The glut-of-the-gut pandemic

India's Generation X grew up with images of starvation, notably skeletal famine victims dissecting cow pats for grain and so, are unlikely to sympathise with an obese cop fat-shamed on social media. Epidemiology has transitioned from less to excess, from death-by-deprivation to disease-by-surfeit. But the enemy of public health remains the same; it goes by the name of Policy and has spawned a skewed food economy of kneejerk design, based on empty data rather than common good.

The adipose epidemic and the bellyful of diseases it has hatched – hypertension, diabetes and heart ailments being the most common – are an outcome of avoidable factors for which Generation X policy-makers are at least partially responsible. Doubtless enchanted by visions of western plenitude, they sought to cast India in the same oversized mould. Bureaucratic inertia carried the policy over decades, to the point where those same corpulent bureaucrats and politicians now undergo weight-loss surgery at public expense.

In 2013, the Ministry of Health and Family Welfare added bariatric surgery – basically snipping the stomach or the small intestine to reduce food intake and absorption – to the list of treatments covered under government health insurance. Cabinet ministers Arun Jaitley, N Venkaiah Naidu and Nitin Gadkari have undergone the procedure, which costs upwards of Rs 2.5 lakh.

The glut of the gut, we are informed by numerous studies, is pandemic. An astounding 70 per cent of the population of our metros is either obese or overweight. The prevalence of general obesity in Tamil Nadu in 2010 was one in four, in Maharashtra one in five and in Chandigarh, one in three. Extrapolating the results of an ICMR study to the whole country, 135 million people are believed to be too bulgy for their own good. Slum populations are not exempt from the fat epidemic; studies have found a high incidence of obesity, dyslipidemia (too much cholesterol) and diabetes in urban slums.

The colour of fat is the new basis for discrimination. We may prefer white skin to brown, but it’s the other way around in terms of fat. White fat is bad, brown and beige are good. Slimmer people have more brown fat, which actually burns calories. The plump are burdened with a sub-dermal blanket of the waxy white stuff, which when wrapped around the vital organs (visceral fat) is horrible for health. It is also responsible for the killer belly – the protruding abdomen – which characterises so many Indians.

The pathologisation of fat is well underway, to the advantage of dieticians, nutritionists and vendors of ayurvedic preparations, all promising radical downsizing in the blink of an eye. The pudgy Bollywood heroes of the 1970s have given way to sculpted gym rats and the pleasing curves of the heroines have been whittled away. While fatness is not yet a basis for social discrimination, it is aesthetically displeasing to the page 3 sorority, who are not averse to short-cutting their way to slimness.

And yet, the traditional Indian diet was healthy. What possessed policy-makers to mangle it into a calorie-rich, nutrition-deficient smorgasbord remains a mystery. The first step, by 1960s Green Revolutionists, was to reject coarse cereals in favour of wheat and rice. Now that dieticians urge patients to consume ragi and jowar in place of “refined” cereals, they are nowhere to be found, since generations of farmers have been discouraged from cultivating millets. Even the nutritive value of once-healthy desi wheat and rice cultivars has been eroded by decades of hybridisation.

Equally, healthy oils like cold-pressed mustard, groundnut and sesame have given way to imported palm oil and soyabean oil. Confused by conflicting claims of heart-healthiness based on relative content of “PUFA” and “MUFA”, consumers no longer know what's good for them. Desi ghee, like mustard oil, has transitioned from good to bad to good and fake fats, like Dalda, from bad to good to bad.

Pulses, too, were edged out by the wheat-andrice focus of policy-makers. A rich source of protein, fibre and secondary nutrients, pulses until recently did not even figure in the essential items made available through the public distribution system. To ice the hollowed-out cake, the food chain was contaminated top to bottom by noxious chemicals sprayed on standing crops, a method of farming aggressively promoted by state governments.

Processed foods flooded the market post-liberalisation, reflecting the narrowing bandwidth for producing home-made snacks. The deleterious effect of fat- and salt-rich packaged foods is, we are told, compounded by chemicals leached from plastic packaging. The cocktail of lurking devils in our food – pesticides, hormones, antibiotics, endocrine disrupters, preservatives, etc – makes healthy eating an obstacle course.

Our policy-makers have simultaneously deemed it unnecessary to allow healthy lifestyles in urban India. Cycling and walking, as opposed to driving, has been systematically discouraged through elimination of parks and pavements. Schools rigorously emphasise academics and ignore fitness. Nor is fitness a criterion for public servants. Sports facilities are made available to a very select few, as memberships of clubs constructed on public land with public money are playgrounds for the rich and influential.

So if a Madhya Pradesh policeman’s belly flops to his knees, it is through no fault of his own. If anyone should be ashamed, it’s the policy-makers.