Worth the Weight?

In a country where poverty and deprivation are common, the words fat and prosperous are synonymous. Many people in India are still unaware that too much fat can be a dangerous thing. According to the World Health Organization (WHO), “obesity-related ailments afflict more than 115 million people in the developing world, up from essentially none two generations ago. By 2030, these diseases as a group are projected to be the number one killer of poor people around the world” (Bidwai 2). In developing countries like India, this is creating a “double burden” as they continue to battle problems and disease associated with hunger and undernourishment, and they are now faced with new, even larger issues associated with over-nutrition and obesity.
The surge in urbanization and globalization around the world in the past three decades has brought economic advancement and development to many previously struggling countries. Unfortunately, this wealth has come at a price. All across the globe, obesity and diet related non-communicable disease has risen in parallel with urbanization (Hossain 214). According to the WHO, “fifty years from now, if current trends persist, obesity will be up there with climate change and water shortage as one of the biggest problems facing India”(Sukhdev 1). In the past thirty years in India, diabetes, obesity and non-communicable disease rates have tripled as urbanization and the adoption of western lifestyles has begun to dominate their culture. Where obesity used to be seen as an individual problem derived from private food choices, it is now associated with large costs to all of society.
At the end of World War II, the majority of India’s population was facing hunger, often starvation and very poor economic and social conditions (Popkin 380). Urbanization has led to rapid changes in lifestyle with more “white-collar” jobs leading to an increase in income as well as a decrease in physical activity. As incomes increased, many Indians rose above poverty level for the first time, and the newly developing country became a target for many U.S. based multi-national corporations. India resisted for some time until the promises of a booming economy and a solution to the hunger problem became too much to pass up. In 1992, the Indian government “admitted foreign soft drink manufacturers and food multi-nationals to its previously protected economy” (Patel 74). Coca Cola, Baskin Robbins, Kellogg’s cereals, McDonalds, KFC, and many others happily set up shop throughout urban Indian centers. While the hook was that these widely available, inexpensive foods could save lives by providing easily accessible food to those who had no other options, “the added values in these new foods is not nutritive, but economically added value which will only bring benefit to the multinational corporations. The people consuming these will only be further denutrified” (Bidwai 7). Malnutrition has typically been seen as a problem of the undernourished and underweight, and in the past, it was. However, malnutrition is not simply caused by a lack of food overall, but by a lack of high quality foods such as whole grains, fiber, fruits and vegetables. Since 1992 obesity and chronic health problems such as heart disease, diabetes and hypertension have increased significantly. In less than a decade, India became “the home of nearly 33 million diabetic subjects which is the highest number in the world” (Joshi 360). According to the WHO, this number is set to more than double in the next 25 years, casting a dark shadow on the health and economic future of India.
Lifestyle and food habits have changed as India’s economy has developed. More women have joined in the work force and as a result there has been a shift away from traditional food preparation and toward precooked, convenience food at home or fast food and snacks for outside meals. This has also meant a shift from diets high in fiber, vitamins and minerals toward one rich in calories, saturated fats, sugar and cholesterol. While the recent infatuation with convenience foods has clearly taken its toll on the waistlines and health of the Indian population, it is not solely to blame for the dramatic increase in diet related illness and non-communicable disease. Rising incomes and urbanization has led to “the substitution of servants or appliances for physical work around the house, while family breadwinners take desk jobs instead of plowing the fields” (Chatterjee 1). These factors also encourage more sedentary leisure activities like television watching, computer use and travel by car instead of walking or riding a bicycle. On top of this, Indian schools promote a culture of fierce academic competitiveness and leave children with no time to play or exercise. With all of these changes occurring at once, studies are showing that while these are dangerous habits for any group of individuals, they seem to be particularly harmful to the people of India. As an ethnic group, Indians seem to be more genetically prone to obesity and its health consequences. Their ancestors had genes which converted food to fat to store as fuel during famines; now however, there are no famines, no physical activity and a bad diet so everything they eat is converted into abdominal fat which leads to killer heart disease (Popkin 389).
There is a growing trend in India toward “Metabolic Syndrome.” This syndrome is a deadly combination of hypertension, diabetes, heart disease and dyslipidemia due to abdominal obesity (Joshi 359). India tops the world with the largest number of diabetic subjects and the spreading cardiac and diabetes epidemic is a major health threat for India threatening to bankrupt the nation. If they continue on the track that they are on, by 2035 “India will contribute to more than one-fifth (20%) of the total diabetic population in the world” (Hossain 1). Even more troubling are the statistics related to childhood obesity and early onset diabetes in India and what these numbers may mean for the future. The prevalence of overweight and obesity in urban children in India’s capital of New Delhi has shown an increase from “16% in 2002 to about 24% in 2006-2007” (Bhardwaj 172). Type 2 diabetes among children in India is increasing at an alarming rate and the serious cardiovascular complications of obesity and diabetes could overwhelm the developing country that is already struggling under the burden of communicable diseases.
Along with the introduction of new, cheap convenience foods, basic food costs have been subsidized up to market levels in the public distribution system, resulting in an 85 percent price increase in the past four years (Bidwai 2). What this means for India’s 380 million poor is that they cannot afford to buy the new convenience foods or the basic dietary staples that have sustained them in the past. They are spending more money to buy less food, reducing their caloric intake and approaching starvation in many cases. The poor are still starving, perhaps even more so than in the past, while the rich are getting fatter. This paradox becomes even more apparent when the local urban schools are studied for statistical purposes. In studies conducted in Kerala and Delhi, roughly 20% of school children are considered overweight with 5% falling in the obese category. Additionally, 16% were found to be underweight, leaving only 58% in the normal weight range (Unnithan 5). This statistic alone should be a red flag for the Indian government. Overweight and obese children are much more likely to remain overweight throughout their life and with health problems starting at younger ages, the life span, quality of life, level of productivity and strain on the health care system will be a considerable threat to the future of India.
As the occurrence of communicable disease has gone down, the costs of lost productivity have shifted from those associated with under-nutrition to those associated with over-nutrition. Healthcare system costs have also increased in parallel with the shift since non-communicable diseases are more costly to treat than communicable ones (Popkin 383). Alongside the burden on health in India, it is predicted that a drop in overall economic productivity and life expectancy may also be of concern when one is weighing the costs of the obesity issue. According to Josef Schmidhuber of the Economic Social Department of the Food and Agriculture Organization of the United Nations, “the human and economic toll could be dramatic and for many the exit out of food-poverty may be associated with a straight entry into health-poverty” (384). It is a shame that India has somehow managed to bypass good health, moving from underweight to obesity in a single generation.
Obesity and its associated diseases have an enormous impact on the healthcare system, the economy and most importantly, on general well-being. However, obesity has not made it to the Indian public health policy agenda in any significant way. Since undernourishment and obesity are occurring side by side, healthcare providers and policy makers are faced with a dual challenge in the “formulation of a broad food policy that encompasses both under- and over-nutrition [as] the only answer to India’s peculiar problem” (Sukhdev 2). While the movement toward urbanization and globalization has stimulated India’s economy with an annual growth rate of between 5 and 5.5 percent, the new economy also brings with it another western tradition, “it is $24 billion deeper in external debt, and more dependent on aid and investment package bailouts” (Bidwai 2). India has gone from completely rejecting western culture to embracing it and all of its flaws. In the generous nature of the United States, we have shared our poor dietary choices, sedentary lifestyles, debt accumulation and global monopolization of agricultural industries that used to sustain lives and communities. What we are witnessing in India is what has been occurring in the United States for the past 50 years, but in fast forward.
According to the WHO, obesity now ranks as the 10th most important health problem in the world (Loureiro 1). There are approximately 1.1 billion hungry and underfed people across the world, but for the first time in history, they are outnumbered by the number that are overweight or obese (Bidwai 7). The trend toward obesity and overweight is now shared by almost all other countries. According to Bidwai, 300 million people worldwide are obese, 750 million are overweight and 17 million of those are under the age of 5. Studies performed by the WHO show that more than half of the populations in Australia, Brazil, Denmark, Italy, Mexico, Russia and Spain are overweight. Not far behind are China, Guatemala, Papa New Guinea and Egypt (Loureiro 1). These problems and contrasts are present even in the United States. Being overweight or obese is the norm in America with 66% of the population falling into that category (Patel 73). Currently, in the United States, health care for overweight and obese individuals costs an average of 37% more than health care for people of normal weight, adding an average of $732 to the annual medical bills of each American (Loureiro 2). Obesity can no longer be viewed as an individual problem as it is now growing to epidemic proportions in India, around the world, and especially among children. Both obesity and hunger (specifically food insecurity) are serious public health concerns. Their existence sounds contradictory but those without resources to purchase adequate food can still be overweight. Awareness and understanding of this apparent paradox is necessary in order for us to tackle these parallel threats to the well-being of many children and adults. The genetic factors, the novelty of westernized living, as well as the economic state of India prior to this evolution have come together to create a problem warranting serious consideration. If India continues on this path, it will see a dramatic decline in the health and productivity of its citizens and the economic benefits will likely be cancelled out by the health and other economic costs.