NEW DELHI: India’s obesity rates are predicted to rise substantially and by 2050, it is estimated that 17.4% of women and 12.1% of men will be living with it, said a whitepaper, which recommends policy change to address the growing epidemic in the country.
What is worrisome is that the prevalence of obesity in children and adolescents (aged 5-19 years) is increasing from 0.1% to 3.1% in girls and from 0.2% to 3.7% in boys between 1990 and 2022, to a total of 12.5 million children and adolescents living with obesity.
The whitepaper written by 12 Indian experts, including from AIIMS, Delhi; Christian Medical College, Vellore, Tamil Nadu; Fortis Memorial Research Institute, Gurugram; and Jothydev's Diabetes Research Centre, Trivandrum, Kerala, said, that a significant barrier in India is that obesity is often viewed as a lifestyle condition rather than a chronic disease, despite broad international recognition of this status.
Recommending policy change to ensure that obesity is adequately managed in India, the whitepaper said, this will help improve health of the overall population and reduce disease burden and healthcare costs.
Published in the International Journal of Clinical Obesity, the official clinical journal of the World Obesity Federation, the whitepaper said obesity is associated with an increased risk of non-communicable diseases (NCDs), including type 2 diabetes (T2D) and cardiovascular disease and is a risk factor for various cancers like colorectal, endometrial, gallbladder, liver, oesophageal, pancreatic and post-menopausal breast cancer.
Speaking with this paper, Dr V Mohan, Chairman of Dr Mohan’s Diabetes Specialities Centre, Chennai, and the co-author of the study, said, “The main aim of this article is to raise the level of awareness about obesity at the policy level. Right now, it is being treated as an individual problem. People eat more, eat junk food, and that's what it is. But it is much more than that.”
“Obesity is not easy to control just by cutting down a little bit of diet. We are calling for governmental action to treat obesity as a chronic disease, which will remove social stigma and bring societal support,” he said, adding that there are various weight-reducing drugs, which are very useful, but not affordable to the common man.
"If we declare it as an essential disease, then steps can be taken to bring it under generic drugs and to make it affordable to the common man,” he added.
The experts stressed that to address the obesity epidemic in India, transformative and comprehensive policy changes, along with greater awareness, are needed from the government and the general population.
“This must begin with recognising obesity as a disease in India and incorporating it into the government of India's NP-NCD (National Programme for prevention and Control of Non-Communicable Disease). Standardised guidelines will be key to driving change in obesity, especially given the multiple stakeholders involved. Prevention and management should be data-driven and evidence-based; there is a need for more alignment from the research community regarding data collection on the societal costs of obesity,” they added.
Recommending a change in the narrative, they said obesity should be moved from a disease-management to a health-focused approach to reduce disparities in its prevention and management.
They also suggested investing in healthcare systems and to initiate, augment, and scale the support provided by the healthcare system to people living with obesity.
“The burden of obesity can only be addressed through acceptance of obesity as a disease and collaboration across healthcare and policy stakeholders, with significant resource commitments at every level,” it said.
Obesity was recognised as a disease by the World Health Organisation (WHO) in 1948 and by the American Medical Association in 2013. The WHO defines obesity as a chronic, complex disease characterised by excessive fat deposits that poses a health risk.
In Asian populations, individuals with a body mass index (BMI) of ≥ 25 kg/m2 are considered to be living with obesity, with those with a BMI of 23–24.9 kg/m2 categorised as overweight.
Using this definition, the Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study estimated that in 2021, there were 254 million individuals with generalised obesity (BMI ≥ 25 kg/m2) and 351 million with abdominal obesity, defined as waist circumference (WC) ≥ 90 cm in males and ≥ 80 cm in females.
“Even using the global threshold of ≥ 30 kg/m2, India had the third largest total number of adults living with obesity worldwide in 2022 and the rise in obesity rates is cause for concern, increasing from 1.2% to 9.8% in women and from 0.5% to 5.4% in men between 1990 and 2022,” the article said.
The World Obesity Federation (WOF) estimates that by 2030, 1.1 billion adults will be living with obesity worldwide and by 2060, the global cost of overweight and obesity is predicted to be over Rs. 1544 trillion.
In India, the cost of overweight and obesity was estimated at Rs. 2.5 trillion in 2019, including Rs. 199 billion of direct medical/non-medical costs and Rs. 2.3 trillion of indirect costs (relating to absenteeism, presenteeism and premature mortality), representing 1.02% of the gross domestic product (GDP).
By 2060, costs are predicted to rise to Rs. 72 trillion (Rs. 3.7 trillion direct and Rs. 68 trillion indirect, the latter largely premature mortality), representing a 29-fold increase and 2.47% of India's GDP.
“Altogether, given the chronic, progressive nature of obesity, which poses both clinical and economic burden, early recognition and diagnosis are crucial to improve outcomes. Proactive screening for high BMI or central adiposity can facilitate timely intervention before severe comorbidities develop,” the article said.