JMIR Publications

ABSTRACT

Background:

India faces a complex double burden of malnutrition, with undernutrition, micronutrient deficiencies, and rising overweight and obesity coexisting within populations. Existing national surveys such as NFHS, CNNS, and STEPS provide valuable but episodic data, lacking the frequency, institutional linkage, and life-stage coverage needed for timely preventive action. This gap limits early detection of risk factors and delays interventions, contributing to the rising burden of noncommunicable diseases (NCDs). Continuous, locally responsive surveillance is essential to enable interventions that address both undernutrition and overweight/obesity (“double-duty actions”).

Objective:

To conceptualize and propose a life-course framework and protocol for institute-based, standardized surveillance of overweight, obesity, and metabolic risk factors in India, leveraging existing national programs and appropriate technologies to inform policy and practice.

Methods:

This Policy/Framework and Protocol Paper synthesizes evidence from international models (YRBS, NHANES, ECHO, COSI, GSHPPS) and integrates theoretical perspectives including Nutrition Transition Theory, Life-course Perspective, Social Ecological Model, Behaviour Change Communication (BCC) Models, and the Surveillance-as-Action paradigm. The protocol design incorporates principles of Primary Health Care—equity, community participation, intersectoral coordination, and appropriate technology—and practical learnings from the initial implementation of two ICMR-funded projects (NULRISC and COPRIME).

Results:

The proposed model anchors surveillance in institutions such as Anganwadi centres, schools, colleges, and health facilities, utilizing hybrid tools including OMR paper-based questionnaires, digital dashboards, and IoT-enabled devices. It enables periodic data capture across core domains—anthropometry, diet, biomarkers, and behaviors—while ensuring confidentiality and body-image sensitivity. Integration with RBSK, RKSK, POSHAN 2.0, PM POSHAN, and Ayushman Bharat facilitates real-time, life-stage data convergence and supports actionable feedback for prevention and policy adaptation.

Conclusions:

An institute-based, standardized surveillance system can transform nutrition monitoring in India from episodic surveys to continuous prevention. By operationalizing double-duty actions and embedding Primary Health Care values, this framework offers a scalable and sustainable public health architecture to address malnutrition in all its forms and inform national policy.