Obesity Challenge in India, Health Risks and Current Situation

Context: Recently, Prime Minister Narendra Modi, in his ‘Mann Ki Baat’ radio programme, highlighted the alarming increase in obesity in India. The National Family Health Survey Round 5 (NFHS-5, 2019-21) suggests that nearly one in every four men or women is obese.

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• He cited that 1 in 8 Indians is affected by obesity.
• Urged people to reduce oil consumption by 10% per month to promote a healthier lifestyle.

Obesity Challenge: The Scale of the Problem

Definition of Obesity: The World Health Organization (WHO) defines overweight and obesity as abnormal or excessive fat accumulation that poses a health risk.

Obesity Trends in India (NFHS Data)

The National Family Health Surveys (NFHS) data shows a steady rise in obesity:

• Women (Overweight/Obese):
  • 2015-16 (NFHS-4): 6%
  • 2019-21 (NFHS-5): 24%
• Men (Overweight/Obese):
  • 2015-16 (NFHS-4): 9%
  • 2019-21 (NFHS-5): 9%
• Urban obesity levels are significantly higher than rural areas.

Abdominal Obesity (Lancet Study, 2023)

A 2023 study in The Lancet Regional Health Southeast Asia analyzed NFHS-5 data and found:

• 40% of women had abdominal obesity.
• 12% of men had abdominal obesity.

Childhood Obesity

NFHS data shows an increase in overweight children under 5 years:

• 2015-16: 2.1%
• 2019-21: 3.4%
• Older children face even higher risks (World Obesity Atlas 2022 estimates for 2030):
  • 5 to 9-year-olds: 81% prevalence
  • 10 to 19-year-olds: 23% prevalence

Health Risks Associated with Obesity

Metabolic Syndrome

Indians are genetically predisposed to storing fat in the abdomen.

• Abdominal obesity contributes to metabolic syndrome, increasing risks of:
  • Type 2 diabetes
  • Heart disease
  • Stroke

Adult Health Risks

According to the WHO, obesity is a major risk factor for leading causes of poor health and early death, including:

• Several types of cancer
• Osteoarthritis

Diabetes

India has the highest number of diabetes cases in the world, with 101 million people suffering from diabetes.

Cancer

Indian Council of Medical Research (ICMR) – National Cancer Registry Programme projects:

• 2022: 14.6 lakh cases
• 2025: 15.7 lakh cases

Cardiovascular Diseases (CVDs)

• One of the leading causes of death and disability in India.
• Indians are affected by CVDs at least 10 years earlier than other populations.

Non-Communicable Diseases (NCDs)

60% of all deaths in India are now due to NCDs, which include obesity-related illnesses.

Childhood and Adolescent Health Risks

Childhood obesity can lead to:

• Higher risk of NCDs at an earlier age.
• Adverse psychosocial effects:
  • Lower school performance.
  • Lower quality of life.
  • Higher risk of stigma, discrimination, and bullying.
• Children with obesity are more likely to remain obese in adulthood.

Causes of Rising Obesity in India

Unhealthy Diet and Ultra-Processed Foods

Urban India has seen a rise in:

• Ultra-processed food consumption.
• Unhealthy eating habits (high in sugar, salt, and unhealthy fats).

Low Physical Activity Levels

A Lancet Global Health Study (2023) found that:

• Nearly 50% of Indians do not get sufficient physical activity.
• Indoor lifestyle: Increased use of digital devices and sedentary work culture.
• Outdoor conditions discourage activity:
  • No safe cycling lanes or pedestrian paths.
  • Shrinking green spaces.
  • Rising street crime deters walking in urban areas.

Air Pollution

Air pollution contributes to inflammation, leading to:

• Increased risk of cardio-metabolic diseases.
• Visceral fat accumulation (fat stored around organs).

Economic Barriers to Healthy Eating

• Low-income households rely on carbohydrate-heavy diets (rice & wheat).
• Protein & micronutrient-rich foods (fruits, vegetables, dairy, pulses, meat) are expensive.
• Rural obesity is rising and may soon overtake urban obesity.

Limitations in Measuring Obesity

• Traditional BMI Limitations: Body Mass Index (BMI) is the most commonly used metric but has limitations:
  • Does not differentiate between muscle mass and fat.
• Does not indicate fat distribution in the body.

Updated Obesity Diagnosis Guidelines

• Indian experts introduced a new obesity classification:
  • Stage 1: Increased fat accumulation but no impact on organs or daily life.
  • Stage 2: Fat accumulation impacts organ function and physical abilities.
• Recommended new measurement methods:
  • Waist circumference
  • Waist-to-height ratio
  • Body fat percentage

Current Situation of Obesity and Related Diseases in India

• Obesity Rates: Increased from 1.2% in 1990 to 9.8% in 2022 for women and from 0.5% to 5.4% for men.
• Prevalence of Overweight/Obesity: 9% among men and 24% among women in NFHS-5.
• Abdominal Obesity: 40% of women and 12% of men are abdominally obese.
• Childhood Obesity: A 60% increase in prevalence among under-five children between NFHS-4 and NFHS-5.

Associated Health Risks

• Diabetes: 1 in 4 Indian adults is diabetic or prediabetic.
• Cardiovascular diseases: Obesity contributes to hypertension and heart-related ailments.
• Liver disorders: High-fat diets and obesity lead to fatty liver disease.
• Economic burden: Obesity-related costs amounted to $28.95 billion in 2019 (1.02% of GDP), expected to rise to 57% of GDP by 2030.

Government Shortcomings

• Lack of Targeted Programs: While undernutrition is a focus of government programs, obesity is not adequately addressed through structured policies.
  • Initiatives like Khelo India, Fit India Movement, and Eat Right India put the burden of action solely on individuals, ignoring systemic issues.
• Inadequate Regulation on Processed Foods: Ultra-processed foods (UPF) and high-fat, salt, and sugar (HFSS) foods are widely available and aggressively marketed.
  • There is no strong policy to tax junk food or regulate misleading food advertisements.
• Lack of Urban Planning for Physical Activity: Most cities lack cycling tracks, pedestrian-friendly roads, and open gyms for public use.
  • Sedentary lifestyles are increasing due to poor infrastructure and lack of accessible recreational spaces.
• Health System Gaps: Doctors rarely check for obesity or discuss healthy weight during routine consultations.
  • No national protocol for obesity management through clinical interventions, medications, or counseling.
• Food Affordability and Nutrition Gap: Healthy food is more expensive than junk food in India.
  • According to the 2024 State of Food Security and Nutrition Report, 55% of Indians cannot afford a healthy diet.

What Needs to be Done?

• Public Awareness and Science Communication: Obesity must be recognized as a chronic disease, not just a lifestyle issue.
  • Nationwide awareness campaigns should focus on the risks of obesity and the benefits of healthy eating.
• Better Urban Planning for Physical Activity: Create dedicated walking and cycling lanes in cities.
  • Ensure open gyms, public parks, and exercise-friendly spaces are available and accessible.
• Taxation on Junk Food & Subsidies for Healthy Food: Higher taxes on ultra-processed foods and sugar-laden beverages.
  • Subsidies on fruits, vegetables, and other nutritious food to make them affordable for all.
• Routine Screening & Medical Interventions: Mandatory weight, height, and waist circumference measurements during health check-ups.
  • Clear guidelines for prescribing anti-obesity medications and interventions.
• School and Workplace Initiatives: Schools should promote healthy eating habits, restrict unhealthy foods in canteens, and introduce nutrition education.
  • Workplaces should provide regular health screenings and promote active lifestyles.
• Inter-Ministerial Coordination: A multi-sectoral task force (Health, Finance, Education, Urban Development, and Agriculture ministries) should lead India’s obesity control strategy.
• Food Industry Regulation: Stringent advertising regulations on HFSS foods, especially those targeting children.
  • Online food delivery platforms should promote healthy choices.

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