India stares at twin threats of obesity and malnutrition
Close to one in five people are overweight in the country; children have foods high in fat, sugar and salt, leaving them deficient in essential nutrients
NEWDELHI: More people are overweight in India than the combined populations of France, Spain and the United Kingdom, a study in the New England Journal of Medicine said this week. This means, the number of overweight adults in India is a staggering 180 million. And for children between 2-19 years, the number is 14.4 million. The extent of this rapidly ballooning problem is supported by nationwide data from India’s National Family Health Surveys, the most comprehensive report card on the nation’s health.
The number of overweight people almost doubled from 10.5% of India’s population in 2006 to 19.6% in 2016, latest data shows, which means close to one in five people weigh more than they should.
Anaemia -- a deficiency of red cells in blood and an indicator of malnutrition -has not shown a corresponding decline, affecting 53% women in 2016, down from 55.3% a decade ago. In comparison, 22.7% men were anaemic in 2016, as against 24.2% in 2006. This shows India is struggling with the twin burdens of chronic malnutrition and obesity.
“Until late in the 20th century, chronic under-nutrition was the primary human nutritional concern globally, but in the recent decades, obesity has emerged as an issue of similar importance,” said Dr Henk Bekedam, the World Health Organisation’s representative to India.
“Paradoxically, the rapid increase in obesity has not been accompanied by corresponding reduction in undernutrition. The two nutritional extremes persist alongside each other in many countries, populations, and even families, a scenario known as the ‘dual burden’,” he added.
HEALTH RISKS
Obesity puts people at an increased risk of diabetes, hypertension, heart and kidney ailments, low back pain, joint problems, and several cancers, including of the uterus, breast, gall bladder, colon, rectum and kidney. Yet, most people do nothing about it.
Malnourishment begins in the womb, when anaemic and undernourished mothers give birth to underweight babies. When these children have foods high in fat, sugar, salt and calories and low in nutrients, they become overweight while continuing to have nutrient deficiencies, which puts them at risk of chronic diseases such as diabetes and hypertension 2 or 3 decades even before their parents.
Childhood obesity and its health impact have been visibly increasing over the past decade. Half-a-dozen teenagers with type-2 diabetes visit the Fortis-CDOC Centre for Diabetes, Metabolic Diseases and Endocrinology each month, said the hospital’s director Anoop Misra, adding that a decade ago only people over 50 years were affected.
He said South Asians exhibit unique features of obesity, including excess body fat and fatty deposits in liver and muscles, which puts them at increased risk of developing diabetes, hypertension, dyslipidemia (abnormal blood fats) and cardiovascular disease at lower bodyweight compared to Caucasians and other ethnicities.
Healthy weight is defined as body mass index (BMI), calculated on the basis of a person’s weight and height. However, the BMI for Indians is lower. Instead of a BMI of 25, the international cut-off for a healthy body weight, south Asians should aim for a BMI of less than 23, recommended an expert committee in the Journal of Association of Physicians of India in 2009.
“These BMI cut-offs have been adopted by the American Diabetes Association for all Asians and the UK for South Asians,” said Dr Misra, who was part of the expert committee on BMI for south Asians.
LOWERING OBESITY
Staying healthy needs will and effort. A healthy diet includes having food that’s low in saturated fat -- oils that solidify at room temperature -- found in animal, dairy and processed products and high in unsaturated fats such as olive, mustard, canola oils, fruit, vegetables, pulses, whole grains and nuts, while limiting sugar and salt. That, along with one hour of moderate-intensity activity seven days a week, keeps weight healthy and lowers disease risk, according to experts.
Instead of working at getting fitter, those who can afford it are opting for surgical solutions such as bariatric surgery, which saw an incredible 135-fold increase in India over the past one decade, shooting up from just 150 cases in 2006 to 20,000 in 2016.
“Bariatric surgery is not a weight-loss method, it is a treatment for morbid obesity that is leading to diabetes and other health problems,” said Dr Pradeep Chowbey, chairman, Max Institute of Minimal Access, Metabolic & Bariatric Surgery, who began bariatric surgery in India in 2003.
“Bad diets and inactivity are feeding the genetic predisposition of south Asians…people need a healthy lifestyle now to stem obesity and related metabolic diseases,” said Dr Pradeep Chowbey, chairman, Max Institute of Minimal Access, Metabolic & Bariatric Surgery, who began bariatric surgery in India in 2003.
Changes in diet and physical activity are often linked to urbanisation and lack of supportive policies in health, transport, urban planning, environment, food processing, distribution, marketing, and education.
Experts say these need to be addressed by policies that address marketing junk food to children, higher taxes on foods high in sugar, salt and saturated fats, improved food labelling, nutritional food alternatives in school and office menus, improved public transport, and creating open and green spaces in cities and urban centres, among others.
“It is imperative that we address both (under-nutrition and obesity) these problems comprehensively using an intersectoral approach to address all elements in the causal pathway of malnutrition,” said Dr Bekedam.
And Anoop Misra is certain the time to start is now. “Obese children have breathing problems, increased fracture risk, hypertension, insulin resistance and psychological distress, which needs to be addressed when they are young and can easily adapt to change their lifestyles to a more healthy one,” he said.