Obese India: A ticking time
By Mahima Sukhdev
years from now, if current trends persist, obesity will be
up there with climate change and water shortage as one of
the biggest problems facing India.
is something very real about obesity-linked diseases and their
prevalence in India. We have the world's largest population
of diabetics and this number - already at 37 million - is
set to more than double in the next 25 years, according to
the World Health Organisation (WHO).
study by a Canada-based professor of medicine warns that by
2010 nearly 60 percent of the world's heart patients will
be in India. School surveys have shown that 30 percent of
adolescents in our cities are already overweight. As these
adolescents reach adulthood they will add to the spiralling
numbers of diabetics, heart patients and hypertension sufferers.
the impact of this on the healthcare system. Given that we
have just marked World Diabetes Day (Nov 14) and India's eighth
Anti-Obesity Day will be held Nov 26, it is a good time to
pause and consider how what we eat today is shaping our nation's
a rapidly developing country, India has a poor prognosis for
its growing obesity problem. Globally, the link between economic
development and nutrition transition has been amply proven.
Shetty, of the Food and Agriculture Organisation (FAO), says
lifestyle and food habits change as an economy develops. There
is a significant increase in the consumption of fats, sugars
and energy-dense foods. The main drivers behind changing lifestyle
and food habits are rising incomes, urbanisation and globalisation.
incomes and urbanisation lead to the substitution of servants
or appliances for physical work around the house, while family
breadwinners take to desk jobs instead of ploughing the fields.
These factors also encourage more sedentary pursuits such
as television viewing and computer use, and well-off city-dwellers
travel by car instead of walking or cycling.
the same time, globalisation puts junk food and fast food
within easy reach of a population often hard-pressed to find
time to cook healthy meals, but with more than enough money
to buy a greasy lunch at a nearby restaurant.
India, these factors have contributed to the rise of bad eating
habits and lack of exercise amongst a growing urban middle
class, and their effects are startlingly visible. A University
of North Carolina study conducted in Andhra Pradesh showed
that 37 percent of women living in cities are clinically overweight
or obese, and a study by the All India Institute of Medical
Sciences (AIIMS) found that 76 percent of women in Delhi suffer
from abdominal obesity.
India's obesity crisis has been further exacerbated by some
peculiarly Indian factors. Despite India being a vegetarianism
stronghold, the average Indian's diet severely lacks fruit
and vegetables - an abysmal low of 150 gm a day against the
WHO recommendation of 400 gm a day.
our calories come mostly from refined carbohydrates and fats.
Indian food also tends to be amongst the most oil-rich in
the world, and while we have taken Western junk food to heart
(quite literally!) we have our own array of fried snacks (think
pakoras, samosas and vadas) which make us susceptible to weight
gain without even factoring in globalisation.
add to this dismal picture are schools which promote a culture
of fierce academic competitiveness and leave children with
no time to play or exercise. That we are as an ethnic group
more genetically prone to obesity and its health consequences
is the cherry on top. Indians have up to five percent more
body fat than Caucasians at a given weight and height, suggesting
that we may face higher health risks than we expect at our
weight. Some researchers have even gone so far as to suggest
that Indians are genetically more likely to store fat due
to a 'thrifty gene' that evolved out of undernourishment in
the enormous impact obesity and its associated diseases are
going to have on our already strained healthcare system, our
economy and most importantly our national well-being, it is
strange that obesity does not make it to the agenda of Indian
public health policy in any significant way.
again this can be traced to our history of undernourishment.
Amidst poverty and deprivation, the words fat and prosperous
are synonymous. Many are still unaware that too much fat can
be a dangerous thing. In addition, healthcare providers and
policymakers in India are historically used to dealing with
is not to say undernourishment does not exist in India. It
does, on a very significant scale, but this just makes the
task of policymakers a dual challenge. The formulation of
a broad food policy that encompasses both under- and over-nutrition
is the only answer to India's peculiar problem.
dealing with obesity, we have to shift from treating it merely
as a personal problem to tackling it as we would any other
public health issue. Given the future trajectory of the obesity
epidemic in India, it will be most economical to nip the problem
in the bud by attempting to prevent rather than cure.
of expensive weight loss clinics and obesity surgery which
only the rich can afford, we must look to large-scale preventive
measures such as nutritional education made mandatory in schools
and for parents, development of parks, playgrounds and school
sports programmes, and sweeping changes to our food environment
through legislation and/or government intervention such as
banning the sale of junk food in and around schools. We must
even seriously consider changing our agricultural and food
price policies to encourage the consumption of healthier foods.
these measures, the ones that focus on children are likely
to yield the best results. Dietary habits last a lifetime
and given India's youth-heavy population pyramid, these children
could grow up into healthy young adults in the future, alleviating
the burden on our healthcare system and, more importantly,
living longer and healthier lives.
us waste no time in acting on these suggestions.
Sukhdev attends Yale University and is a student of Dr. Kelly
Brownell, internationally renowned expert on obesity and weight
control. She can be contacted at firstname.lastname@example.org)