The Central Government has announced a plan to make rice fortification mandatory in India over the next three years in order to fight the high prevalence of anemia in the country. Fortification means increasing rice’s content of essential micronutrients, especially iron, vitamin B12, and folic acid, which together prevent anemia.

This move, however, is not the end of anemia in the country. Fortified food only addresses iron-deficiency anemia, not other types of anemia. Even then, its effectiveness at reducing iron-deficiency anemia is hit-or-miss. And the trade-offs aren’t always worth the attempt — fortifying food can worsen malnutrition, some experts say, and fortifying rice, specifically, overlooks the very real health risks associated with high rice consumption.

Iron-deficiency anemia is a deficiency disease that causes low red blood cell levels, leading to fatigue and dizziness among other symptoms. It is the most common type of anemia in India. But food fortification hasn’t had a blanket success in curbing it. A study of programs using fortified wheat flour in Jordan found iron-deficiency anemia rates reduced from 26% to 14% in children, but stayed the same among adult women. (And this kind of success appears highly dependant on taste — in a meta-analysis of iron-fortification programs published in Nutrients, researchers observed that a 25% decrease in anemia prevalence only occurred if the smell and taste of fortified foods matched that of their non-fortified versions.)

Even then, food fortification might be worth its marginal successes — except fortified foods can sometimes exacerbate overall malnutrition. Nutrition policy researchers believe India’s malnutrition problem is endemic, with 69% of children below five years old dying of malnutrition as of 2019.

“Sometimes [food fortification] can have the opposite effect. Natural foods contain protective substances such as phytochemicals and polyunsaturated fat that are adversely affected by the process of blending micronutrients,” Delhi-based pediatrician Arun Gupta told Down to Earth.

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There’s no doubt anemia is a problem in India. “Anemia leads to the economic loss to the nation due to lesser productivity of the population. Furthermore, [addressing anemia] will reduce the problem of low birth rate and compromised mental development,” an official from the Food Safety and Standards Authority of India (FSSAI) told The Print.

But focusing on rice, a staple food for 70% of the Indian population, as the grain to fortify, comes with potential drawbacks that could have implications for the economy as well. Namely, the direct link between high white rice consumption and both diabetes and metabolic syndrome. Fortifying rice may reduce the prevalence of anemia, but may also encourage the high consumption of white rice, potentially driving the prevalence of diabetes. Diabetes is a growing problem in India, with a 12% national prevalence for men and women. As of 2019, India is home to one in every six people diagnosed worldwide with diabetes (around 77 million patients).

The good news is, rice is one of several foods the government will be mandating fortification for. The Government announcement suggests fortification rules around edible oil, milk, wheat, and salt are on the horizon as well. Still, the focus on rice fortification assumes any gains against anemia won’t be offset by losses to diabetes. Let’s hope that assumption is right.