Refined Grains Fuels Obesity Among Indians, Finds Survey

The study, published in Nature Medicine, found that more than 62 per cent of daily calories in Indian diets come from low-quality carbohydrates, while protein intake remains low and saturated fat consumption exceeds recommended levels in most states. In Telangana, high reliance on refined cereals and inadequate protein has been linked to an elevated risk of type-2 diabetes, prediabetes and obesity.

The survey was conducted with over 18,000 adults. It was a national cross-sectional population-based survey conducted from 2008 to 2020.

The survey found that Indian diets are dominated by low-quality carbohydrates, with major daily calories (62.3 per cent of total dietary energy) coming from white rice, milled wheat and added sugars, while protein intake remains low at about 12 per cent of energy, mainly from plant sources (8.9 per cent) with smaller contributions from dairy (2.1 per cent) and animal foods (1 per cent).

The intake of saturated fat exceeded recommended limits in most states, including Telangana, and millet consumption was minimal except in Karnataka, Gujarat and Maharashtra.

The study also found that the high intake of carbohydrates, regardless of grain type, was linked to a 14-30 per cent higher risk of type 2 diabetes, prediabetes, general and abdominal obesity. Added sugar intake, which surpassed the recommended threshold of 10 per cent of total dietary energy, further contributed to higher metabolic risk.

However, a key thing to note is that replacing five per cent of energy from carbohydrates with plant protein, dairy, egg or fish, significantly reduced the likelihood of diabetes and prediabetes.

Replacing refined cereals with whole wheat or millet flour also failed to reduce risk, likely due to the effects of milling, although intact whole grains such as brown rice and unprocessed wheat and millets may offer benefits but these are rarely consumed.

The study emphasised the urgent need for public health strategies to reduce carbohydrate and saturated fat intake while promoting pulses, legumes, dairy proteins, and healthier oils, alongside policy shifts such as restructuring Public Distribution System subsidies to prioritise protein-rich foods over refined grains.

The study took the data in 2012-13 for undivided Andhra Pradesh, where white rice served as the primary staple with very limited millet consumption. The findings were the same for this region as well. As per Dr Mohsin Aslam, a consultant physician, Asian institute of Gastroenterology, Somajiguda, the findings of the study align with his observations in his practice.

“We need to reduce total caloric intake by exercising portion control and increasing nutrient-dense foods. Limit refined carbohydrates (white rice, maida, sugar) and replace with whole grains (millets, brown rice, whole wheat) in limited amounts. Increase intake of fibre-rich foods such as vegetables, leafy greens, pulses and fruits with low glycemic index. Choose healthy fats: include moderate use of unsaturated fats (mustard oil, groundnut oil, olive oil, nuts, seeds) instead of saturated fats (ghee, butter, coconut oil). Also, restrict deep-fried foods, processed snacks and sugary drinks. Focus on regular and balanced meals; avoid skipping meals or overeating in one sitting,” he advised.

He also added that besides day-to-day changes, community practices can also be adopted that help bring the desired change in diet.

“We can modify our traditional Indian recipes to reduce oil, sugar and salt while maintaining flavour using herbs and spices. Promote family-based or community group interventions for better adherence and motivation. Address social and emotional aspects of eating — such as festive overeating — through mindful eating practices,” he said.