Consumption prevalence of ultra-processed food items among rural poor, marginalized

Note on survey conducted in Bihar and Uttar Pradesh by Peoples’ Vigilance Committee on Human Rights (PVCHR) and People’s Initiative for Participatory Action on Food Labeling (PIPAL)

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India is a Nutrition Paradox where undernutrition and obesity coexist as a classic case of the double burden of malnutrition. Over one-third of children under age 5 in India are stunted and underweight. On the other hand, obesity among children is on an upward trend, with around 3.4 % children either overweight or obsess. This is more than 50% increase in the last five years. On average, 15 % of Indian children are facing some form of obesity. Nearly half of all under-5 child mortality in India is attributable to undernutrition. Global estimates suggest that almost 2.3 billion children and adults are overweight.
The growing availability of ultra-processed foods containing high levels of sugar, sodium, saturated fats, and refined carbohydrates is a key contributor to the current obesity epidemic.
The adverse health effect of unregulated ultra-processed food and drinks in an under-nourished or stunted child, who received inadequate nutrition early in life, is more pronounced than in children who received adequate nutrition. This is due to their weak immune system, which makes them more susceptible to obesity and later may face one or other form of NCDs.
A study conducted by the Lancet Commission on a comparison of the Indian Diet found that Ultra-processed package food accounts for nearly 10% of the average total caloric intake in both rural and urban India. Urban households in high economic affluence consume almost 30% of their daily calories from processed food.

The objective of the study:

There is a general perception that the high consumption of ultra-processed food and drinks is mainly among the wealthy, urban, and affluent classes. It is somewhat valid, but consumption of ultra-processed food and drinks among an economically poor, rural, and under-privilege section of society is multiplying. Therefore, the study objective was to identify the level of consumption prevalence of ultra-processed food items and its share in overall food expenditure of the socially most under-privilege and economically poor households and families in the rural part of the country. The study was conducted primarily in the country's two most populous states with a high share of the rural population to affirm that ultra-processed food items have deep penetration among under-privilege and marginalized populations, causing a severe double burden of malnutrition.

Methodology

The study follows Descriptive Research Design involving qualitative & quantative research methods to explain prevalence of Ultra-processed food products among rural households. The study was carried out in two states – Uttar Pradesh and Bihar. Varanasi was selected from Uttar Pradesh, and Gaya was selected from Bihar. The sample consisted of 330 families In Uttar Pradesh and Bihar. Five blocks were selected from Varanasi and two from Bihar through cluster sampling. From each village, households were identified using purposive random selection to obtain the responses. The required information was obtained based on the objectives by constructing a structured questionnaire. The questionnaire consisted of a general information schedule with questions about age, religion, education, marital status, personal habits, frequency of processed foods, and significant driving force for purchasing processed food. 74 % respondents in the survey are female.
Before the data collection, pre-testing of the data collection tool was done on a similar and small population group. After introducing suitable modifications, it was administered to the respondents to obtain the required information.
All ethical guidelines were followed in the research study. After obtaining informed consent, an adult respondent from each household was administered a pre-tested questionnaire to gauge information on various aspects of food consumption. This descriptive cross-sectional study was done over two months, from March to May 2022.

Survey Profile

• Around 90 % of survey respondents earn Rs.400 or less daily and live at least 20 km from the closest urban centers.
• 40% of the families surveyed belong to the Dalit community (Mushaars), and over one-third belong to other backward castes.
• The majority of respondents who were surveyed are illiterate, while another one-third studied up to class 10. Less than 4 % of respondents are graduates or post-graduate.
• In all families who are surveyed, no one has formal employment. The maximum number of families are employed as casual laborers in farm or non-farm activities such as transport, restaurants, etc. Those receiving regular salaries are also daily wage earners without formal employment contracts.
• 40 % of respondents in the survey are female, while 60 % are male.

Key Findings

1. As we move down in income level and social structure, expenditure on food increases while expenses on non-food items like housing, education, fuels, etc., reduces. Dalit families spend 94 % of their earning on food items while Upper caste and Other backward caste communities spending on food items are around 65% of their earning.
2. Average Dalit families spend more than 90% of their earnings on food items of which 10-15 % is spent on ultra-processed and packaged food.
3. Their expenses on healthcare and education are 1.3 % and 0.5 %.
4. Among the general category and other backward caste groups, expenses on food items are 65 % of total earning while spending on education in both social groups are 2.5 %. Health relaed expense among OBC families are around 9 %.
5. Still, in rural areas of Uttar Pradesh and Bihar, a majority of food expenditure are on food items like cereals, wheat, pulses, cooking oil, etc (75-80 % of total food expenditure depending on income of household.) On average they spend 15 % of their food expenditure on Ultra-processed food items like chocolates, carbonated drinks, jellies, biscuits, and chips.
6. A household which earns Rs 400 daily ( roughly Rs. 5000 per month), spend Rs. 60 per day (15 %) on Ultra-processed food items. A family with annual earning between Rs. 200,000 to 500,000 spend roughly around 18 % of their food expense on Ultra-procssed food items. An average urban middle class families spend 10 % of their food expenses on Ultra-processed food items ( Lancet Commssion).
7. The study reveals a correlation between level of education and prevalence of ultra-processed food items consumption. Consumption of of ultra-processed food items is higher in housholds which are either illiterate (10%) or have only primary level education (17 %) compared to households with secondary (6.6 %) or higher education (5.9%).
8. Affordability of ultra-processed food items available in the market is an important factor attributed to the higher consumption rates in low income groups and Dalit families.
9. Types of livelihood practiced by Dalit families do not allow enough time for preparation of home cooked food, increasing their dependance on cheap packaged food.

Key takeaways

• The survey once again reaffirms that the prevalence of ultra-processed food consumption is a country-wide phenomenon seen in all social grouping and income levels.
• There is a transition from home-cooked traditional food to Ultra-processed food, even in the villages. It comprises children's nutrition intake, as they are the biggest consumer of Ultra-processed food items.
• Even in villages, marketing is the major driving factor for increasing consumption of ultra-processed food items. Respondents agree that they buy them because of TV / social media advertisements or Neighborhood influence.
• There is a general awareness among respondents/consumers that Ultra-processed food like chocolate, chips and carbonated drinks aren't good for health. However, they are willing to consume it for taste/experience and expression for better living standards.

Four factors contribute to the high prevalence of unregulated ultra-processed food & drink consumption in an economically poor, rural, and under-privilege section of society where the maximum number of stunted or underweight children belongs. These are:

1. Increasing urbanization or urban functions in a smaller town and rural areas,
2. Rising income among all strata of society,
3. Less time for food preparation due to high work-stress environment, and
4. Lucrative marketing strategies of the Food and beverage industry.

These four factors contribute significantly to the food transition where affordable, convenient, and hyper-palatable Ultra-processed food or drinks which are ready to eat take up a significant share of the daily diet of a larger population in the country, including economically weaker sections and migrant workforce.