Fighting Diabetes in India
A Man’s Effort to Ban Junk Food Near Schools Meets Tough Resistance
NEW DELHI — Rahul Verma’s son was born gravely ill with digestive problems, but over years of visits to the boy’s endocrinologist, Mr. Verma saw the doctor grow alarmed about a different problem, one threatening healthy children. Junk food, the doctor warned, was especially dangerous to Indians, who are far more prone to diabetes than people from other parts of the world.
One day in the doctor’s waiting room, Mr. Verma noticed a girl who had gotten fat by compulsively eating potato chips. He decided he had to do something.
“On one side you have children like my son, who are born with problems,” said Mr. Verma, “and on the other side you have children who are healthy and everything is fine and you are damaging them giving them unhealthy food.”
Mr. Verma, who had no legal train- ing, sat late into the nights with his wife, Tullika, drafting a petition in their apartment. He filed the public interest lawsuit in the Delhi High Court in 2010, seeking a ban on the sale of junk food and soft drinks in and around schools across India.
The case resulted i n sweeping court- ordered proposals to regulate the food industry, although the government has not acted on them. They have outsize importance in India, because its 1.3 billion people are far more likely to develop diabetes — which can lead to heart disease, kidney failure, blindness and amputations — as they gain weight than people from other regions, according to health experts.
Since 1990, the percent of children and adults in India who are overweight or obese has almost tripled to 18.8 percent from 6.4 percent, according to the Institute for Health Metrics and Evalu- ation at the University of Washington.
The International Diabetes Federation projects that the number of Indians with diabetes will soar to 123 million by 2040 as diets rich in carbohydrates and fat spread to less affluent rural areas.
“We are sitting on a volcano,” said Dr. Anoop Misra, chairman of a diabetes hospital at Fortis Healthcare, one of India’s biggest private hospital chains.
In the years since the court ordered the government to develop guidelines to regulate junk food, the case has encountered ferocious opposition from the All India Food Processors Association, which counts Coca- Cola India, PepsiCo India and Nestlé India as members, as well as hundreds of other companies.
Subodh Jindal, the president of the association, said that junk food was
unfairly blamed for diabetes and obesity. It was overeating, not the food itself, that has caused the problem, he said.
Last year, the government took a significant step that public health experts believe will help combat the rise of obesity. It implemented a 40 percent tax on sugar-sweetened carbonated beverages.
But so far, the regulations to ban sales near schools sought by the court in Mr. Verma’s case have led to nothing.
Jagat Prakash Nadda, India’s minister of health and family welfare, did not respond to requests for comment, but Pawan Agarwal, chief executive of the Food Safety Standards Authority of India, the body in the ministry responsible for such regulations, insisted that the government’s efforts have been sincere.
“This may appear to be typical of India. When you have an issue, you set up so many committees and confuse the whole issue,” he said. But he insisted: “People are concerned. They want to do something about it. Therefore everyone is setting up committees.”
As the case has played out on Twitter and in newspapers, students have rallied, seeking to make obesity an issue in a country where feeding the hungry has been an obsession. Some schools have voluntarily stopped serving junk food.
Mr. Verma, 42, quit his job as a corporate marketing executive after his son’s birth in 2006 and set up a foundation in 2007 to help families like his with sick children. At one point, doubting his decision to venture into India’s overburdened legal system, Mr. Verma begged the judge to let him withdraw the petition.
“Nothing is happening. I’ve wasted my time,” he said as he bemoaned getting sidetracked from his foundation’s mission of helping poor, sick children at the public hospital where his son had been treated. “I could have helped hundreds of kids.”
But Chief Justice Dipak Misra refused. Instead, spotting a senior advocate, Neeraj Kishan Kaul, the judge ordered him to act as the pro bono lawyer for Mr. Verma’s case.
As Mr. Kaul, 54, approached the bench, he recalled, he joked to the judge, “You’ve got the wrong guy. I like junk food.”
When scientists searched for genes that predisposed Indians to diabetes, they didn’t find any. Instead, a growing body of research suggests that Indians’ body type — one that is smaller but with more abdominal fat — may be responsible.
Being born to a malnourished woman — common in India — may also increase the odds of developing diabetes.
Dr. Chittaranjan Yajnik, a diabetes specialist, and Barry Popkin, a professor of nutrition at the University of North Carolina, are among the researchers exploring a theory that Indians evolved what Dr. Yajnik has called “a thin- fat” body type over millenniums as a way to survive famines when monsoons failed.
In the years since Mr. Verma filed his suit, consumption of junk food has risen sharply across India. Sales of packaged foods have increased 138 percent; fast food 83 percent; and carbonated drinks 58 percent, according to Euromonitor International, the market research firm.
Coca- Cola Company’s chief executive, James Quincey, in an interview with Indian news media last year, said that he expected the Indian market to eventually become the company’s third largest in sales, up from sixth.
Coca- Cola and PepsiCo have announced plans to invest billions of dollars in the Indian market. They have also said they plan to increase their offerings of drinks with less sugar and more fruit.
Sanjay Khajuria, a Nestlé India spokesman, said the food processors association, which opposed Mr. Verma’s case, had “taken into account inputs received by the association from its members,” and declined further comment on the case. He also noted that the company has joined other companies in India to restrict advertising directed at children under 12 to products with a certain level of nutrients.
Becoming a crusader against junk food was far from Mr. Verma’s mind as he and his wife battled to save their son, Uday, who was born with parts of his digestive system missing.
The boy endured nine surgeries, but emerged thriving. His parents decided they wanted to help families facing similar challenges and formed the Uday Foundation. Mr. Verma ran it, while his wife supported the family on her $1,000-a-month salary as an administrator in the government education system.
First the couple approached state officials about banning junk food in New Delhi schools — to no avail.
Then in 2010 he filed the lawsuit, basing his case on the constitutional authority of courts to intervene to protect citizens’ right to life.
The hearings dragged on. Finally, in 2014, the working group of an expert committee picked by the food authority recommended that sales of potato chips, sugar sweetened beverages, ready-to- eat noodles and chocolates be banned within 450 meters of schools.
The food association strenuously objected. D. V. Malhan, its executive secretary, said there are so many schools that the proposed sales ban would have hurt the industry badly.
In early 2015, the food authority in the health ministry finally recommended regulations to the court, including some limitations on the sale of junk food around schools. The judge ordered the recommendations carried out within three months. Instead, the food authority appointed yet another committee.
Mr. Agarwal, chief executive of the food authority, insisted his agency is finally ready to start adopting new rules this year for labeling healthy food with a green light and those high in fat, sugar and salt with a red light.
But he said taxing junk food and banning it around schools were longterm goals. “There is no point in confronting industry on these issues,” he said.
Mr. Verma was emphatic that someone needs to continue the fight; he is just not sure that someone is him. He is convinced the unending legal battle gave him high blood pressure.
His former partner on the case, the pro bono lawyer Mr. Kaul, said India needs more than Mr. Verma to make change happen.
Mr. Kaul said the government will only move on junk food once public pressure builds: “You need a movement to fight the inertia of the system.”