Hidden Hunger: Contemplating Public Health Nutrition In Pakistan

Hidden Hunger: Contemplating Public Health Nutrition In Pakistan
Pakistan is facing triple burden of diseases ranging from stunting to obesity and ‘hidden hunger’ referring to the lack of intake of an appropriate amount of vitamins and minerals. Primary causes include malnutrition including both under- and over-nutrition. More adolescents are underweight than overweight, while the opposite is true for adults. A scientific review article by the author has shown clear differences based on ethnicity, rural or urban residence, age, and immigrant status regarding the prevalence of obesity and cardiovascular risk factors in the Pakistani population. There were consistent results regarding the high prevalence of central obesity in different regions of Pakistan but inconsistent results regarding the prevalence of overweight and obesity based on body mass index (BMI). BMI is the measure of weight status of individuals.

Hidden hunger is an important public health nutrition problem of South Asia, including India and Pakistan. It refers to the deficiency of key vitamins and minerals due to an imbalanced diet. Malnutrition is a key factor in the case of hidden hunger. As such, malnutrition generally refers to the lack of enough food or an imbalanced diet. It is highly prevalent in the rural or far off areas in countries like Pakistan. In Pakistan, some regions like rural Sindh, South Punjab and Balochistan carry the weight of hidden hunger. There is a recent trend of urban malnutrition, which refers to the intake of energy-dense and nutrient-scarce foods among the urban masses, resulting in increased obesity and the lack of an intake of essential vitamins and minerals needed for the proper functioning of the human body. Hidden hunger affects more than two billion individuals around the world and mostly in low- and middle-income countries.

There has been mushrooming of fast food chains across Pakistan, ranging from big to small cities. People from different socio-economic strata, and especially the younger generation ranging from adolescents to teenagers and young adults, are particularly attracted towards fast foods including pizzas, burgers, fries and fizzy drinks. These foods and drinks contain an extra amount of salt, fat and sugar which has devastating effects on the health of an individual. This kind of dietary pattern leads to obesity, which in turn can lead to related non-communicable diseases like diabetes, hypertension, hypercholesterolemia and cardiovascular diseases.

A traditional Pakistani diet consists of fruits, vegetables, grains, pulses, meat, milk and eggs. Due to advent of Westernised diets, Pakistani people have started moving away from their traditional diet, which might be one of the plausible reasons for increase in obesity and related non-communicable diseases among different Pakistani communities.

Pakistanis have a collectivist culture with strong communities leading to interdependence. Thus, from a sociological perspective, food holds a central value in Pakistani culture and among various communities living in Pakistan. At any kind of occasion, ranging from religious festivals like Eids or cultural activities to family gatherings, food is a must. In general people are cooking some kind of curry preferably meat curry with rotis (an unleavened bread made from wheat) and supplemental dishes including kebabs (small pieces of meat cooked on a skewer) and Biryani (rice-based food made with spices, meat, potatoes and eggs). There is also a lot of consumption of local fruits and vegetables among the Pakistani people. For example, mangoes and melons during the summer season while oranges and grapefruits during the winter season are very famous in Pakistan. There are certain vegetables which are either cooked alone or with meat like spinach, okra (ladyfinger), bitter melon and local pumpkins. There is a use of lots of herbs, condiments and spices in the Pakistani dishes. People also consume lot of dairy products like milk and yoghurt. There is a lot of emphasis on using fresh products, especially milk. There are many sweet dishes which are made from milk including Sevian (a dessert made with vermicelli, sugar, ghee and nuts) mostly consumed on Eid-ul-Fitr.

In general, the Pakistani diet contains a variety of food groups but still there is high prevalence of non-communicable diseases among the Pakistanis. This warrants a deep analysis of the dietary patterns of Pakistanis, the nutritional composition of these dietary patterns and their overall effect on health.