Consumption of ultra-processed food items
among rural poor and marginalized households
A SURVEY STUDY IN UTTAR PRADESH AND BIHAR
Background
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 a
more than 50% increase in the last five years [1]. Almost, 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, due to their weak immune
systems. 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 [2]
Methodology
The study follows a Descriptive Research Design involving qualitative &
quantitative research methods to explain the 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.
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.
Objective
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.
This study is jointly carried by the People’s Vigilance
Committee on Human Rights (PVCHR) and People’s
Initiative for Participatory Action on food Labelling
(PIPAL).
PVCHR, since its inception, is working on Child right,
nutrition issues especially on malnutrition and hunger,
children health and Neo-natal & maternal death as a core
thematic area along with Human rights of Dalits,
minorities and women. PVCHR are already linked with
progressive forums such as Global India and grassroots
level NGOs. PIPAL is a network of civil society
organizations working on health & nutrition, global &
Indian think-tanks, health advocates, professionals
working for betterment of child & maternal health; and
women organizations. It is started as a public forum to
engage and sensitize policy makers and decision makers
through research, survey, community mobilization and
public testimonies. The data were collected by network
members of PIPAL and research & analysis were carried
by researchers from Kashi Vidyapeeth, Varanasi.
This study is part of national sensitization campaign for
strong and science-based Front of Pack Labeling (FOPL)
regulation to help Indian consumers to identify unhealthy
ultra-processed package food products which has high
health risk factors and reduce their consumption.
 Survey Respondent
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.
74 % of respondents in the survey are female, while 26 % are male.
Key Findings
1. 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.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 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 related 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). They usually 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. 12,000 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-processed food items. An
average urban middle class families spend 10 % of their food expenses
on Ultra-processed food items ( Lancet Commission).
7. The study reveals a correlation between level of education and
prevalence of ultra-processed food items consumption. Consumption of
ultra-processed food items is higher in households 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 dependence on
cheap packaged food.
[1] http://rchiips.org/nfhs/NFHS-5_FCTS/India.pdf
[2] Lancet Commission Study on comparison of Indian Diets
Policy Takeaways
Implementing front-of-package labeling (FOPL) that
gives clear warning regarding high content of sugar,
sodium and saturated fat in utra-porcessed and
packaged food and discourages purchase of unhealthy
packaged food, is the an impactful policy solution to
safeguard public health.
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.