India's huge population, its density, and very large numbers of poor present an extraordinary challenge for the country's COVID-19 response, and the Indian government imposed the largest lockdown in history: 1.3 billion people ordered to shelter in place for 21 days as a part of "lockdown 1.0" which began March 25. Even China, where the disease originated, ordered a total lockdown in just one area, Hubei Province (while imposing other restrictions throughout the country). Implementing a lockdown in a country of India's size has been socially, economically, institutionally, and politically very demanding and disproportionately affects the poor, daily wage earners, and other marginalized groups.
This study examines patterns of snack food consumption (SFC) in the rural-urban-slum transect (RUST) of a large city Pune and its precincts (population 10 million) in India. The transect structure aims to mimic a representative survey for the location capturing differences by age, gender, urbanicity, and socio-economic levels. Dietary data from 1405 individuals were used to describe snacking patterns and other food consumed at different frequencies; extent of physical activity; and Body Mass Index (BMI) and waist circumference of children, adolescents, and adults. Our results indicate high incidence of SFC across all population age groups, gender, socio-economic levels, and locations. A distinctive finding in relation to studies in high income countries is the prevalence of hunger snacking with 70% identifying hunger as the primary reason for SFC. Apart from hunger, particularly for adolescents, peer influence and social interactions played a significant role in SFC. Dietary behaviors of slum dwellers were characterized by three-quarters of them having SFC together with family members at home. SFC supplemented calories for low-income consumers and complemented calorie intake for high income ones. No significant association with BMI is possibly due to obesogenic SFC being likely offset by lower consumption of non-snack food and higher physical activity among poor and slum dwellers. Promoting awareness about diets and lifestyles, improving physical and economic access to healthier snacks and nutrient dense foods can improve diet quality in a large and heterogeneous population such as Pune.
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