Unhealthy food consumption patterns among Indians: A qualitative analysis based on parliamentary questions documented between 2001 and 2021

ABSTRACT

Background:

From the dawn of the 21^st century, there has been an exponential increase in junk food consumption among Indians. The Indian parliament holds periodic question and answer sessions wherein several key issues of the nation are discussed by representatives across the country.

Materials and Methods:

Questions pertaining to junk foods and soft drinks that were documented between January 2001 and July 2021 in both houses of the parliament were included in the study. They were organized using MaxQDA software. Thematic analysis of the questions was done using Braun and Clarke’s phases for thematic analysis.

Results:

A total of 424 questions (0.08%) were asked collectively on junk foods including soft drinks in both the houses of which 160 questions (0.03%) were exclusively on junk food and 264 questions (0.05%) were on soft drinks respectively. Out of a total of 28,240 questions asked on all topics across both houses to the MOHFW, a total of 166 questions (0.6 %) were on junk food and soft drinks. Only 84 unique parliamentarians from 21 states have raised their voices on the present topic of concern.

Conclusion:

A majority of questions were on the adverse effects of junk food and soft drinks. Though there has been consistency in certain states on raising their voices on this topic, around 12 states/union territories failed to represent this issue even once. Further discussions have to be raised under the themes of food poisoning due to junk foods, marketing regulations, stricter media/advertisement regulations and future research objectivess.

Introduction

The past few decades have seen substantial change in the food consumption patterns of the Indian population. The term “junk food” refers to a food that lacks micronutrients like vitamins, minerals, fibers, or amino acids but has high numbers of calories.[1] The National Health and Nutrition Examination Survey (NHANES 2003–2006) reported that the total daily energy intake has increased up to 13% in children and adolescents due to junk food intake.[2] Unhealthy foods pose as a serious risk factor in the development of obesity and associated chronic diseases like diabetes, dementia, mental illness, and cancer. According to the World Health Organization (WHO)-Global Burden of Disease, in 2019, a diet high in trans-saturated fatty acids was responsible for 14.2 million disability adjusted life years (DALYs) and 645,000 deaths. In the same year, a diet high in sugar-sweetened beverages was responsible for 6.31 million DALYs and 242,000 deaths. Diet high in trans-saturated fats is the seventh leading dietary risk factor, and sugar-sweetened beverages are the 13th-leading risk factor for attributable DALYs.[3]

The parliament is the pillar of democracy that allows the representatives from each and every state/union territory to voice their questions on any issue. Parliamentary discussions are part of an intricate system where each opinion is heard and utilized for policy and law reforms. The present study aims to assess the questions asked by the Indian parliamentarians from January 2001 to July 2021 concerning junk/fast food and soft drinks and analyze the context qualitatively.

Material and Methods

The present qualitative analysis was carried out in accordance with the Standards for Reporting Qualitative Research guidelines recommended by the EQUATOR network. The questions on junk foods that were available on the official websites of the upper house (Rajya Sabha) and lower house (Lok Sabha) were collected. The advanced search engines of Rajya Sabha and Lok Sabha were used to search for the terms, “junk food,” “fast food,” “cold drinks,” “soft drinks,” “carbonated drinks,” and “non-alcoholic beverages.” All the questions documented between January 2001 and July 2021 that were relevant to the above terms were included. The transcripts were downloaded and organized using MaxQDA (Qualitative data analysis software version 2020.4 developed by VERBI software, Germany). The questions were classified according to the descriptive data, namely the date and year of question, the name and electoral constituency of the parliamentarian, the ministry to which the question was posed, and the title of the question. Thematic analysis of the content was done using open coding, and an inductive approach was used. A semantic approach involving analyzing the explicit content of data was done. A total of 424 questions on junk food including soft drinks were coded into nodes and a total of 720 nodes were obtained. These nodes were manually exported to MS excel and further coding was done using Braun and Clarke’s phases for thematic analysis. A six-phase model using data familiarization, coding, theme development, revision, naming, and writing up was employed.[4] From the thematic analysis of all questions from both sets, five main themes were identified. Subthemes were categorized for each theme and a thematic map was designed. [Table 1] [Figure 1]

Table 1.

Examples of questions grouped under each theme and subtheme

Themes and sub-themes	Examples of questions
Trends in junk food consumption
Urban junk food culture	Junk food is gaining popularity in metropolitan cities like Mumbai, Delhi, and Chandigarh
Junk food in schools	The reason why the sale of junk in and around schools has escalated
Health impact
Adverse effects	Whether junk food is causing heart disease in children
Incidence of food poisoning	Whether the number of incidents of food poisoning due to unhygienic food served in school canteens in India, state/UT wise database is available?
Ill effects of soft drinks	Whether 10,000 deaths are caused by sugar mixed drinks in our country and what are the steps taken for it
Marketing regulations
Salt and sugar content	Whether ICMR has finalized the standards of sugar content in soft drinks
Chemical content and quality control of soft drinks	What is the percentage of phosphoric acid, chemical sweetener called aspartame and anti-freeze compound permitted in soft drinks
Advertisement/media regulations	Why has government allowed sugar-based soft drink advertisements in movies, televisions, and hospitals?
Nutrition labeling	Whether honorable court has issued orders on the effect of statutory warning on bottles?
Research proposals
Surveillance studies	Will the government conduct studies to correlate heart attacks with junk food/energy drinks with high caffeine levels
Policy formulations
Nutrition awareness	Whether the government is planning to conduct nationwide awareness programs on the ill effects of junk foods
Nation-wide junk ban	Whether the government proposes to ban automatic vending machine for sale of soft drinks in government hospitals
Ban in educational institutions	Has UGC issued advisory on ban of junk food inside all affiliated college campuses

Figure 1.

Thematic map

Results

Between January 2001 and July 2021, the total number of questions submitted in all ministries across all categories in both the houses was 4,99,953. A total of 424 questions (0.08%) were asked collectively on junk foods including soft drinks in both the houses of which 160 questions (0.03%) were exclusively on junk food and 264 questions (0.05%) were on soft drinks, respectively. The total number of questions asked between 2001 and 2021 on all topics and concerning all ministries in the Lok Sabha amounted to 2,96,522. The total number of questions on junk food and cold drinks asked in Lok Sabha was 204 (0.1%). The total number of questions documented from 2001 to 2021 in all ministries and on all issues in the Rajya Sabha was 2,16,477, and the number of questions on junk food including soft drinks was 220 (0.1%). A majority of 166 questions (39.2%) were submitted to the Ministry of Health and Family Welfare (MOHFW) followed by 59 questions to the Ministry of Human Resource Development (HRD) (13.9%), 31 questions to the Ministry of Consumer Affairs (7.3%), and 11 questions to the Ministry of Food and Public Distribution (2.6%). Out of a total of 28,240 questions asked on all topics across both houses to the MOHFW, a total of 166 questions (0.6%) were on junk food and soft drinks. A total of 84 unique parliamentarians from 21 states had submitted questions on junk food and soft drinks out of whom the maximum number of questions was posed by Mr. Motilal Vora (Durg Constituency, Uttar Pradesh) and Mr. Rajesh Verma (Sitapur Constituency, Uttar Pradesh) (5 questions each). The top five states that have submitted the highest number of questions on the present topic are given in Table 2. The theme-wise results are briefed below.

Table 2.

Top five states who have submitted highest number of questions on Junk foods

State	Population	No of questions	% of total questions on junk food/cold drinks	No of unique members who submitted questions	Most commonly questioned themes
Uttar Pradesh	199,812,341	33	7.8%	12	Adverse effects of junk food : 05
Maharashtra	112,374,333	28	6.6%	15	Marketing regulations:  Chemical content in soft drinks: 03  Insecticides/pesticides concern: 03  Advertisement/media regulations: 03
Andhra Pradesh	49,577,103	15	3.5%	08	Marketing regulations:  Chemical content in soft drinks: 03
Tamil Nadu	72,147,030	14	3.3%	07	Marketing regulations:  Quality control: 03
Rajasthan	68,548,437	11	2.6%	04	Marketing regulations  Quality control: 02  Nutrition labeling: 02

1. Trends in junk food consumption: The first theme discusses questions on increasing prevalence of junk food intake among urban population and increasing junk food sales in schools.

   1. Urban food culture: Only one question was recorded on the increasing popularity of junk food in metropolitan cities like Mumbai, Delhi, and Chandigarh. It was raised in 2005 by a Member of Parliament (MP) from Punjab. No other questions have been documented under this theme.
   2. Increase in school sales: The parliamentarians expressed concern on the rampant increase in school sales of junk food and soft drinks. Questions were raised by MPs from Karnataka, Maharashtra, Odisha, and Tamil Nadu. They raised questions on the sale of junk food with discount coupons especially in CBSE schools. Questions were posed primarily to the Ministry of HRD followed by the MOHFW.

2. Health impact:

   1. Adverse effects of junk food: Questions under this theme comprised of various adverse effects of junk food like lifestyle diseases, namely obesity, cardiovascular diseases, diabetes, and hypertension. One of the parliamentarians enquired whether the government was aware of an AIIMS research paper that concluded that 80–90% of population had gingivitis and 60% had medium-level gingivitis owing to junk food and soft drink intake. Majority of the questions were asked by MPs from Uttar Pradesh. The other states that contributed to this theme were Karnataka, Punjab, Bihar, West Bengal, Maharashtra, Lakshadweep, Andhra Pradesh, Chhattisgarh, and Jharkhand. All of the questions were submitted to the MOHFW. The questions under this theme were documented only after 2011, beyond which there was a steady increase in questions.
   2. Incidence of food poisoning: Only one question was asked on the incidence of food poisoning due to unhygienic junk food served in school canteens. The question was asked to the MOHFW by an MP from Maharashtra in 2013. No other questions were documented under this theme.
   3. Ill effects of soft drinks: A number of questions were asked by parliamentarians on the ill effects of soft drinks from 2005 onwards. They enquired if the percentage of chemicals in soft drinks were evaluated periodically. They asked if the government is aware of the fact that most of the energy drink manufacturers maintain a level of 320 ppm of caffeine that is believed to cause heart attack, stroke, and paralysis. Further, the parliamentarians specifically mentioned popular brands of soft drinks and enquired about their safety standards. Majority of the questions were posed to the MOHFW followed by the Ministry of Food Processing Industries and Ministry of Agriculture, Consumer Affairs, Food, and Public Distribution.

3. Marketing Regulations:

   1. Salt and sugar content in junk foods: Questions under this theme comprised of the permissible limits of sugar in aerated drinks and salt in bread, biscuits, and bakery items. The members further enquired if any standards have been proposed by Indian Council of Medical Research (ICMR) for salt and sugar regulation. Parliamentarians asked if actions have been taken against companies which sell soft drinks having higher levels of salt and sugar. Most of the questions were asked between 2011 and 2020. Majority of questions were asked by members from Uttar Pradesh followed by Punjab.
   2. Chemical content in soft drinks and quality control: The issue of chemicals in soft drinks was one of the most documented themes. Questions were asked about the percentage levels of individual chemicals like phosphoric acid, aspartame, and anti-freeze compounds. Majority of questions were asked by Uttar Pradesh followed by Bihar, Maharashtra, and Andhra Pradesh. Few parliamentarians questioned about the levels of ammonium sulphite which is carcinogenic and urged the incorporation of cancer warning labels on the pet bottles. A few members highlighted the findings of Centre for Science and Environment on the presence of high pesticide content in soft drinks. The MPs mentioned specific brands of popular soft drinks and demanded for test results. All of the questions were documented between 2002 and 2019.
   3. Advertisement/media regulations: A set of compelling questions were asked on the regulations of advertisements promoting junk foods. Parliamentarians questioned why sugary drinks were allowed to be sold on hospital campuses across the country. They insisted on banning advertisement boards in and around school campuses. A few of them highlighted the false claims of energy drinks for promotional purpose and questioned the reason for endorsement by celebrities. Questions were asked majorly from Maharashtra. Majority of questions were submitted to the MOHFW followed by Ministry of Information and Broadcasting and the Ministry of HRD.
   4. Nutrition labeling: Nutrition labeling-related questions comprised of mandatory display regulations to include the percentage of caffeine, calorie content, and the type and amount of sweetener used in food products and beverages. One of the parliamentarians even demanded the need for a statutory warning on the bottles of soft drinks similar to cigarette packets. Questions under this theme were repeatedly posed by Uttar Pradesh followed Maharashtra and Rajasthan. The questions were raised over a span of two decades between 2002 and 2018.

4. Research and Development:

   1. Surveillance studies: Many parliamentarians urged the ICMR and National Institute of Nutrition to conduct large-scale follow-up studies on the effects of unhealthy junk food consumption among the population. They urged to conduct studies on the correlation between sudden heart attacks and junk food/energy drinks with high caffeine levels. The questions were put forward majorly from Tamil Nadu followed by Uttar Pradesh, and most of the questions were directed toward MOHFW. Questions on research-based initiatives were proposed between the years 2003–2010 and between the years 2015–2021.

5. Policy Formulation:

   1. Nutrition awareness: The parliamentarians urged the government to conduct nationwide nutrition awareness programmes and save the youth from sugary beverage and junk food predatory marketing. Questions accounted under this theme were directed to the MOHFW followed by the Ministry of HRD and the Ministry of Social Justice and Empowerment.
   2. Nationwide junk ban: Parliamentarians from Maharashtra, Andhra Pradesh, Bihar, Jharkhand, and Uttar Pradesh strictly demanded a ban on soft drinks and junk foods across the country. They insisted on closure of fast-food outlets and named various popular fast-food chains in particular. Nationwide ban was repeatedly urged during a period of 5 years between 2003 and 2007.
   3. Ban in educational institutions: School-level interventions in the form of a complete ban on junk food sales in school cafeterias were urged by parliamentarians from 2005 to 2019. Most of the questions were submitted to the MOHFW followed by the Ministry of HRD. Members also urged to declare a blanket ban in junk food sales in all colleges recognized under the UGC commission.

Discussion

The present study analyzed the parliamentary questions raised on unhealthy food consumption patterns among Indians. Junk food is considered as a major factor that contributes to the increasing burden of lifestyle diseases. Considering the massive impact it has on the health economy of a nation, the total number of questions raised on this topic does not justify the urgency of the issue. Out of a total of 28,240 questions asked on all topics in both houses to the MOHFW, only a sum of 166 questions (0.6%) were on junk food and soft drinks. These numbers are alarming and reflect lack of awareness among the democratic representatives of the country. Only 84 unique parliamentarians from 21 states have raised their voices on the present topic of concern. There has not been a single representation from Puducherry, Goa, Andaman and Nicobar, Arunachal Pradesh, Assam, Himachal Pradesh, Manipur, Meghalaya, Mizoram, Nagaland, and Uttarakhand. However, many of these states have high prevalence of overweight and obese population. According to the National Family Health Survey 2015–2016, Andaman has the highest percentage of overweight/obese males (38.2%) followed by Puducherry (37.1%). Goa ranks fifth among overweight/obese males with a percentage of 32.7%.[5] Uttarakhand had the highest percentage of overweight persons (21.6%) in the age group of 18–59 years according to the Annual Health Survey 2014.[6] Questions on the increase in urban junk food culture have been poorly represented at the parliament. Only three questions were asked on the increase in junk food consumption among urban population. These findings do not correlate with the fact that one-third of urban population in India are overweight/obese.[7] Members from urban constituencies should realize the dangers posed by easy availability of junk foods which can lead to significant health inequality in the country.

Questions on health impact of junk food

The questions documented under the theme of health impact were robust, diverse, and informative. Majority of questions from most of the states were based on adverse effects of junk foods. The members focused on rising obesity levels as one of the main effects of junk food intake. These questions have inevitably played a major role in initiating a couple of national level studies on obesity prevalence. Such collective emphasis on a particular issue will definitely garner attention among the policy-making bodies. However, questions on incidence of food poisoning due to substandard junk foods/soft drinks were poorly documented. In 2009, a doctor reported presence of fungus in a bottle of soft drinks from a popular brand.[8] Various other cases have emerged in newspapers including a child vomiting blood after drinking soft drinks. In 2021, a 13-year-old girl succumbed to death after consuming a soft drink. The postmortem revealed that the girl asphyxiated to death after the drink entered her respiratory system.[9] None of these cases have been discussed at the parliament. In many instances, even the brand name of the soft drink has not been revealed by the media. Such practices have to be corrected and members of parliament have to work on stricter laws surrounding food poisoning due to junk foods. The defaulting companies have to be filed under the “Consumer Protection Act of India.”

Questions on the ill effects of soft drinks were discussed moderately. Members raised questions on the lifestyle diseases that arise as a result of soft drink intake. However, specific questions on certain energy drinks and their high caffeine content could have been represented more intensely. Young population have developed addictive tendencies toward sports drinks and energy drinks which are endorsed by popular celebrities. A meta-analysis of clinical studies on energy drinks stated that acute consumption of caffeinated drinks caused hemodynamic effects including raised systolic and diastolic blood pressure.[10] Another randomized trial on the effect of energy drinks on electrocardiographic parameters revealed significant prolong in QTc interval and high blood pressure.[11] Considering the dangers of energy drinks, members of parliament should urge on strict streamlining of such energy drinks, their composition, and celebrity endorsements.

Questions on marketing regulations of junk food

When the questions under the theme of marketing regulations were analyzed, a good number of questions were raised on mandatory display regulations and nutrition labeling apart from the salt and sugar levels in junk food, chemical content in soft drinks, and the permitted pesticide residue levels. Consistent demand from members on these topics successfully manifested in the form of the Food Safety and Standards Act (FSS) in 2006 followed by the “Food Safety and Standards (labeling and display regulations)” in 2011 and a stricter, labeling mandate in 2018. This mandate directs manufacturing companies to mandatorily disclose information on the serving size and the per serve percentage contribution of a particular ingredient (like sugar, salt, trans fats) to the recommended dietary allowance. These rules were framed based on food regulations followed in US, Canada, Israel, Singapore, and Brazil. The FSSAI further urged “front-of-the-packet” labeling contrary to the existing “back-of-the-packet” labeling.[12] This is a positive move that should be put into immediate effect without delay. In such scenarios, we realize the importance of topics discussed in the parliament and the magnanimous changes it can bring about in a democratic nation.

Questions on research, development, and policy formulation

Under the theme of research, many members asked the MOHFW to conduct large-scale studies on the impact of junk food. Repeated representation under this theme has led to the successful execution of “State Level Disease Burden Survey 2016,” “National Family Health survey 2015–16,” and the “Urban Nutrition Survey 2015–16.” However considering the incidence rate of obesity which has doubled in the past single decade, the government has to work on more elaborate research settings and constitutes exclusive committees that maintain a national database on the eating patterns of the population and conduct periodic interventions to eradicate lifestyle diseases.

Under policy formulations, a large percentage of members demanded for a blanket ban on junk foods and soft drinks across the nation and in educational institutions. It is their collective voice that meticulously evolved in the form of “Food Safety and Standards (Safe Foods and Healthy Diets for School Children) in 2019.” This official mandate from FSSAI contained a 10-point charter that bans sale of foods high in fats, salt, and sugar within the school premises and within 50 m around the schools.[13] Such actions prove the combined ability of the parliamentary members in bringing about constructive changes in the interests of the public.

Conclusion

The WHO has been urging countries to maintain strict marketing regulations for foods high in saturated fats, sugars, and salt.[14] Such actions can be taken only with the strong representation and support of parliamentary members. The present study is a novel attempt at analyzing the awareness among parliamentarians regarding unhealthy food consumption, unregulated junk food sales, and its sequelae. The results reveal that questions on junk food and their adverse effects have to be represented much more strongly for creating a desired mark. For a country like India with a majority of young population, it is obvious that food consumption value is huge, rapid, and booming. The stakeholders need to work on more responsible manufacturing of packaged foods and their endorsements. The present study can be a tool in helping policy makers and primary care physicians work on lifestyle diseases and its causes in the Indian subcontinent.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.