Increased urbanized lifestyle implies diet transition, reduced physical activity, mental strains with tobacco and alcohol use. That in turn, increases obesity, raises blood pressure, sugar and lipids, the common risk factors of interrelated non-communicable diseases (NCDs). Individual susceptibility and chronic inflammation make huge area of biomedical understanding. Behaviour modifying interventions are prudent for control but food choices also depend on affordability and availability. The low and middle income groups are driven to cheap unhealthy energy dense foods. The scenario of socioeconomic and nutrition transition in India is mounting the non communicable diseases at alarming speed and magnitude. Cardiac death has become number one killer already. Demographic transition is making the poorer and rural population vulnerable too. Prevention programmes are warranted with urgency. Whole grains, legumes, fish, fresh fruits and vegetables constitute healthy old food pattern. Dietary education under strained finances may be ineffective. Policies of food availability made in exclusion of consultation with health sector undermine prevention of NCDs. Recognition of diverse perspectives in social life and environment call for multisectorial engagement with appropriate interventions to reverse the NCDs epidemic.