India’s Burden of Rising Obesity, the Hefty Cost to Pay

Context

• The prevalence of obesity varies widely across states, affecting both urban and rural populations.
• Additionally, the World Obesity Federation has identified India as having one of the highest annual increases in childhood obesity globally.
• The alarming rise in obesity has severe health implications, contributing to conditions like diabetes, hypertension, and cardiovascular diseases, as well as imposing a heavy economic burden on the country.
• Despite these concerns, obesity remains an under-addressed issue in India’s public health agenda, requiring urgent attention and policy-driven interventions.

Rising Prevalence of Obesity in India

• Recent data from the National Family Health Survey (NFHS-5, 2019-21) indicates that nearly one in four Indian adults is either overweight or obese.
• However, the prevalence of obesity varies significantly across states, regions, and demographic groups.
• In some states, obesity rates are as low as 8%, while in others, they exceed 50%.
• Both men and women in urban and rural settings are affected, although urban populations tend to have a higher prevalence due to lifestyle factors.
• The situation is even more alarming among children. The World Obesity Federation has identified India as having one of the steepest annual increases in childhood obesity worldwide.
• Over the past 15 years, the number of overweight and obese children in India has doubled, and in the last 30 years, it has tripled.
• This trend is concerning as childhood obesity often leads to obesity in adulthood, increasing the risk of chronic diseases at an earlier age.
• A nationwide study published in The Lancet Diabetes and Endocrinology (2023) estimated that among Indian adults aged 20 and above:
  • 35 crore people (one in three) have abdominal obesity
  • 25 crore people (one in four) have general obesity
  • 21 crore people (one in five) have high levels of blood cholesterol
• These figures indicate that obesity is not only a growing problem but also a complex health issue affecting multiple aspects of well-being, including cardiovascular health, metabolism, and overall quality of life.

Causes of the Obesity Epidemic in India

• Transition from Undernutrition to Overnutrition
  • Historically, India has battled malnutrition and undernutrition, with large sections of the population suffering from food scarcity.
  • However, in recent years, the country has transitioned from being a "calorie-deficient" to a "calorie-sufficient" nation, though food distribution remains inequitable.
  • While many still struggle with hunger and undernutrition, a significant portion of the population has easy access to calorie-dense foods, leading to a paradoxical rise in obesity alongside malnutrition.
• Poor Dietary Habits
  • The increased consumption of high-fat, salt, and sugar (HFSS) foods and ultra-processed foods (UPFs) is one of the primary drivers of obesity.
  • These foods, which include sugary beverages, fast food, packaged snacks, and processed meats, are often low in essential nutrients but high in calories.
  • The affordability and accessibility of such foods have led to an increase in unhealthy eating habits, especially among urban populations.
  • A significant challenge is that eating healthy is becoming more expensive than consuming junk food.
  • Fresh fruits, vegetables, and nutritious whole foods are often costlier than processed, packaged, and fried foods, making it difficult for many families to maintain a balanced diet.
• Sedentary Lifestyles and Lack of Physical Activity
  • Urbanisation has led to drastic changes in how people live and work.
  • Traditional lifestyles, which involved higher levels of physical activity, have been replaced by sedentary habits, especially in cities.
  • Long hours of screen time, desk jobs, reduced outdoor activities, and increased dependence on motorized transport have all contributed to lower levels of physical movement.
  • According to the World Health Organization (WHO), nearly 50% of Indians fail to meet the recommended levels of physical activity.
  • The lack of open spaces, parks, cycling tracks, and pedestrian-friendly infrastructure in cities has further discouraged physical movement.

Health and Economic Consequences of Obesity

• Increased Burden of Non-Communicable Diseases (NCDs)
  • Diabetes: India is home to over 100 million diabetics, with numbers rising due to obesity.
  • Cardiovascular Diseases: High cholesterol and obesity contribute to heart disease, the leading cause of death in India.
  • Hypertension: Obesity leads to high blood pressure, increasing the risk of strokes and kidney diseases.
  • Cancer: Certain types of cancer, including breast and colon cancer, are linked to obesity.
  • The increasing burden of obesity-related diseases places immense pressure on India’s healthcare system, requiring urgent intervention.
• Economic Costs of Obesity
  • The Global Obesity Observatory (2019) estimated that the economic cost of obesity in India was $28.95 billion (₹1,800 per capita), or 1.02% of GDP.
  • These costs are associated with:
    • Higher healthcare expenditures for obesity-related diseases
    • Lost productivity due to obesity-related illnesses
    • Reduced workforce efficiency and higher absenteeism
  • If left unchecked, the economic burden of obesity is projected to increase to ₹4,700 per capita by 2030 (1.57% of GDP).
  • This growing financial strain highlights the urgent need for policy-driven solutions to curb the obesity epidemic.

Policy and Programmatic Solutions to Tackle Obesity

• Public Awareness and Education
  • A structured public awareness campaign is needed to reframe obesity as a chronic disease that requires prevention and management.
  • Educating people about the link between obesity and conditions like diabetes, hypertension, and liver disorders is crucial.
• Promotion of Physical Activity
  • Urban planning must prioritise active lifestyles by incorporating bicycle lanes, public parks, and open gymnasiums to encourage physical activity.
  • Workplaces and schools should also facilitate exercise-friendly environments.
• Regulation of Processed and Unhealthy Foods
  • HFSS and UPF products should be taxed at higher rates, while subsidies should be provided for healthier food options like fruits and vegetables.
  • The food industry should be encouraged to adopt ethical marketing practices to reduce the appeal of unhealthy foods.
• Integration of Obesity Screening in Healthcare
  • Regular health check-ups should include measurements of weight, height, and waist circumference.
  • Discussions about maintaining a healthy weight should be a routine part of healthcare visits.
  • A simple guideline, such as maintaining a waist circumference below 80 cm for women and 90 cm for men, can help individuals track their health.
• Medical Interventions and Guidelines
  • The availability of anti-obesity medications is increasing, but there is a need for clear guidelines on their appropriate use.
  • Medical professionals must be trained to identify and treat obesity effectively.
• Workplace and Community Interventions
  • Workplaces should promote awareness campaigns, provide weighing scales, and encourage employees to maintain a healthy weight.
  • A culture of regular health monitoring should be embedded in corporate policies.

Conclusion

• The rising prevalence of overweight and obesity in India poses a serious threat to public health and economic stability.
• Tackling obesity requires a collective effort from individuals, healthcare professionals, policymakers, and businesses.
• A comprehensive strategy involving awareness, taxation, urban planning, healthcare screening, medical interventions, and school programs is essential.
• By taking immediate and coordinated action, India can build a healthier and more prosperous future, ensuring that its economic growth is not undermined by preventable health crises.

Q1. What percentage of Indian adults are overweight or obese, according to NFHS-5 (2019-21)?
Ans. Nearly one in four Indian adults is overweight or obese.

Q2. What is the "thin-fat Indian" hypothesis?
Ans. It suggests that Indians, even with a normal BMI, tend to have higher body fat, increasing their risk of metabolic diseases.

Q3. How does obesity impact India's economy?
Ans. In 2019, obesity cost India $28.95 billion (1.02% of GDP), and this could rise to 1.57% of GDP by 2030.

Q4. Why is childhood obesity a growing concern in India?
Ans. India has one of the highest annual increases in childhood obesity globally, with rates doubling in the last 15 years.

Q5. What are some major causes of rising obesity in India?
Ans. Poor diets, HFSS and ultra-processed foods, sedentary lifestyles, urbanization, and cultural attitudes toward body weight. 

Source:The Hindu