India's Largest Dietary Survey Reveals a Nation at Risk
In what could be called India's most comprehensive health wake-up call, the Indian Council of Medical Research (ICMR) has published groundbreaking findings from the ICMR-INDIAB study—a massive survey tracking 1.2 lakh (113,043) adults across all 30 states and union territories between 2008 and 2020. The detailed dietary analysis of 18,090 participants paints a troubling picture of how our traditional diets have evolved into a recipe for chronic disease.
Published in Nature Medicine in 2025, this landmark study connects the dots between what Indians eat and the alarming rise in diabetes, obesity, and heart disease plaguing the nation.
The Diet Crisis: What We're Eating Wrong
1. Carbohydrate Overload
Indians are consuming a staggering 62% of their daily calories from carbohydrates—one of the highest rates in the world. But here's the catch: most of these aren't the healthy kind.
Sources of carbohydrates breakdown:
- White rice and refined cereals: 28.5% of total energy
- Milled whole grains (wheat flour, millet flour): 16.2% of total energy
- Added sugar: Varies by region, with many states exceeding safe limits
The study found that 21 states and Union Territories consume more added sugar than the WHO-recommended limit of 5% of total daily energy. States like Haryana, Delhi, Karnataka, and Madhya Pradesh recorded sugar intakes exceeding 10% - double the safe limit
2. The Protein Problem
While we're drowning in carbs, we're starving for protein. Indians consume only 12% of their daily calories from protein, well below the recommended 15%.
Protein sources:
- Plant protein (cereals, pulses, legumes): 8.9%
- Dairy protein: 2%
- Animal protein (meat, fish, eggs): Just 1%
3. Fat Quality Issues
Total fat intake (25.2% of energy) falls within acceptable limits, but the devil is in the details. Most states exceed the recommended limit for saturated fat consumption, primarily from:
- Ghee (clarified butter) in Northern states
- Palm oil and coconut oil in Southern states
- Widespread use of cheap palmolein oil in processed foods
The Health Toll: What This Diet is Doing to Us
The statistics are sobering. The study found that 83% of participants had at least one metabolic risk factor—including newly diagnosed diabetes, prediabetes, obesity, or hypertension.
High Carbohydrate Consumption Increases Risk:
Compared to those eating the least carbohydrates, people consuming the most (around 69% of daily calories) faced:
- 30% higher risk of newly diagnosed type 2 diabetes
- 20% higher risk of prediabetes
- 22% higher risk of generalized obesity
- 15% higher risk of abdominal obesity
White Rice: A Major Culprit
Those consuming the highest amounts of white rice (about 198g per day) had a 19-26% higher likelihood of diabetes, prediabetes, and obesity compared to those eating the least (around 81g per day).
The Whole Grain Myth Busted
Here's a surprising finding: Simply replacing refined grains with whole wheat or millet flour doesn't help if you keep eating the same amount of carbohydrates. The study found that milling whole grains into flour increases their glycemic index so much that they behave almost like refined grains in your body.
This challenges the popular belief that switching to whole wheat rotis or millet-based foods alone will solve the problem.
Regional Variations: A Diverse Nation, A Common Problem
While carbohydrate consumption was high across India (59-65% of calories), the sources varied dramatically:
Rice-Dominant Regions:
- Northeast: 99% rely on white rice
- South: 87% prefer white rice
- East: 78% consume primarily white rice
Wheat-Dominant Regions:
- North: 90% use whole wheat flour
- Central: 70% prefer wheat
The Millet Exception:
Only three states showed significant millet consumption:
- Karnataka: 47.7% use whole millet flour
- Gujarat and Maharashtra: 35% each
The Solution: Small Changes, Big Impact
The good news? You don't need to overhaul your entire diet. The study found that replacing just 5% of carbohydrate calories with protein significantly reduces disease risk.
What to Eat More Of:
Plant Proteins:
- Pulses and legumes (dal, rajma, chana)
- Associated with 11-18% lower diabetes risk
Dairy Products:
- Milk, curd, paneer
- Associated with 11% lower diabetes risk
- Fermented dairy (yogurt, buttermilk) showed additional benefits
Eggs and Fish:
- Eggs: 9% lower diabetes risk
- Fish: 6% lower diabetes risk
What to Eat Less Of:
- Reduce total carbohydrate intake from current 62% to closer to 50-55% of calories
- Limit white rice consumption or mix with other grains
- Cut added sugar to below 5% of daily calories (roughly 6 teaspoons for a 2000-calorie diet)
- Replace saturated fats (ghee, palm oil) with healthier oils
Urban vs. Rural Divide
The study revealed interesting urban-rural differences:
Urban Indians:
- More physically inactive (70% vs. 57% rural)
- Higher obesity rates (37% vs. 22% rural)
- Consume more added sugar
- Higher rates of diabetes and metabolic diseases
Rural Indians:
- Get more calories from refined cereals
- Consume more plant and animal protein
- Lower dairy protein intake
- Despite "healthier" activity levels, still face high carbohydrate-related risks
Why This Matters: The Economic Burden
This isn't just a health crisis—it's an economic time bomb. By 2060, the costs of overweight and obesity alone are projected to reach $839 billion (2.47% of India's GDP). Noncommunicable diseases already account for 68% of all deaths in India.
But here's the silver lining: improving diet and physical activity can prevent nearly 50% of incident diabetes cases.
What Needs to Change: Policy Recommendations
The ICMR study calls for urgent, multi-sectoral action:
1. Revamp the Public Distribution System (PDS)
- Prioritize subsidies for pulses and legumes over refined rice
- Provide healthier cooking oils (low in saturated fat)
- Extend minimum support prices to protein-rich foods
2. Regulate Sugar and Processed Foods
- Current taxes on carbonated drinks haven't reduced consumption
- Stricter labeling requirements for added sugar
- Address the unregulated food sector (street vendors, local bakeries, traditional sweets)
3. Public Awareness Campaigns
- Educate on the "total carbohydrate" problem, not just refined vs. whole grains
- Promote practical strategies: gradually increase pulses and dairy in meals
- Shift cultural norms around rice-heavy meals
4. State-Level Action
Since healthcare is a state responsibility, each state needs tailored interventions based on their dietary patterns.
Practical Takeaways for Your Kitchen
Based on this landmark study, here's what you can do today:
The Plate Method:
- 1/2 plate: Vegetables and salads
- 1/4 plate: Protein (dal, curd, eggs, fish, chicken)
- 1/4 plate: Carbohydrates (rice, roti, but less than before)
Simple Swaps:
- Mix rice with quinoa, broken wheat, or millets (not flour—whole grains)
- Replace one roti with a bowl of dal or curd
- Add an egg or fish to at least one meal daily
- Reduce sugar in tea/coffee gradually
- Choose nuts and seeds over traditional fried snacks
Don't Fall for the Flour Trap:
Remember, whole wheat flour or millet flour isn't much better than refined flour when it comes to blood sugar. Try to include intact whole grains where possible (brown rice, whole wheat kernels, whole millets).
This massive ICMR study, encompassing 1.2 lakh Indians over 12 years, delivers a clear message: our carbohydrate-heavy diet is making us sick. The path forward isn't about exotic superfoods or expensive diets—it's about eating less rice and roti, and more dal, curd, eggs, and fish.