KATHMANDU: To mark World Diabetes Day, we examine a city case study to gauge the prevalent Nepali dietary regimen: Sita Khatri, a homemaker residing in Shankhamul, Kathmandu, maintains a lifelong, bi-daily necessity for rice consumption, a deeply ingrained habit. Should she forgo rice, she reports a persistent sensation of insufficient sustenance. She articulates this widespread sentiment: “It is simply our customary practice to consume rice both morning and evening at home. Everyone in my family asserts that without rice, one simply does not achieve satiety.”

Arjun Kumar Bhattarai, residing in Bhumahi, Ward 12 of Sunwal Municipality, Nawalparasi, similarly experienced the compulsion of feeling incomplete without rice. His daily dietary structure was heavily dominated by rice during both his morning and evening repasts. Furthermore, his midday sustenance was also demonstrably carbohydrate-rich. His professional life mandated sedentary desk work, rather than demanding physical exertion. This convergence of physical inertia and a diet overwhelmingly comprised of carbohydrates precipitated the onset of diabetes for Bhattarai at the premature age of just 40. He notes the imperative change: “I now restrict my rice intake to only one meal per day, complemented by regular physical exercise.”

The examples of Khatri and Bhattarai, whose adherence to bi-daily rice consumption is non-negotiable, are highly illustrative, serving as mere proxies for the wider populace. Across the nation, rice remains the pre-eminent dietary staple for Nepalis.

Approximately 80 percent of the daily caloric intake for Nepalis is derived from carbohydrates sourced predominantly from rice, wheat, and maize. Consequently, the nutritional patterns of the vast majority of the population exhibit little significant variation.

However, this pervasive reliance on rice is now escalating into a critical national health risk. The excessive, habitual consumption of rice is being scientifically linked as a primary etiological factor contributing to the mounting prevalence of obesity, diabetes, and cardiovascular disease.

According to the Food Composition Table for Nepal, 2012, prepared by the Department of Food Technology and Quality Control, some 100 grams of polished rice contains 78.2 grams of carbohydrates, while 100 grams of parboiled rice contains 77.4 grams of carbohydrates. Some 100 grams of unpolished rice contains 76.7 grams of carbohydrates, and beaten rice contains 77.3 grams. However, the main choices for common Nepalis are rice and beaten rice.

Although the amount of carbohydrates in the diet is excessive, there is no data on how much of each food Nepalis consume. Nepalis have made rice, potatoes, and items made from refined flour the main part of their daily diet. In the mountains, potatoes; in the hills, rice; and in the Terai, wheat bread are the main parts of the Nepali daily diet. White rice and dishes made from refined flour instantly raise glucose in the body compared to high-fiber grains like millet and buckwheat. Ultimately, this increases the imbalance of insulin in the blood, leading to an increase in obesity, diabetes, and heart disease.

The surge in patients presenting with heightened obesity, diabetes, and hypertension is the direct consequence of the elevated carbohydrate composition within the Nepali diet, placing a significant and growing strain on the nation’s healthcare facilities.

Dr. Jyoti Bhattarai, a diabetes specialist based at Metro Hospital Maharajgunj, dedicates her clinical hours to managing these patients in the OPD and offering specialized dietary consultation. Her clinic receives between 20 and 25 patients suffering from obesity and diabetes daily.

Dr. Jyoti Bhattarai, a diabetes specialist at Metro Hospital, explains to a patient about a balanced diet. Photo: Bikram Rai/Nepal News

Dr. Bhattarai’s observations reveal a widespread tendency to disregard established knowledge concerning the maintenance of physical fitness through judicious nutrition and a structured physical regimen. She attributes the rising prevalence of diabetes, obesity, high blood pressure, and cardiovascular ailments among Nepalis to this pervasive lack of dietary and exercise discipline. She underscores the gravity of the situation, stating, “Approximately 30 percent of the patients seen in the OPD daily are either diabetic or in a pre-diabetic state. The principal etiology for this is the immoderate intake of carbohydrate-laden foodstuffs.”

According to Dr. Bhattarai, the Nepali diet is primarily dominated by carbohydrates. Many Nepalis eat rice at both meals, and the afternoon snack is also rich. Carbohydrate-laden foodstuffs provide energy to the body, but when that is more than the body needs, health risks increase. She says, “For a healthy life, about 50 percent of daily calories should be obtained from healthy carbohydrates. But the average Nepali gets 80 percent of calories from carbohydrates. This has increased health risks.”

In 2023, the World Health Organization (WHO) issued new standards for carbohydrate and fiber intake for a healthy diet. According to that standard, the main sources of carbohydrates should be vegetables, fruits, and pulses. Individuals aged two years or above should consume 400 grams of fruits and vegetables and more than 25 grams of fiber daily. For children aged two to five years, at least 250 grams; for six to nine years, 350 grams; and for 10 years or above, 400 grams of carbohydrates per day should come from vegetables, fruits, and pulses. However, the number of Nepalis who eat vegetables and fruits according to this standard is low. Many are not even aware of this standard. Still, it is a distant prospect for Nepalis in rural areas to get regular fruit, and even in the city, fruit is not easily available to everyone. Therefore, the easy choice for many has become pulses, rice, and vegetables.

A 2023 study by the World Health Organization in Asian countries showed that people who consume more carbohydrates have a heart disease risk 1.52 times greater, or more than 52 percent higher, than those who consume fewer carbohydrates. It may be the effect of excessive sugar and carbohydrates: data from the Department of Health Services shows that diabetes affects 8.5 percent of Nepal’s adult population. A study on carbohydrate intake and the risk of heart disease published in the PubMed journal in 2025 concluded that consuming too many carbohydrates increases the risk of heart disease and metabolic syndrome. It states that individuals who consume more than 60 percent of their daily calories from carbohydrates have a higher risk of heart disease. To what extent is this true? That study suggested consuming only 52 percent of daily calories from carbohydrates. According to Kabita Maharjan, a nutritionist working at the Nepal Cancer Hospital in Harisiddhi, Lalitpur, to be healthy, not only must carbohydrate intake be balanced, but its quality must also be good. Carbohydrates like fiber-rich, less processed or parboiled rice, and whole wheat flour are considered good for health, while highly processed white rice and carbohydrates derived from refined flour are harmful.

A study on carbohydrate intake and the risk of heart disease published in the PubMed journal in 2025 concluded that consuming too many carbohydrates increases the risk of heart disease and metabolic syndrome.

According to nutritionist Maharjan, although the consumption of carbohydrates is not measured, the diet of Nepali adults is based on rice and potatoes, so the source of calories is, on average, 70 to 80 percent carbohydrate. The 2023 standard issued by the World Health Organization states that adults should get a minimum of 45 percent to a maximum of 65 percent of total calories from carbohydrates. But the average Nepali consumes more carbohydrates than this standard.

Across the border: India suffers the same dietary crisis

On September 30, 2025, the Indian Council of Medical Research conducted a survey on diseases like diabetes, pre-diabetes, and high blood pressure in various states of India. That survey shows that diabetes, obesity, and metabolic diseases are increasing. The survey covered the dietary patterns of more than 18,000 adults in India. It shows that more than 62 percent of the total daily calories of Indians come from low-quality carbohydrates such as white rice, refined wheat flour, and added sugar. The survey showed that individuals who consumed the most carbohydrates had a 30 percent higher risk of type two diabetes, a 20 percent higher risk of pre-diabetes, and a 22 percent higher risk of general obesity compared to those who consumed the least carbohydrates.

Since there is not a big difference between Nepali and Indian eating styles, doctors’ analysis is that this risk will be the same for Nepalis as it is for Indians. Nutritionist Maharjan says, “There is not a big difference in the eating habits of Nepalis and Indians. Therefore, the carbohydrate risk for Nepalis is the same as for Indians.” According to her, the nutritional needs (carbohydrates) for each person are different. However, there is insufficient information available to the general public about how many calories, how much zinc, or how much potassium is needed for a healthy person.

According to Deepak Jha, Chief of the Nutrition Unit of the Family Welfare Division under the Department of Health Services, there is a lack of information about diet and nutrition in Nepal. Nutrition Unit Chief Jha says, “There is no significant difference in the way food is consumed in Nepal and India. But we do not have standards to measure how much carbohydrate, protein, or other nutrients are needed. There is also no practice of counting how much carbohydrate we are consuming daily.” According to him, although the calories are mentioned on the rice and packaged food items found in the market, information about the necessary nutrients is lacking. As a result, the average Nepali does not know how many calories they need and how much they are consuming.

The WHO and the Food and Agriculture Organization have jointly determined the daily required amounts of protein, carbohydrates, vitamins, and minerals. That guidance on good eating, issued two years ago, states that Nepalis get an average of 2,536 calories from the food they consume daily. This is slightly more than the minimum daily calories required for the average adult. According to that guidance, every adult needs an average of 2,220 calories daily. However, the daily calorie intake can vary according to geographic-economic conditions, the person’s work, and profession. What is interesting in that guidance is that Nepal’s annual per capita rice consumption is mentioned as 84.4 kilograms. That is, an average adult in Nepal consumes 84 kilograms of rice per year. It states that the use of grains like beaten rice, barley, and sorghum or proso millet is very low.

According to Deepak Jha, Chief of the Nutrition Unit of the Family Welfare Division under the Department of Health Services, there is a lack of information about diet and nutrition in Nepal.

Junk food, which many people like, is simply food that provides calories but no other nutrients. These carbohydrate-rich foods have increased the risk of non-communicable diseases like diabetes and cancer. Besides grains like rice and wheat, beverages like juice and coke also contain high carbohydrates. Therefore, it is necessary to limit their consumption. Dr. Jyoti Bhattarai, a diabetes specialist, says that knowledge of balanced eating should be taught from school. She says, “When preparing a nutrition plan, 80 percent carbohydrates used to be included, but now it has been reduced to 50 percent. A diet plan should only be made after examining daily activities and the digestive process.”

According to her suggestion, a diet that is nutritionally balanced consists of home-cooked food, unpackaged food, and a higher quantity of vegetables, pulses, legumes, and curd, with a lower amount of rice. However, Nepalis are not found to follow a balanced nutrition plan. Eating whatever is available and eating a lot is a common habit of many Nepalis. Diabetes specialist Dr. Bhattarai states that carbohydrates should not be completely eliminated from the diet, but excessive consumption is definitely fatal. She adds, “Taxes should be imposed on beverages like Coke, Fanta, and juice, and their sale near schools should be stopped. Junk food increases diabetes in children. High-carb junk food should be banned entirely to protect health.”

Due to increasing carbohydrate consumption, the prevalence of non-communicable diseases is rising in Nepal. The latest data from the Global Burden of Disease, 2021, presents a frightening picture where non-communicable diseases account for 73 percent of total deaths in Nepal. This was 71.1 percent in 2019 and 66 percent in 2017, making non-communicable diseases the biggest threat to the lives of Nepalis now. The dietary pattern of Nepalis is very different from the World Health Organization’s standard.

The Ministry of Health and Population has introduced the ‘Multisectoral Action Plan (2021–2025).’ It aims to reduce deaths from non-communicable diseases by 25 percent. However, there is no major awareness campaign about what to eat and how much to eat to be healthy. According to nutritionist Maharjan, there is no preparation in Nepal to control carbohydrate levels or educate the public about proper nutrition. Consequently, oil rich in trans fat and processed foods are easily available everywhere. High-carbohydrate and high-fat foods that are easily available in cities, like momo, chowmein, samosa, roti, and pizza, including noodles, have also become easily available in villages. This has increased the risk further. Nevertheless, World Health Organization data shows that carbohydrate consumption in urban areas is 30 percent higher than in rural areas due to work busyness and easy access to fast food. The reason doctors emphasize reducing processed grains and consuming fiber-rich grains, pulses, vegetables, and fruits is precisely to reduce carbohydrates. However, this is not widely followed. Nutritionist Maharjan states that limiting carbohydrates to 50 percent of daily calories reduces health risks. She says, “But currently, many times more carbs than necessary are being consumed.”

In the understanding of diabetes specialist Dr. Jyoti Bhattarai, if attention is not paid to the quantity and quality of carbohydrates now, this crisis will become a serious challenge for the health system in a few years. A balanced diet, regular exercise, and awareness education are mandatory for a healthy society. She says, “Not medicine, but proper diet and lifestyle is the cheapest and most permanent way to fight diseases. But if the diet consists of only carbohydrates morning and evening, a health crisis that the country cannot withstand will arise.”