Dr Shabana Safdar Khan
Pakistan confronts a paradox that captures the fundamental dysfunction of its approach to food security and public health. The country produces enough calories to feed its entire population, yet millions suffer from malnutrition while simultaneously facing an obesity epidemic that ranks among the worst globally. This contradiction reveals not scarcity but profound structural failure: a food system designed to generate energy rather than nourishment, one that fills stomachs while systematically depriving bodies of the nutrients essential for health and development.
A recent assessment by the United Nations Food and Agriculture Organisation has exposed the depth of this crisis with troubling clarity. Presented at a February workshop examining Pakistan’s food systems, the analysis documents how the nation’s agricultural and dietary patterns have become dangerously misaligned with basic nutritional requirements. The system delivers abundance in the wrong categories while creating scarcity in precisely those foods most critical for human wellbeing. This misalignment operates not as accident but as the predictable outcome of policy choices, subsidy structures, and market incentives that prioritize production volume over nutritional value.
The core distortion manifests in stark numerical terms. Cereals, sugar, and edible oils dominate both production and consumption at levels far exceeding what constitutes healthy intake. Meanwhile, nutrient-dense foods including fruits, pulses, and legumes remain chronically undersupplied and underconsumed. This imbalance has locked Pakistani diets into a cereal-dominated pattern that pervades both urban and rural communities, though rural areas suffer even more severe limitations. The monotony of this diet crowds out the diversity essential for adequate nutrition, trapping households in choices that undermine their long-term health regardless of whether they consume sufficient calories.
Milk and dairy products occupy the second position in national consumption patterns, providing some nutritional benefit but insufficient to compensate for deficiencies elsewhere. Vegetable intake remains merely moderate rather than abundant, falling short of levels needed to supply essential micronutrients. Fruit consumption registers consistently low across the country, with rural communities particularly deprived of these vital sources of vitamins and minerals. This scarcity of fruits represents not just dietary preference but systematic failure to make these foods accessible and affordable to populations who need them most.
Protein deficiency presents another dimension of this nutritional catastrophe. Beyond dairy, protein sources appear scarce in Pakistani diets, with meat, poultry, and eggs consumed infrequently particularly in rural areas where purchasing power limits access to these relatively expensive foods. Pulses provide partial supplementation but cannot adequately substitute for animal-source proteins in delivering the full spectrum of amino acids and micronutrients essential for growth and development. The result is chronic deficiency in nutrients foundational to physical and cognitive development, condemning millions to diminished potential from birth.
Perhaps most alarming is the documented surge in consumption of sweets and snack foods. Rural communities, counterintuitively, consume more free sugars and fats than urban populations. This pattern reflects the perverse economics of malnutrition: energy-dense foods laden with sugar and fat cost less than nutrient-rich alternatives, making them accessible to impoverished communities even as they deliver empty calories that satisfy hunger while deepening nutritional deficiency. The relative affordability of these harmful products compared to fruits, vegetables, and quality proteins creates a situation where poverty directly translates into poor nutrition even when total caloric intake appears adequate.
The explosion of processed food consumption compounds this crisis dramatically. Sales of processed foods in Pakistan have nearly doubled in recent years, representing a rapid transformation of dietary patterns toward industrially manufactured products typically high in sugar, salt, and unhealthy fats while deficient in essential nutrients. This shift mirrors destructive patterns observed globally as traditional food systems give way to corporate-dominated industrial food production optimized for profit rather than public health. The combination of cheap sugar-rich products and surging processed food consumption signals a transition that will impose devastating long-term costs on Pakistani society.
The health consequences of these dietary failures manifest in dual burdens that strain the nation’s already inadequate health infrastructure. Malnutrition and obesity coexist, often within the same communities and sometimes even the same households, creating complex challenges that demand coordinated responses across multiple domains. This double burden intensifies pressure on health systems designed for neither prevention nor management of chronic disease, forcing reactive emergency interventions while neglecting the upstream interventions that could prevent illness.
Widespread consumption of nutrient-deficient foods has amplified Pakistan’s longstanding malnutrition crisis, with women and children bearing the heaviest burden. Anemia affects approximately forty-one percent of women, undermining maternal health and contributing to one of the region’s highest maternal mortality rates at one hundred eighty-six deaths per hundred thousand live births. Maternal malnutrition cascades across generations, compromising infant health from conception and perpetuating cycles of deprivation. Child malnutrition reaches catastrophic levels, with stunting affecting forty percent of children under five years old, permanently limiting their physical growth and cognitive development while consigning them to diminished life prospects.
Simultaneously, obesity has surged to affect forty percent of adults, fueling explosive growth in non-communicable diseases including cardiovascular illness, hypertension, and diabetes. Pakistan now ranks third globally in diabetes prevalence, a devastating distinction reflecting years of accumulated dietary dysfunction. These chronic conditions require sustained medical management, consuming health resources while rarely achieving cure. The dual pressures of malnutrition and obesity force health systems to manage both deficiency diseases and excess-related illnesses, driving demand for expensive tertiary care facilities while diverting scarce funding from primary care and preventive services that could address root causes.
Addressing this crisis demands comprehensive strategic action coordinated across federal and provincial governments. The FAO assessment recommends fundamental realignment of incentives and subsidies currently distorting food production and consumption. Making nutrient-rich foods including fruits, vegetables, and pulses abundantly available and genuinely affordable for all communities requires policy intervention to correct market failures that privilege empty calories over nourishment. Subsidies currently supporting cereal and sugar production must shift toward foods that build rather than undermine health.
Curbing excessive sugar intake represents a critical priority requiring aggressive intervention. Higher taxes on sugary drinks, confectionery, and processed foods can create financial incentives for reduced consumption while generating revenue specifically dedicated to nutrition and health initiatives. This dual benefit makes such taxation among the most efficient policy tools available. Policies rewarding producers who reduce sugar content or meet nutritional targets would further reinforce healthier patterns by aligning commercial incentives with public health objectives rather than leaving them in opposition.
The fundamental imperative is transforming a food system currently optimized for calorie production into one supporting genuine wellbeing and human capital development. Pakistan cannot achieve its development potential while condemning millions to malnutrition and diet-related disease. The technical solutions exist. What remains is political will to implement policies that prioritize long-term health over short-term convenience, that value nutrition over mere energy, that recognize food as foundation for human flourishing rather than simple commodity. The cost of continued failure will be measured not just in health expenditure but in generations of diminished potential and preventable suffering.
