Dietary practices, physical activity and social determinants of non-communicable diseases in Nepal: a systemic analysis

Background: The objective of this paper was to describe the role of dietary practices and physical activity in the interaction of the social determinants of non-communicable diseases (NCDs) in Nepal. Method: The study was a qualitative study design guided by systemic intervention methodology. Qualitative data were collected through key informant interviews (n=63) and focus group discussions (n= 12), and case study-based thematic analysis was carried out. Causal loop diagram was utilised to illustrate the dynamic interactions of the social determinants based on the themes. The study also involved sense-making sessions with policy level and local stakeholders. Findings: Four key interacting themes emerged from the study. Dietary and physical activity practices have shifted significantly at community level contributing to increased risk of NCDs. The practice of healthy and locally produced meals was gradually being displaced by junk food and linked to junk food availability and declining agricultural activities. Health system was ineffective in preventing unhealthy practices. Gender and social economic factors were driving the poor dietary practices and physical inactivity. Conclusion: While the current dietary and physical activity-related practices within communities were poor, the broader determinants such as socio-economic circumstances and gender further fuelled such practices. The health system has potential to play an effective role in the prevention of the behavioural and social determinants of NCDs.