You Are What You Eat: How Far Does The Urban Pakistani Diet Contribute To A Public Health Crisis?

You Are What You Eat: How Far Does The Urban Pakistani Diet Contribute To A Public Health Crisis?
Pakistan is facing a dual burden of both communicable and non-communicable diseases, like many of the other developing countries. The country stands at number four in terms of the highest number of people suffering from diabetes. Similarly, cardiovascular diseases (CVD) are also playing havoc with the lives of people. According to World Health Organisation, there are 49 people dying every day from heart diseases. Non-communicable diseases – including cardiovascular diseases – account for 58% of total burden of disease in Pakistan. In addition, the National Health Survey of Pakistan has shown that 18% of adults suffer from hypertension; this number rises to a whooping 33% for adults aged 45 and above. The prevalence of dyslipidemia is also very high in Pakistan, and it is a major risk factor for cardiovascular diseases. In terms of communicable diseases, Pakistan is the only country in the world, apart from Afghanistan, where polio cases are still intact. Similarly Hepatitis B and C, tuberculosis and HIV/AIDS are amongst the most prevalent diseases in Pakistan.

Diet, along with factors like physical activity and good hygienic practices, plays an important role in preventing both communicable and non-communicable diseases.  Research has shown that optimal nutrition plays a very important role in strengthening the immune system and thus ultimately preventing the onset of COVID-19. Similarly a healthy diet can also improve the defense system of the body against other kinds of communicable diseases. A balanced diet consisting of a high intake of fruits and vegetables and less intake of processed foods also provides a protective effect against the non-communicable diseases like CVD, diabetes, hypertension and hypercholesterolemia. A balanced diet refers to the intake of foods from all the food groups ranging from proteins, carbohydrates and fats, as well as vitamins and minerals. The protein group entails chicken, meat, beans, lentils and fish. Carbohydrates are obtained from cereals like wheat and maize and used as chapatti (an unleavened flatbread mostly used in South Asia), bread, pasta and rice. Fats are mostly obtained from butter, oil, fatty fish, nuts, flax-seed and eggs. A general recommendation is to use lean meat, complex carbohydrates like whole-wheat flour, brown and high fibre bread, brown rice and healthy fats like nuts, fatty fish and flaxseeds.

The traditional Pakistani diet generally consists of chapatti, rice, vegetables, fruits and meat. Seasonal fruits and vegetables have held a very important position in the traditional dietary patterns of Pakistanis, along with the use of lentils and beans. Nutrition transition is a phenomenon whereby the world in general and developing countries in particular – including Pakistanis – have moved from traditional dietary patterns to the use of processed foods. We have seen unprecedented levels of obesity in developed countries like the United States of America. Obesity in itself is a risk factor for non-communicable diseases like cardiovascular disease, diabetes, hypertension and hypercholesterolemia. Diet is presumed to be a key lifestyle factor in the development of diseases. The advent of the industrial era has seen a rise in the production and use of processed and ultra-processed foods like burgers, pizzas, fries etc. These foods well known as the main culprits for increase in obesity levels of Americans. In Pakistan, the phenomenon of urbanisation has increased the population burden in cities. These cities are now faced with ever increasing demands of food supplies and what they have found is that one way of coping with these dietary demands is the increased production and use of processed foods. Fast food outlets ranging from pricey ones like Mcdonalds or KFC to cheap dhabas (roadside food outlets) providing shawarma (an unhealthy wrap made up of white bread and chicken meat) and fries are playing havoc with the health of people in terms of providing them with high fat, high sugar and high sodium foods which tend to make them more prone towards getting non-communicable diseases. Eating out at pricey food outlets is also considered a ‘status symbol’ which makes obesity culturally relevant to the lives of urban Pakistanis.
Nutrition transition is a phenomenon whereby the world in general and developing countries in particular – including Pakistanis – have moved from traditional dietary patterns to the use of processed foods

The phenomenon of nutrition transition implicating with the rise of diseases can also be explained with the help of behavioral nutrition. There are two very interesting theories from behavioral and psychological sciences namely, the ‘Health Belief Model’ and ‘Social Cognitive theory’ which can help explain the dietary choices of urban Pakistanis.

According to these theories, actions of individuals are the result of their beliefs and environment. A person is therefore the product of their environment, including their belief system. In urban Pakistan including the major cities like Lahore, Karachi, Islamabad and Peshawar, there is an obesogenic environment - referring to the fact that the urban centers offer eateries with high calories, high energy and less nutritious foods. The major entertainment for urban Pakistanis is to go to a restaurant and eat unhealthy foods. There are less people who are going to parks or for some physical activity, be it individually or in groups. In addition, there is no major infrastructure to promote physical activity in cities like Lahore. You cannot bicycle here on the roads, as there are no bicycle paths and city traffic is congested. This kind of environment promotes eating unhealthy foods and less physical activity.

It is high time for all the stakeholders including government institutions, academia, private food companies and the citizens to sit together to promote healthy food environment and physical activity levels to improve the health of people. For example, the government can make physical infrastructure to promote physical activity and also market it. Academia can also help introduce students to healthy food choices and highlight importance of physical activity in their curriculum to increase awareness amongst younger generations. Similarly, private food companies can also improve the nutritional value of their foods and improve nutrition labeling. But the most important thing is that the citizens learn to eat and act responsibly and healthily to lessen the burden of diseases.

The march towards a healthy Pakistan is a marathon – but it needs to gain momentum now.


Dr. Qaisar Raza is Assistant Professor at the Department of Food Science and Human Nutrition, University of Veterinary and Animal Sciences (UVAS), Lahore; and Research Fellow at the Vrij Universiteit Amsterdam.