Overweight and Obesity in India

Context:

In the past two decades, India has undergone a significant epidemiological shift, with overweight and obesity emerging as major public health concerns. 

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• According to the National Family Health Survey (NFHS-5, 2019-21), nearly one in four adults in India is obese. 
• The problem spans across diverse regions, urban and rural areas, and both genders, with the proportion of overweight and obese individuals ranging from 8% to 50%. 
• The World Obesity Federation has pointed out that India is experiencing one of the steepest increases in childhood obesity globally.

What Is Obesity?

• Obesity is defined by the World Health Organisation (WHO) as an abnormal or excessive fat accumulation that presents a risk to health. Body Mass Index (BMI) is used as a common metric to classify obesity:
  • Overweight: BMI of 25 or above
  • Obese: BMI of 30 or above

Body Mass Index (BMI) is a simple method used to assess if an adult has a healthy weight, calculated by dividing a person’s weight in kilograms by the square of their height in meters (kg/m²). A normal BMI is considered to be between 18.5 and 24.9 according to WHO guidelines.

Rising Obesity Rates in India

• A nationwide study by the Indian Council of Medical Research (ICMR) published in The Lancet Diabetes and Endocrinology (2023) revealed alarming statistics:
  • 35 crore adults have abdominal obesity.
  • 25 crore adults are suffering from generalised obesity.
  • 21 crore adults have high blood cholesterol.
• Overweight and obesity in India have doubled in the last 15 years and tripled in the past 30 years. This rise is associated with lifestyle changes, dietary patterns, and urbanisation.

Why the Issue Needs Urgent Attention?

• Overweight and obesity are often seen as personal issues in India, and societal attitudes often normalise these conditions. However, this widespread belief ignores the broader public health implications:
• Dietary Shifts: India, once food deficient, has transitioned into a nation where calories are more than sufficient, though with significant inequities in distribution.
• Poor Nutritional Quality:  The State of Food Security and Nutrition in the World report (2024) estimates that nearly 55% of India’s population (78 crore people) cannot afford a healthy diet, and 40% of the population falls short of adequate nutrient intake. 
  • The rise of high-fat, salt, and sugar (HFSS) foods and ultra-processed foods (UPFs) has exacerbated the obesity crisis.
• Sedentary Lifestyles: Urbanisation has led to more sedentary lifestyles, with 50% of Indians failing to meet the recommended physical activity levels according to the World Health Organisation (WHO).

The ‘Thin Fat Indian’ and Obesity’s Health Risks

• The concept of the ‘thin fat Indian’ has been scientifically validated. 
  • Even individuals with normal body mass index (BMI) can have higher body fat levels. Furthermore, obesity is strongly linked to diabetes and hypertension. 
  • The ‘common soil hypothesis’ highlights obesity as a risk factor for diabetes, with one in four Indian adults being diabetic or prediabetic.
• Globally, overweight and obesity are responsible for approximately 3.4 million deaths annually. 
  • In India, the economic cost of obesity was estimated to be $28.95 billion (₹1,800 per capita) in 2019, approximately 1.02% of GDP. This includes healthcare costs and lost productivity, and without adequate interventions, the cost is projected to increase to ₹4,700 per capita by 2030.

The Policy and Programmatic Response

• Tackling obesity requires multifaceted policy interventions and a change in societal attitudes toward health. 
• Government campaigns like Khelo India, Fit India Movement, and Eat Right India focus on personal responsibility but lack broader, systemic action.
  • Fit India Movement and Khelo India have been pivotal in encouraging physical activity across the population, especially among youth.
  • POSHAN Abhiyaan focuses on improving nutritional outcomes for children, pregnant women, and lactating mothers, helping to tackle childhood obesity.
  • Eat Right India, launched by the Food Safety and Standards Authority of India (FSSAI), promotes healthier food choices and awareness, with campaigns like Aaj Se Thoda Kam urging people to reduce intake of harmful fats, salts, and sugars.

Proposed Solutions

• Raising Awareness: Begin a nationwide dialogue to highlight that obesity is a disease, not just a lifestyle choice. Address its link to chronic diseases such as diabetes, hypertension, and liver disorders.
• Promote Physical Activity: Invest in urban infrastructure to encourage physical activity, such as creating bicycle lanes, accessible parks, and open gymnasiums.
• Taxation on Unhealthy Foods: Introduce higher taxes on HFSS foods and ultra-processed foods, while providing subsidies for healthier food options, such as fruits and vegetables. The food industry should adopt ethical practices in food marketing, especially targeting children.
• Health Check-ups: Weight, height, and waist circumference measurements should become standard at every health visit. People need to be educated on optimal weight and the risks of high waist circumference. For example, women should aim for a waist circumference under 80 cm and men under 90 cm.
• Anti-Obesity Medications: Anti-obesity drugs are being licensed in several countries. India needs clinical guidelines to identify individuals who can benefit from such medications, which should be prescribed only when medically indicated.
• Workplace Initiatives: Offices and workplaces should focus on obesity prevention by raising awareness about unhealthy weight and providing access to weighing scales. Body fat analysis should also become part of routine health practices in workplaces.
• School and College Engagement: Schools should teach healthy eating habits, and canteens should serve healthier food. The adoption of health-promoting schools, modelled after countries like Japan, where dietitians are involved in school nutrition, should be explored.
• Coordinated Interventions: Multiple ministries (health, finance, education, agriculture, urban development) need to collaborate to tackle obesity. The nutrition intervention program should evolve into a ‘Suposhan Abhiyan’, addressing not only undernutrition but also mindful under-feeding and micronutrient deficiencies.
• Research and Evidence Generation: The medical and research communities must focus on generating epidemiological data on obesity. Doctors and health professionals should be trained to handle obesity as a chronic disease.
• Making Healthy Eating Affordable: Healthy food should be made more accessible and affordable. The food industry, particularly online food delivery platforms, should promote healthy eating habits. Corporate social responsibility (CSR) funds should be dedicated to promoting healthier lifestyles.