There is a silent 'pandemic' that is taking over the world, including India, and costing lives—obesity. World Obesity Atlas report from the World Obesity Federation, predicted that 51% of the global population will be living with overweight or obesity by 2035 if current lifestyle trends continue.

In recent years, developing countries are experiencing a more dramatic rise in the prevalence of obesity, and India is no different. India has the third most number of obese people in the world, after USA and China.  In fact, some estimates based on the National Family Health Survey-5 (NFHS-5), show that one in every four Indians are now obese.

These trends can have serious consequences too.

"Obesity can lead to increased risk of type 2 diabetes and heart disease, it can affect bone health and reproduction, it increases the risk of certain cancers. Obesity influences the quality of living, such as sleeping or moving," according to the World Health Organization (WHO).

Why is India getting obese?

Dr Rajiv Kovil, Head of Diabetology at Zandra Healthcare in Mumbai, Maharashtra explained that genetics, lifestyle, and dietary factors are driving India's obesity crisis. "The interplay between genetics and environment is a major factor. While our ancestors adapted to food scarcity with genes that promote fat storage, today, these same genes contribute to obesity because of easy access to high-calorie, processed foods and sedentary lifestyles," he said.

He elaborated on the thrifty gene hypothesis, which suggests that populations like South Asians have a genetic tendency to store fat efficiently.

"The thrifty gene hypothesis is a key reason why South Asians are more prone to obesity and metabolic disorders. It was once an advantage during food shortages, but today, it has become a health risk," Dr Kovil explained, while adding that South Asians tend to have higher insulin sensitivity, lower lean muscle mass, and a greater tendency to accumulate visceral fat, making them more vulnerable to obesity-related diseases like type 2 diabetes and heart disease.

Is India facing a dual burden of malnutrition and obesity?

India’s obesity crisis is further complicated by the dual burden of malnutrition and obesity. According to research published in The Lancet in 2016, the world has transitioned from a time when underweight prevalence was more than double that of obesity to an era where obesity surpasses undernutrition.

However, India is still grappling with both challenges simultaneously. A paper published by the Observer Research Foundation (ORF) noted that "undernutrition remains a leading cause of childhood morbidity and mortality in India, even as overnutrition is emerging as a silent epidemic."

"This paradox occurs due to economic disparities, lifestyle changes, and shifts in food consumption patterns," Dr Kovil said.

He explained that economic and social inequality play a crucial role in this situation. While poorer populations struggle with undernutrition due to lack of access to adequate food, wealthier and urban populations face obesity due to increased consumption of high-calorie, processed foods.

"Many Indians consume calorie-dense but nutrient-poor foods, leading to deficiencies in protein, iron, vitamin D, and B12," he explained.

Rising obesity among children and adolescents

The impact of urbanization is particularly evident among children and adolescents. A March 2024 Lancet report revealed that 1 crore children aged 5–19 were obese, with childhood obesity rates in 2022 being four times higher than in 1990.

"Urban schoolchildren and young professionals (aged 5–40 years) are among the fastest-growing obesity segments," Dr. Kovil noted. "This is due to excessive screen time, lack of physical activity, and easy access to unhealthy, processed food."

He warned that childhood obesity significantly increases the risk of developing chronic diseases in adulthood.

Economic burden of obesity

Overweight and obesity cause over 3.4 million deaths, 4% of years of life lost, and at least 4% of disability-adjusted life years worldwide. "Without proper public health measures such as screening, treatment, and awareness programs, the country may suffer a loss of almost $440 billion, a 19-fold increase in obesity costs by 2060," this study noted. A report by the World Obesity Federation in 2017 said that India will spend US$13 million annually for treating obesity-related illnesses by 2025.

To address this crisis, Dr Kovil suggested a multi-pronged approach. "We need better nutrition education to promote balanced diets, increased protein and micronutrient intake, and public health campaigns encouraging physical activity," he said. He also stressed the importance of government intervention. "We must strengthen public health programs to address both malnutrition and obesity simultaneously. Additionally, tax benefits and incentives for weight loss initiatives can encourage healthier lifestyles," he added.

Also read: US obesity rate doubles since 1990, hits 208m in 2021, to reach 260m by 2050 - First Check