India’s Obesity Time Bomb

Dr. Tarun Mittal is a surgeon in New Delhi. He is fighting on the front lines of an epidemic silently sweeping India, fueled by a new threat: junk food. We reduce the size of the stomach, which is called sleeve gastrectomy. We have operated from ages 13 to 74. Initially, when I joined my practice, I saw maybe one or two patients a month. Now I see between 15 and 20 patients a month. In India, almost one in four adults is overweight or obese. If nothing changes, the country's

obesity

rate will increase by more than 80% by 2035. This is not simply a story of people making unhealthy lifestyle choices.

In India, and in much of the world, larger economic and social forces are threatening people's health and prosperity. Much of India's history has been marked by famine. In 1943, the Bengal famine killed up to three million people. Even now, about a third of children are stunted. And yet, over the past three decades,

obesity

has increased. And everything is going to get worse. This has been accompanied by an increase in cardiovascular diseases and diabetes. The economic costs are enormous. Premature deaths, healthcare costs, and productivity losses Premature deaths, healthcare costs, and productivity losses resulting from an overweight population are estimated to exceed $129 billion by 2035 and account for nearly 2% of its GDP.

Now malnutrition poses a double burden. Malnutrition means less and more. Now we are also seeing a lot of overnutrition. Dr. Arun Gupta is a pediatrician and health activist. He is co-author of The Junk Push, a report detailing how changing food consumption threatens health. Since globalization, the marketing of processed and ultra-processed foods has increased. In fact, this has influenced many eating habits. One of the main contributions here is an unhealthy diet composed of ultra-processed foods, high in sugar, high in saturated fat or high in salt or sodium. Across the country, home-cooked meals are losing empty calories and sugar.

In the space of a decade, consumption of breakfast cereals and potato chips in India has more than tripled, while sales of confectionery and soft drinks have doubled. India is a huge emerging market for Western brands. Sales of ultra-processed snacks and sugary drinks grew from $6.2 billion in 2009 to $32 billion in 2022. For companies like Nestlé, Unilever or Kellanova, sales are growing at double-digit rates. And who are the main targets? Whenever we go to a party, let's say a friend's birthday party, there will be various junk food products like Coca-Cola, Pepsi. I really enjoy Maggi and I like noodles and ramen.

Burger King, McDonald's. Maggi. Pasta. French fries. Burgers. Pizza. That's very delicious. India's new food economy has created a public health conundrum as the packaged food and beverage industry increasingly impacts the diets of 1.4 billion Indians. One remedy other countries have turned to is stricter regulation. Chile, for example, prohibits television advertising of certain foods between 6 a.m. and 7 p.m. and 10 p.m. It has also restricted the use of images aimed at children in the marketing of these products. After these interventions were introduced, sales of sugary drinks fell by 24%, as did calorie consumption, calories from sugar, and calories from saturated fat.

Until now, India has mainly relied on companies themselves to self-regulate how they convey the nutritional value of their products. Some argue that the results are misleading. If you look at the front of the package, you'll see they say it's like 50% vitamin D. Rich in vitamin C, with no added preservatives. And it says very clearly: 20% protein. But if you look at the back of the label, you will find that 46% is sugar. More than 13 grams of sugar. Stabilizers, colorants and flavors. If you tell people it's high in protein, you might as well tell them it's also high in sugar and fat.

Efforts are underway to introduce a more rigorous system. Throughout 2021 and 2022, Indian authorities consulted health and consumer rights experts, and food company representatives, about a new labeling system. While health and consumer rights groups advocated for a traffic light system, used in much of Europe, that flags products high in sugar, fat or salt in red, the authority's final conclusion was a rating Health Star Rating, which assigns star ratings to a product's overall nutritional value. Not everyone was happy. Health Stars only notes that this food is healthy or less healthy. It doesn't tell people it's unhealthy. For example, a package of cookies may have a very high amount of sugar.

But, if manufacturers add nuts, it could receive one star for containing fiber. Getting this regulation correct has been eluding us in the country. So that's part of the story. But what we are missing is working at the community level, with children, parents and families to create an environment conducive to healthy eating and sustainable food environments. Pawan Agarwal runs the Food Future Foundation, a non-profit organization that seeks to educate schoolchildren about healthy eating. The foundation runs programs in schools like this one to educate children and parents. It is very important to focus on a preventative strategy and use diet and lifestyle as an entry point for this intervention.

The government or any regulatory body cannot reach individual citizens during all meal

time

s. So at the end of the day, it's about individual choices. While nutrition advocates seek stricter regulation, that may run counter to Prime Minister Narendra Modi's strategy of attracting more investment from multinational companies. The fear among health experts is that the burden will ultimately fall on people to make healthy decisions for themselves, with little guidance from the government. One of the tactics they use is to impose responsibility on the people. That it is people who choose to eat the wrong foods. It's not us.

Which is probably one of the strategies they have also been using for tobacco. That people smoke by choice and not by marketing. What cigarette do you smoke, doctor? The most mentioned brand was Camel. Smoke camels. The cigarette that doctors enjoy so much. The tactic is: industry will become part of the solution. They want to be part of the solution. They enter policy-making bodies. Of course, the government allows them to do so, as stakeholders. Strict regulations and education have reduced smoking rates around the world. Controls on the food industry may be necessary to combat rising rates of obesity in India and the diseases it causes.

Diabetes, hypertension, joint pain, back pain, varicose veins, gallstones, hernia, cancers, infertility, chest problems, heart problems. It is putting enormous pressure on our economy. A country once plagued by too few calories must face a new battle with too many empty calories.