India could be hit by a tsunami of obesity!

Pallava Bagla

New Delhi: India stares at a huge epidemic of obesity, a new study by the Indian Council of Medical Research (ICMR) finds.

A landmark study finds that nearly 13 per cent of the 1.2 billion population could be suffering from obesity. This is ironical since until recently the discourse was mostly about rampant malnourishment in the country. Now it seems India is being hit at both ends of the spectrum. The multi-hospital 16-person research team says "under-nutrition due to poverty which dominated in the past, is being rapidly replaced by obesity associated with affluence".

Obesity or being highly overweight is an avoidable health condition and it can be a precipitating factor for many debilitating lifestyle diseases like diabetes, hypertension, heart disease and strokes.

Dr Rajendra Pradeepa from the Madras Diabetes Research Foundation, Chennai and the lead author of the study quips, "The longer the waist belt the shorter is the lifetime!"

The main causes for rising obesity in India the ICMR funded study attributes is to increasing urbanization, use of mechanized transport, consumption of fast foods, long hours of television viewing and the intake of energy dense but nutrient poor diets. High blood pressure, high blood sugar among others are the "leading causes of health loss in India at present", says Dr Soumya Swaminathan, Director-General of the ICMR.

The India Diabetes Study (INDIAB), spearheaded by the ICMR, finds that a huge number 153 million that is comparable to the half the population of the US could be suffering from abdominal obesity or what is colloquially called having a large paunch or a pear-shaped body.

In this study, a man is considered to be obese if the waist circumference is more than 90 cm and a woman is obese if the waist is more than 80 cm. The startling finding is that as many as 88 million people could be overweight who could sooner than later tip over and become obese with time. Without sounding too alarmist it means that almost a fifth of Indians are carrying more weight than they should.

On the same lines, a new study published in the latest issue of The Lancet on health risks finds "fewer Indians are having health loss from ailments associated with childhood under-nutrition and unsafe water sources, but more Indians are having health loss from diseases attributable to high blood pressure, high blood sugar and high cholesterol".

There could be an overlap in numbers and the ICMR study finds that as many as 107 million Indians, which is equal to the population of Philippines, could suffer from combined obesity. While another 135 million, which is equal to the entire population of Japan could be suffering from generalized obesity. All of these conditions are susceptible to contracting many forms of lifestyle diseases.

It is like "an impending tsunami", feels Dr Gautam Ahluwalia from the Department of Medicine, Dayanand Medical College in Ludhiana who says the study finds that "less than 10 per cent of people in India performed recreational physical activity", this lack of exercise is the root cause for many of the lifestyle related health problems.
Ahluwalia adds that "India is being confronted with the phenomenon of double burden of disease" like infectious illnesses on the one hand and non-communicable diseases like lifestyle-related problems on the other.

The 16-member team of researchers intensively surveyed some 16,000 individuals in Tamil Nadu, Maharashtra, Jharkhand and Chandigarh and they have published the results of the first phase of their work in the latest issue of the regarded Indian Journal of Medical Research (IJMR), with the big India numbers are an extrapolation.

When the entire study is completed in three years, the sample size would jump to 124,000 people making it the largest study of its kind ever to be undertaken. The sample includes residents of both rural and urban areas. On expected lines, the prevalence of obesity was higher in urban populations as compared to rural populations but the worrying fact is that the curve has an upward swing with numbers likely to increase. The study implicates higher levels of obesity with the higher consumption of wheat and rice in daily diets as compared to diets that are rich in millets.

According to the World Health Organization (WHO), every sixth individual on Earth is obese and some 2.8 million individuals die every year because of obesity and today "obesity is being recognized as a disease itself".

"Metabolic risk factors that include high blood pressure, blood sugar and cholesterol, along with unhealthy dietary habits and smoking are responsible for about 5.2 million premature deaths in India every year," confirms Dr K Srinath Reddy, who is President of the Public Health Foundation of India, Gurgaon, adding "This trend will continue to increase unless effective prevention strategies to address these risk factors are implemented in India rapidly."

There is a highly counter-intuitive finding in the study; the more educated suffer from higher levels of obesity. Ahluwalia says "the increasing trend of obesity with increasing education status is paradoxical", highlighting that "possibly higher education with its increasing economic sovereignty results in higher consumption of obesogenic foods and a sedentary lifestyle".

Leading Indian diabetes specialist Dr Ambrish Mithal who is Head of Endocrinology and Diabetes Division of Medanta Hospital, Gurgaon, says, "The big challenge India faces is the burgeoning epidemic of childhood obesity. Linked to greater affluence and urbanization, obesity fuels an epidemic of non- communicable diseases like diabetes, hypertension and heart disease. The exponential increase in diabetes, especially among the youth, with its attendant complications can be directly attributed to increasing obesity. The challenge is huge we need 'upstream' strategies like greater awareness regarding diet and exercise and, even more importantly, availability of healthy food options for youngsters at schools and their work place."

"This is really a wake-up call," says Pradeepa, who adds that today the take-off age for obesity has reduced to the 25-34 age group which is "very worrying" and policy makers should address this on an urgent basis else obesity could well become the number one killer for the country.