India's big fat problem

Amid a slowing Chinese economy and global gloom, there is nothing quite as comforting as the glow of a growth story. But, alas, not all growth stories bring cheer. Especially when the growth is in girth. Overweight constables were recently put through an unusual fitness test in Uttarakhand’s Udham Singh Nagar. One constable found weighing 97 kg was asked to go around carrying a senior on his back. A probe is on. But being fat is not funny.

The latest National Family Health Survey (NFHS-4) tells us that India is growing at the wrong places. Obesity is now a serious issue even as vast areas of the country continue to battle malnutrition. Since 2005-06, the number of obese people has almost doubled. City dwellers fare worse than villagers. The urban woman is growing fatter at a faster rate than the urban man. In West Bengal, 10 years ago, 11.4 per cent of women were found to be overweight or obese. That has gone up to 19.9 per cent now. If you break that up, it is 30.6 per cent for urban areas and 15 per cent for rural, which means urban women are putting on weight at twice the rate of rural women. Men are a little better off but not much — nearly 5 per cent of men in the state were overweight or obese a decade ago. That figure has shot up to 14 per cent.

West Bengal conforms to the national trend. States like AP, Puducherry and Sikkim now have nearly 30 per cent of their population classified as obese. In Sikkim the number of overweight/obese men has jumped from 11.9 per cent to 34.8 per cent, with cities leading. Even in a poor state like Bihar, the number of overweight women has grown almost three-fold in the last 10 years, from 4.6 per cent of the population to 11.7 per cent. In TN, the number of obese women has shot up from 20.9 per cent to 30.9 per cent in 10 years.

Significantly, both under nutrition and obesity are higher for women than for men. The words overweight and obese describe a clinical condition —  “abnormal or excessive fat accumulation that presents a risk to health”. For adults, overweight and obesity ranges are determined by using weight and height to calculate what is known as the body mass index or BMI (weight in kg divided by the square of the height in metres). The WHO defines a BMI equal to or greater than 25 as overweight and a BMI equal to or greater than 30 as obese. Both are major risk factors for diabetes, cardiovascular diseases and cancer.

Once viewed as a disease of affluent countries, overweight and obesity are now hitting low and middle-income countries like India. What causes overweight and obesity? The reasons are well known. As doctors have been telling us for quite some time, Indians are not eating wisely. Poor nutrition, too much junk food that is high in fat, salt and sugars but low in vitamins, minerals and other micronutrients, not enough fresh fruits and vegetables combined with an increasingly sedentary lifestyle are the key factors fuelling the obesity epidemic.

Paradoxically, this epidemic has hit India even while stunting and anaemia due to malnutrition remain widespread. Studies show the overweight can also suffer from anaemia caused by a deficiency of iron in their diet. Though much of what needs to be done to shed weight is known, the government has a responsibility to spread public awareness about diet and physical activity. In this year’s Budget, the finance minister may well consider steeper taxes on unhealthy food, while providing more incentives for walking, cycling, sports and other physical activities.

The battle against obesity needs supportive environments and communities to help people choose regular physical activity and healthy food. People cannot walk if public places remain unsafe. Some schools are making sure their canteens serve healthy food and that they have playgrounds. Many more must follow. Three out of five obese children in the capital are at risk of chronic liver diseases, researchers at the All-India Institute of Medical Sciences have found.

India is not the fattest country in the world. That dubious honour goes to the Pacific island of Tonga where up to 40 per cent of the population is thought to have Type 2 diabetes with life expectancy falling. But if unchecked, the rate of increase in overweight and obese people in India could push it in that direction. India’s policymakers have been focused on dealing with malnutrition. Now they have a double whammy. The sooner they deal with it the better.

The writer focuses on development issues in India and emerging economies. She can be reached at patralekha.chatterjee@gmail.com