India has seen a steady increase in obesity levels — not only in adults but children too — over the last 32 years. At the same time, the prevalence of undernutrition has also remained high in the country. As a result, India has become one of the countries with a high “double burden,” according to a new Lancet study, which examined the trends of malnutrition across the world over the last 32 years.
The study, published on Thursday (February 29), blamed a lack of access to affordable and nutritious food for the prominence of undernutrition and obesity. While lack of access to food can lead to undernutrition, increased access to processed foods high in fats, salt, and sugar has driven up obesity, the study added.
What are the parameters of being obese and underweight?
According to the World Health Organisation (WHO), obesity is an abnormal or excessive accumulation of fat that poses health risks.
Adults — anyone over the age of 20 years — are considered to be obese, if they have a body mass index (BMI) of 30 kg/m2 or more. BMI is a person’s weight in kilograms divided by the square of height in meters, according to the Centers for Disease Control and Prevention. School-aged children and adolescents — anyone between the ages of 5 and 19 years — are considered obese, if their BMI is more than two standard deviations above the mean.
Underweight is one of the four broad sub-forms of undernutrition. An adult is considered underweight if their BMI is less than 18 kg/m2. School-aged children and adolescents are considered underweight if their BMI is less than two standard deviations below the mean.
What does the data tell about India?
Obesity in women has spiked in the past three decades — it increased from 1.2% in 1990 to 9.8% in 2022, according to the study. There were 44 million women living with obesity in 2022. Meanwhile, obesity in men increased by 4.9 percentage points during the same period, with 26 million men living with obesity in 2022.
Notably, there has also been a significant increase in childhood obesity. There has been a spike of 3 percentage points in girls and 3.7 percentage points in boys over the 32 years that the study examined. In 2022, 3.1% of girls and 3.9% of boys were obese. In other words, while 0.2 million boys and 0.2 million girls were obese in 1990, 7.3 million boys and 5.2 million girls were obese in 2022.
Despite a significant decline, the prevalence of underweight and thinness continues to be high across genders and age groups. The study found that 13.7% of women and 12.5% of men were underweight. Thinness — a measure of being underweight in children — in Indian girls was found to be the highest in the world, with a prevalence of 20.3%. And, it was the second highest in Indian boys, with a prevalence of 21.7%.
Why are more women obese as compared to men?
Speaking to The Indian Express, Dr V Mohan, one of the authors of the study from India, said: “Women are more prone to putting on weight because most of them do not have
access to or time for physical activities such as walks or gyms. They are also likely to put the nutrition of the family above theirs. They are also likely to have fewer hours of proper sleep, waking up first and going to bed last”.
Dr Mohan added that if central obesity were to be considered, obesity in women would be as high as 40% to 50% in many parts of the country. A better predictor of future risk of diseases like diabetes and hypertension, central obesity is an excess accumulation of fat in the abdominal area.
How do socio-economic conditions affect obesity and undernutrition?
Dr Mohan explained that obesity is no longer the disease of the rich in India. He said: “Eating junk food is cheaper and easier. For example, the cost of samosas and pakoras available at roadside shacks is less than fruit and vegetables. While it is not nutritious, it is tastier. It is the same as the West, where a McDonald’s burger will cost say a dollar but fresh vegetables much more. This has led to an increase in obesity even among the poor, especially in states that are better off such as Tamil Nadu, Punjab, and Goa.”
While it is affecting more people, there continues to be a rural-urban divide when it comes to obesity. An analysis of the NFHS-5 data from last year shows that the prevalence of obesity was 31.7% in urban women and 19% in rural women. It was 28.6% among urban men and 18.8% among rural men.
Undernutrition persists in extremely remote and rural parts of poorer states where access to any kind of food is low. “Undernutrition is prevalent in the extremely poor populations in states like Bihar, Jharkhand, or Odisha, where people might be eating just one meal a day,” said Dr Mohan.
What are the impacts of obesity and undernutrition?
The health consequences of obesity are obvious. An increase in obesity, especially in children, is likely to lead to an increase in diseases such as diabetes, hypertension, heart attacks, and strokes. The effect of undernutrition, however, is not so obvious.
Dr Mohan said that undernutrition is likely to increase the burden of non-communicable diseases. “There is a well-known hypothesis that says babies who are born small are likely to have smaller organs and vessels. They have a catch-up growth later in life, but their bodies are less likely to adjust to increases in nutrition, making them more prone to lifestyle disease. So when a healthy-weight baby and an under-weight baby become obese later in life, the risk of diabetes or other diseases is much higher in the under-weight baby,” he said.
Dr Mohan explained that this has been seen even in famines, where the rate of diseases like diabetes shoots up ten to fifteen years later.
What needs to be done?
Obesity and underweight should not be considered in isolation, according to the study. “Because the underweight-obesity transition can occur rapidly, leaving their combined burden unchanged or higher. It proposes that the focus has to be on programmes that enhance healthy nutrition, such as targeted cash transfers, food assistance as subsidies or vouchers for healthy foods, free healthy school meals, and primary care-based nutritional interventions,” the study said.
Other than ensuring food security, the study also mentioned that there is an urgent need for supporting weight loss in those with obesity. “Prevention and management are especially important because the age of onset of obesity has decreased, which increases the duration of exposure. Making healthy food affordable and accessible is the challenge,” the study said.
With a boom in the market for drugs to treat obesity, the study added: “New pharmacological treatment of obesity, although promising, is likely to have a low impact globally in the short-term, due to high cost and the absence of generalisable clinical guidelines.”
Rohit Malhotra is a medical expert and health journalist who offers evidence-based advice on fitness, nutrition, and mental well-being. His articles aim to help readers lead healthier lives.
