Life-Course Framework for Institute-Based Surveillance of Overweight, Obesity, and Metabolic Risk Factors in India: Protocol for Surveillance System Development

Background: India faces a complex spectrum of malnutrition, with undernutrition, micronutrient deficiencies, and rising overweight and obesity coexisting across populations and life stages. National surveys, such as the National Family Health Survey, Comprehensive National Nutrition Survey, and WHO STEPwise approach to Surveillance, provide essential population-level estimates but are episodic, limiting their utility for timely, institution-level prevention and early detection of nutrition and metabolic risks. Continuous, life course-oriented surveillance is required to support responsive public health action and double-duty approaches addressing multiple forms of malnutrition. Objective: This study aims to describe a life course framework and study protocol for an institute-based, standardized surveillance system to monitor overweight, obesity, and metabolic risk factors in India. Methods: This study protocol was developed through a structured synthesis of international surveillance models and public health frameworks, combined with operational insights from ongoing implementation initiatives in India. The proposed surveillance system is institution-anchored and spans key life stages from preconception to young adulthood. Core domains include anthropometry, diet, selected biochemical markers, and behavioral risk factors. Data collection is designed using a hybrid model incorporating optical mark recognition-based paper tools, digital platforms, and connected measurement devices, guided by principles of primary health care, including equity, community participation, intersectoral coordination, and appropriate technology. Results: The surveillance protocol has transitioned from conceptual development to implementation through 2 intramural research platforms: NULRISC (sanctioned July 2024) and COPRIME (sanctioned May 2025). Formative phase activities are ongoing in Telangana across approximately 15 high schools and colleges, as well as primary health care-linked platforms, including 3 primary health centers, 2 kindergartens, and 5 primary schools. At the time of manuscript revision, 10 educational institutions (5 schools and 5 colleges) were onboarded, with expansion to 30 institutions planned. The first surveillance round is scheduled for June 2026 in Hyderabad and Medchal-Malkajgiri districts, and initial analytical outputs are anticipated in 2027. Conclusions: An institute-based, standardized surveillance system has the potential to shift nutrition and metabolic risk monitoring in India from episodic assessment to continuous prevention. By embedding surveillance within routine institutional platforms and aligning with primary health care principles, the proposed protocol offers a feasible and sustainable approach to strengthening evidence-informed policy and practice across the life course.