Why in News?

Recently Prime Minister, in ‘Mann Ki Baat’ radio programme highlighted the alarming increase in obesity in the country.

What is the status of obesity in India?

• Indian obesity - The National Family Health Survey round 5 (NFHS-5, 2019-21) suggests that nearly one in every four men or women is obese.
• Gender variation - At the national level, Obesity has increased from 21% to 24% among women and 19% to 23% among men.
• Childhood obesity - The percentage of children under 5 who were overweight rose from 2.1% to 3.4% from 2015-16 to 2019-21, as per NFHS data.

• Regional variation - The proportion of those who are overweight and obese ranges from 8% to 50% across States, in both men and women, and in rural and urban settings.
• Recent increase -  Overweight and obesity in adults and children have doubled in the last 15 years and tripled in the last three decades.
• Forecast - World Obesity Atlas 2022 estimates that India will have a child obesity prevalence of 10.81% amongst 5 to 9-yearolds and 6.23% amongst 10 to 19-year-olds by 2030.

What are the causes for the high prevalence of  obesity in India?

• Societal normalization - The general societal attitude in India normalises obesity or being overweight.
• Inadequate balanced diet - ‘State of Food Security and Nutrition in the World’ report (2024), estimated that nearly 40% of Indians fall short of an adequate-nutrient diet.
• High cost of health diet  - Eating healthy is becoming more expensive than eating junk food and that around 55% (78 crore) of India’s population could not afford a healthy diet.
• High fat, salt, sugar (HFSS) - In the last two decades, easy and low-cost availability of high fat, salt, sugar (HFSS) and the ultra-processed food (UPF) has compounded the challenge.
• Sedentary lifestyle - A recent World Health Organization (WHO) report says that 50% of Indians fail to meet recommended physical activity levels driven by urbanization.
• Lack of awareness - Many people are not fully aware of the health risks associated with obesity and the importance of maintaining a healthy lifestyle

What are the impacts of obesity?

• Health impact – Obesity is often called the ‘mother of all diseases’ and affects the overall  personal health.
• Chronic disease - WHO and the medical profession across the world have recognised that obesity is both a risk factor/lifestyle challenge and a complex and chronic disease.
• NCD’s risk - Being overweight in childhood and adolescence, the WHO says, affects children’s and adolescents’ immediate health and is associated with greater risk and earlier onset of various NCDs.
• Diabetes risk - The ‘common soil hypothesis’ highlights obesity as a cause and risk factor for diabetes (one in every fourth Indian adult, or 25 crore Indians, is either diabetic or prediabetic).
• Mortality - Overweight and obesity are associated with an estimated 3.4 million deaths annually in the world.
• Affects childhood development - Obesity can also have adverse psychosocial consequences affecting school performance and quality of life, compounded by stigma, discrimination and bullying.
• Economic cost - The global obesity observatory estimates that the annual economic cost of obesity and being overweight in India in 2019 was $28.95 billion (Rs.1,800 per capita), or 1.02% of India’s GDP.
• These costs are linked to health-care expenditures and lost productivity, among others.
• Increasing burden - Without sufficient interventions, it is estimated that the economic burden is likely to increase to Rs.4,700 per capita by 2030 (or 1.57% of GDP).

What are the government measures in tackling obesity?

• India’s Economic Survey 2024-25 takes note of obesity as an emerging health challenge, recommending higher taxation on UPF.
• Public campaigns – Programs like  ‘Khelo India’, ‘Fit India Movement’ or ‘Eat Right India’ campaigns, promote physical activity and healthy lifestyle.
• NCD control  – National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD) focuses on preventing and controlling NCDs, including obesity.
• Adolscent health - Rashtriya Kishor Swasthya Karyakram (RKSK)  addresses adolescent health by providing nutrition awareness and services to prevent NCDs like obesity.
• Nutrition promotion - POSHAN Abhiyaan Tackles malnutrition by addressing both undernutrition and overnutrition, including obesity.
• Trans Fat regulation - FSSAI limits trans fatty acids in oils and fats to ≤2% by weight to reduce unhealthy fat consumption.

What are the deficiencies in these measure?

• No dedicated program - Unlike undernutrition, there are not enough programmatic initiatives to tackle obesity.
• Underplayed responsibility – Most initiatives place far too much of a responsibility on the individual, and the responsibility of most other stakeholders is underplayed.
• Insufficient Screening - Despite the growing prevalence of obesity, there is a lack of comprehensive public health measures such as screening, treatment, and awareness programs.
• BMI Limitations - Traditional measures like BMI often fail to capture obesity-related risks accurately, especially in Asian populations.

BMI does not indicate how much of the weight is fat and where the fat is distributed in the body.

• Financial Constraints - Limited financial resources and budget allocations restrict the ability to provide necessary equipment and facilities for obesity prevention initiatives

What can be done to address the issue?

• Public awareness creation - Start a societal dialogue, and a structured science communication to highlight that obesity is a disease with rising burden.
• Management - Obesity needs prevention, care and management, just like any other health condition.
• Healthy ecosystem - There needs to be better urban planning and urban infrastructure development with place for bicycle lanes, free access to parks and other public spaces and open gymnasiums.
• Taxation – Levy high tax rate for HFSS and UPF products and provide subsidies for healthier food items including fruits and vegetables and ensure their easy and widespread availability.
• Health check ups - The ‘weight, height and waist circumference’ measurement has to be an integral part of all health visits and preventive health check-ups.

A very generic but useful parameter to know one’s ideal weight is the height in centimetre minus 100 for males and minus 105 for females.

• Drugs and medicines - Developing and widely disseminating clinical practice guidelines about the ideal candidates for anti-obesity medicines, which need to be used as per medical indication.
• Occupational health - Every office and workplace needs to raise awareness about ‘unhealthy weight’ in the workforce and make weighing scales easily available.
• Incorporate nutrition education - Curriculum should include lessons on balanced diets, the importance of various nutrients, and how to make healthier food choices.
• Engage dietitians and nutritionists - Following Japan's example, schools should consider hiring dietitians to plan nutritious meals, provide dietary advice, and conduct workshops for students and staff.
• Healthy school canteens - Canteens should offer a variety of healthy food options, with a focus on fresh, local produce. Junk food should be limited or replaced with healthier alternatives.
• Coordinated interventions - Obesity prevention requires multiple ministry engagements (health, finance, education, agriculture, urban planning and development) to work together.
• Wholistic approach - India’s nutrition intervention programme needs to be reimagined as ‘Suposhan Abhiyan’ with a focus on not just feeding but also ‘mindful under-feeding’ and ‘rightful micronutrient supplementation’.

Reference

The Hindu | India’s burden of rising obesity

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