NFHS-6: Southern States Lead India’s Diabetes And Obesity Rankings

Nearly one in three adult men in Kerala now has diabetes or elevated blood sugar levels.

The figure, 31.9 per cent, according to the latest National Family Health Survey (NFHS-6), is among the starkest indicators yet of a profound health transition underway in India. While large parts of northern and central India continue to struggle with stunting, wasting and underweight children, much of South India is confronting a very different public-health challenge: soaring obesity, rising diabetes and an expanding burden of chronic disease.

The latest NFHS fact sheets suggest that the South might become India's diabetes and obesity story.

Kerala leads the country in diabetes prevalence among both men and women. Nearly one in three men (31.9 per cent) and close to three in ten women (28.9 per cent) either have high blood sugar levels or are on medication for diabetes. Tamil Nadu follows closely, with diabetes affecting 26.7 per cent of men and 25.2 per cent of women. Karnataka and Telangana have also recorded substantial increases, indicating that the trend is spreading across the region.

The numbers reflect a broader epidemiological shift. States that historically performed better on maternal and child health indicators are now grappling with diseases linked to ageing populations, sedentary lifestyles and changing diets. 

The obesity figures tell a similar story.

In Kerala, nearly half of all women, 46.7 per cent, are overweight or obese. Tamil Nadu follows at 44.2 per cent, while Karnataka has crossed the 40 per cent mark at 41.2 per cent. Among men, Tamil Nadu tops the chart with 38.8 per cent classified as overweight or obese, followed by Kerala at 37 per cent and Telangana at 35.5 per cent.

Taken together, the data show that southern states dominate India's rankings for both diabetes and obesity.

Perhaps the most dramatic shift is visible in Karnataka. Among women, diabetes prevalence jumped from 14 percent in NFHS-5 to 22.3 per cent in NFHS-6. Obesity rose from 30.2 per cent to 41.2 per cent during the same period. Among men, diabetes surged from 15.6 per cent to 26.1 per cent, while obesity increased from 30.9 per cent to 36.4 per cent.

Few states in the country have recorded such sharp increases across multiple metabolic-health indicators over a single survey cycle. Kerala's trajectory is equally significant, though for a different reason.

Unlike Karnataka, Kerala was already carrying a heavy burden of non-communicable diseases during NFHS-5. The latest survey shows that the trend has only intensified. Diabetes among women increased from 24.8 per cent to 28.9 per cent, while obesity rose from 38.2 per cent to 46.7 per cent. Among men, diabetes climbed from 27 per cent to 31.9 per cent.

The data suggest that Kerala may have entered a phase where chronic disease have become the state's dominant public-health concern.

Tamil Nadu presents an even more complex picture. The state has managed to reduce stunting among children from 25 per cent to 20.7 per cent, a sign of progress on long-standing nutrition challenges. Yet child wasting increased from 14.6 per cent to 17.4 per cent, while underweight prevalence rose from 22 per cent to 23.2 per cent.

At the same time, adult obesity and diabetes continued to climb.

The result is what public-health experts describe as a "double burden of malnutrition", a situation where obesity and diabetes coexist alongside persistent child undernutrition within the same population.

Telangana appears to be moving in a similar direction. Diabetes among women increased from 14.7 per cent to 19.6 per cent, while prevalence among men rose from 18.1 per cent to 24.5 per cent. Obesity rates also climbed steadily among both sexes.

The state's profile increasingly resembles that of Kerala and Tamil Nadu, suggesting that metabolic diseases are becoming a defining health challenge across much of southern India.

The contrast with northern and central India is striking. States such as Jharkhand, Bihar, Rajasthan and Madhya Pradesh continue to dominate the country's stunting, wasting and underweight rankings. Their public-health battle remains centred on inadequate nutrition, poor maternal health and childhood growth deficits.

In the South, however, the challenge has shifted. The region's relatively better socioeconomic indicators, lower fertility rates, urbanisation and longer life expectancy have coincided with rising rates of obesity, diabetes and other non-communicable diseases.

A study published in The Lancet Global Health, which analysed data from nearly 58,000 participants across India between 2017 and 2019 as part of the Longitudinal Ageing Study in India, also found that nearly one in three middle-aged and older adults in South India is living with diabetes, placing the region among the worst affected in the country.

The findings come as India continues to lag behind the targets set under the World Health Organization's Global Diabetes Compact, which aims to improve diabetes prevention, diagnosis and treatment outcomes by 2030.

While diabetes increased sharply across southern states, the trend for hypertension was more mixed. In Telangana, the prevalence of elevated blood pressure among women fell from 26.1 per cent in NFHS-5 to 24.2 per cent in NFHS-6, while among men it declined from 31.4 per cent to 28.2 per cent. 

Tamil Nadu recorded an even steeper decline, with hypertension among women dropping from 31.2 per cent to 24.5 per cent and among men from 37.7 per cent to 26.3 per cent. In contrast, Kerala saw a modest increase, from 23.1 per cent to 24.9 per cent among women and from 24.4 per cent to 27.7 per cent among men. Karnataka remained largely stable, with hypertension among women rising marginally from 25.0 per cent to 25.1 per cent and among men from 26.9 per cent to 28.2 per cent.

In Andhra Pradesh, the prevalence was broadly unchanged among men at 28.7 per cent, while among women it increased slightly from 22.3 per cent to 23.7 per cent. These findings suggest that unlike diabetes and obesity, which rose consistently across the region, hypertension did not register a uniform increase.