BIG ISN’T BEAUTIFUL

From a cosmetic problem, obesity is now a bonafide disease. And the desperation to lose weight is opening up new medical frontiers across the world.

The year was 2000. I was invited to a conference in Singapore, a confluence of some of the top clinical minds from around the world. The obesity epidemic was at its peak in the US then and some eminent American surgeons discussed how it was opening up new medical frontiers, for instance, weight- loss surgeries. It got me thinking. I came back and took out all the data I could find on obesity in India. They showed a steep rise from 1989- 1999. But more alarmingly, the jump was exactly the same during the three years, 1999- 2001. It was clear to me that obesity was stealthily and relentlessly invading India.

Something was seriously going wrong somewhere: Indian food habits were changing. In 1990, the Indian government had opened its doors to the world in a landmark policy reform. The first foreign fast food chain in India opened its restaurant in Connaught Place, Delhi, that very year. That first flush of excite- ment with new and convenient food made us forget how we always ate. While genes determine a person’s susceptibility to weight gain, energy balance is the key to maintaining a healthy weight. Energy- dense diets— high in complex carbohydrates, sugars and saturated fats, coupled with reduced physical activity— contributed to this rising epidemic.

It was a tide that had to be turned. Until then, we were used to looking at obesity tolerantly, as a sort of cosmetic problem. But obesity is a very difficult and expensive disease. In fact, it’s the mother of all diseases. I spoke to my friend, Shyama Chona, the then principal of DPS, R. K. Puram, in Delhi, and started awareness campaigns, first in her school. A survey of schoolchildren in affluent Delhi schools showed an obesity rate of 12- 13 per cent in 2002. By 2006, the rate had gone up to 30 per cent. Now it stands at around 40 per cent. In 2004, I set up the Obesity & Metabolic Surgery Society of India, made presentations to the movers and shakers of the country and ultimately to presidents K. R. Narayanan and APJ Abul Kalam.

By then the rapidly rising global prevalence of obesity, or ‘ globesity’, was no longer a problem of the developed world. In India, the condition coexisting paradoxically with undernutrition, created a dual medical and economic burden. Obesity is a complex condition with serious social and psychological dimensions affecting virtually all age groups. Obesity increases the risk of developing Type II