18-year-old battling obesity, diabetes, borderline cholesterol: Lancet study looks inside India’s ultra-processed food epidemic

“This worrisome shift is fuelling obesity and other non-communicable diseases. India is witnessing the same shift that the Lancet series warns about,” says Dr Arun Gupta, co-author of the study, and also the convenor, Nutrition Advocacy for Public Interest (NAPI) and former member of PM’s Council on India’s Nutrition Challenges. “Traditional meals are being fast replaced by hyper-palatable industrial ultra-processed food products via aggressive marketing and advertising campaigns. Yet India does not have exact data on ultra-processed food consumption. Our regulations are ineffective to restrict marketing. India must act immediately to take action and cut the consumption of ultra-processed foods to halt obesity and diabetes in the coming years. Given that India is fastest in sales growth and with evidence of poor health outcomes, India needs to frame stronger norms for ultra-processed foods as a priority health issue,” he adds.

What are ultra-processed foods?

Ultra-processed foods are those which go through multiple industrial processes, use manufactured ingredients, preservatives and additives rather than whole foods, and are designed to be convenient with a long shelf life. Examples are soft drinks, chips, chocolate, candy, ice-cream, sweetened breakfast cereals, packaged soups, chicken nuggets, hotdogs, fries, ready-to-heat foods and more.

Why is the India scenario worrisome?

Retail sales of ultra-processed foods in India have surged from $0.9 billion in 2006 to nearly $38 billion in 2019, a 40-fold increase. During the same period, obesity doubled in India, as per the Lancet series. In India, obesity affects one in four people (28.6 per cent), diabetes affects one in 10 (11.4 percent), prediabetes one in seven people (15.3 per cent) and abdominal obesity, one in three (39.5 per cent), according to ICMR-INDIAB data of 2023. Childhood obesity is rising at an alarming rate (from 2.1 to 3.4 per cent between 2016 and 2019-21) as per National Family Health Survey (NFHS) data.

Ultra-processed foods are associated with an increased risk of 12 health conditions, including obesity, Type 2 diabetes, high blood pressure, depressive symptoms, heart, kidney, and gastrointestinal diseases, as well as premature death from all causes.

Dr Aparna Govil Bhasker, Mumbai based bariatric and laparoscopic surgeon, explains how regular consumption of such foods contributes to visceral obesity. “People consuming ultra-processed foods generally end up having at least 500 calories more per day as compared to those who have unprocessed foods. These get converted to fat around the abdomen. Unfortunately, there is a lack of awareness about how these common and popular food items can be so harmful in a country like India, where the population is genetically predisposed to visceral obesity and metabolic diseases,” she says.

“The country’s modern food system is increasingly shaping an unhealthy dietary environment. Through aggressive marketing, celebrity endorsements and promotional tactics, it drives the widespread consumption of ultra-processed foods. Not surprisingly, retail shop shelves are now dominated by pre-packaged food and beverage products such as namkeens, noodles, biscuits, sugar-sweetened beverages, chips, breakfast cereals, exposing children and youth in both urban and rural India via their advertising,” Dr Gupta adds.

He also calls for an educative campaign on the differences between processed and ultra-processed foods. “All processing is not bad. Processed foods are whole foods, which have undergone some alteration, like washing, canning, or cooking for increasing their shelf lives or transit to the kitchen. Ultra-processed foods are artificially made, high on calories, low on nutrients. This difference must reach policy makers and people,” Dr Gupta says.

Call to action

Prof K Srinath Reddy, chancellor of PHFI University of Public Health Sciences, says ultra-processed foods are fuelling the growing pandemic of obesity by pumping energy dense foods into people’s diets and displacing fibre-rich healthy components of natural foods. This alters the balance of gut microbes, which feed on fibre, stokes inflammation and changes hormone functions. “This includes lowering production and release of the naturally produced GLP-1 hormone, which is released by the small intestine. This stimulates the pancreas to release insulin, slows down gastric emptying and signals the brain to promote feelings of fullness (satiety), which can lead to reduced food intake and contribute to weight loss,” says Prof Reddy, explaining the link between ultra-processed foods and obesity.

Prof Reddy also stressed that while global regulation of such products is needed, India needs to adopt strong regulatory measures directed at their production, marketing and public disclosure of their constituents. “Front of pack warning labels must clearly communicate the harmful levels of salt, sugar and fat to consumers.”

Experts have suggested a nutrition information panel and traffic light labelling, a panel that not only shows the amount of fats, salt, sugar and other nutrients present in a serving of the packaged food but also colours it red, orange or green based on how healthy it is. They have also proposed a star rating based on how healthy the product is at first glance.