On the occasion of the World Health Day, on Thursday, Chandigarh scored the dubious honour of having the highest prevalence of diabetes and pre-diabetes in a new survey unveiled by the Union health minister JP Nadda.

The first phase of the Indian Council Medical Research’s ongoing survey to determine diabetes and pre-diabetes in the country, encompassing Chandigarh, Maharashtra, Tamil Nadu and Jharkhand, pegged Chandigarh with the highest prevalence and Jharkhand with the lowest.

16,000 people across three states and the Union Territory of Chandigarh, studied from 2008 to 2011, showed India in a fairly poor light concerning this non-communicable disease, and its rising disease burden on the state, with urban areas leading over rural.

Chandigarh, according to the study ICMR-INDIAB, has 13.6% prevalence of diabetes and 14.6% of prediabetes. It’s followed by Tamil Nadu with 10.4% prevalence of diabetes and 8.3% of pre-diabetes, Maharashtra with 8.4% diabetes and 12.8% pre-diabetes, Jharkhand with 5.3% diabetes and 8.1% pre-diabetes.

Translated into numbers, however, Maharashtra with a higher population ends up with 6 million people with diabetes and 9.2 million with prediabetes.Chandigarh also showed the highest rates of obesity, generalised and abdominal.

Though ICMR has published data for only four states; they do have unpublished findings however for 15 states; the results are worrying enough. They call into question lifestyle choices, particularly in urban areas which have seen markedly higher numbers of diabetes prevalence and of inactivity among subjects, and worrying unawareness about the disease among urban and rural populations. Across regions, 58% urban and 36.8% people were unaware of diabetes and its complications.

Chandigarh saw 14.2% diabetes prevalence in urban areas and 8.3% in rural. Jharkhand however had the starkest difference between urban and rural prevalence, with 13.5% in the former and 3% in the latter. As the study notes, this large gap could be due to urban areas concentrated around industry, with an influx of people from different parts of the country.

There was a marked difference in the food habits of the people studied — 85.3% urban and 83.9% rural population ate wheat, while the rest ate rice in Chandigarh. Tamil Nadu on the other hand was overwhelmingly dependent on rice. Maharashtra had the most diverse food profile, with bajra, jowar and even some ragi incorporated in diets.

At WHO’s technical briefing last week, Dr Anoop Misra, chairman of Fortis Centre for Diabetes, Obesity and Cholesterol, had lambasted Indian, especially urban, food choices and habits, pulling up people’s penchant for fried snacks — samosas, pakoras, parathas, etc — as deeply harmful, and the glaring lack of enough physical exercise. His admonishments find bearings in the study’s figures that point out how much urban India is inactive compared to rural, 65% to the latter’s 50%.

Speaking to dna on Thursday, he said that instead of just focusing on Chandigarh or north Indian lifestyles, he would put major metropolitan cities across India, north and south, in the same basket. “Exposure to Indian and western fast foods, to sweetened beverages, less consumption of fruits and vegetables and disturbed sleep cycles due to professional lives are a combination of factors in urban cities,” he said, adding, “kids get exposed to all these earlier, driving up obesity in them, not just adults, which contributes to diabetes.”

However, he and other experts and also cautioned that lower rural numbers could also mean many unreported cases, possible due to unawareness among people. Indeed, during the survey, doctors found a higher number of newly diagnosed people than subjects who already knew they had diabetes. This was revered only in Tamil Nadu, due to regular screening in the state.

The ICMR survey comes on the heels of a Lancet study, released on 6 April, that put China, India and USA among the top three countries with large numbers of diabetic patients. India has seen a rise from 11.9 million patients in 1980 to 64.5 million in 2014, according to Lancet, with double the prevalence among men and an 80% increase among women.