrition security instead of food security. The talk of the paradigm shift has been reverberating in many a scientific forum and it also surfaced at the IX Asian Congress of Nutrition held in New Delhi in February 2003. Isn't it time to look beyond the obvious, broaden our perspectives, reset our goals and foster new stream of ideas that are conducive to general health and nutritional well-being of all?

The writer is a Research Officer in the National Institute of Nutrition, Hyderabad.

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