LET us commit to Act for Nutrition. After all, Pakistan’s nutrition emergency is most visible in its children — around four in 10 children under five are stunted — due to poverty, poor maternal nutrition, recurrent illness, unsafe water, and inadequate feeding habits. However, a conversation conducted entirely in the language of scarcity will miss the other end — the fact that well-fed affluent households are not well nourished. Money can buy good food. It cannot make you choose it.
The national household consumption data shows carbohydrates supply over 76 per cent of the average Pakistani diet, while protein barely reaches the minimum level of 10pc recommended by WHO — four out of 10 households fell below the minimum recommended share; 58pc of urban households and 44pc of our rural households experience protein deficiency. The middle-class Pakistani’s plate is dominated by carbohydrates. Protein forms a small portion.
This imbalance extends to other dietary components too. We have conducted hundreds of nutrition assessments in Islamabad, including population- and individual-level evaluations for people from all socioeconomic backgrounds. Rice or roti dominates the meal; a small piece of chicken, consumed once or twice a week, defines many people’s protein intake, and their milk intake means the few spoonfuls taken in tea. Breakfast, frequently skipped by the working class, is likely to contain negligible or no protein; the first proper serving is often only consumed at dinner.
We have also found flaws in some population-level questionnaires, such as the Diet Quality Questionnaire. While globally accepted, the DQQ can only record whether a food was eaten but not how much of it was eaten. A splash of milk in tea, therefore, receives the same ‘yes’ on the survey as a glass of milk. Our one-on-one nutrition assessments have exposed how protein is often merely an accessory in a meal composed mainly of carbohydrates. The distinction determines what we can do to Act for Nutrition. When protein-rich foods are absent, price and access require attention. When they appear in token quantities, we must examine portions, household routines, and how meals are planned. For households that can afford eggs, yogurt, pulses, chicken, or fish, it is not a problem of scarcity but one that is a behavioural issue. Poor nutrition is as harmful for the poor as it is for the affluent. Take protein as an example. It supports growth, tissue repair, immunity, and muscle maintenance. In our assessments, inadequate protein intake appears consistently alongside low muscle mass and excess body fat. Some studies say almost half of urban Pakistanis suffer from skeletal muscle mass deficits.
Nutritional outcomes aren’t determined by poverty alone.
With age, the impact becomes harder to ignore. Low muscle mass leaves less reserve during illness, slows recovery, and turns ordinary tasks into physical tests. Stairs become harder to take, falls more dangerous, and independence begins to narrow. When coupled with a chronic disease like diabetes, protein deficiency can lead to severe — and irreversible — consequences like muscular atrophy. Yet we discuss protein as though it is reserved for bodybuilders alone. It belongs just as urgently to children, pregnant women, working adults, and senior citizens who want to go on with their activities without assistance.
So yes, let’s Act for Nutrition. Let’s acknowledge that poverty and scarcity are not the only determinants of nutritional outcomes. Many affluent people today are full — yet malnourished. Let’s make protein visible. Let’s include a recognisable portion of protein in every meal: dal, chana, lobia, eggs, yogurt, milk, fish, chicken, or meat are easily available locally and can adapt to various mealtimes. Protein should be distributed across the day instead of being saved for dinner. Roti and rice need not disappear; they must simply stop occupying most of the plate. Let’s make nutrition assessments routine in primary care, educational institutions, workplaces, and fitness settings. Let’s encourage canteens and cafeterias — especially in hospitals, schools, and workplaces — to serve adequate amounts of quality protein.
None of this reduces concerns regarding poverty. Millions of Pakistanis need better incomes, affordable food, social protection, and nutritious school meals because meaningful choices remain out of their reach. Meanwhile, households with sufficient means need help in converting their purchasing power into daily behaviour — and a better understanding of what it means to Act for Nutrition when they donate to the poor. A nutrition response designed around food availability alone will not achieve this.
Faria Faisal is a diet and nutrition specialist at Karavan, a public health enterprise in Islamabad.
Faizaan Qayyum, has a PhD in planning, studies urban public health in Global South cities and heads Karavan.
Published in Dawn, September 18th, 2026
