A 25-year-old techie from Thiruvananthapuram had a dream job that gave him Rs 4 lakh a month and the freedom to work from home. Food was his only stress-busting indulgence as he stayed glued to his work. This, coupled with long sedentary hours on devices, resulted in massive weight gain. When he weighed 150 kg and developed diabetes and hypertension, he consulted research diabetologist Dr Jothydev Kesavadev, who feels obesity is now more than a lifestyle disorder, it’s a public health concern.
“Obesity should be considered a chronic disease because it involves abnormal biological processes, is a result of them, causes health damage, has clear diagnostic criteria and requires medical therapies and long-term management,” he says.
That’s the reason he and other top diabetologists have written a white paper, predicting that India’s obesity rates are predicted to rise substantially. By 2050, the paper says, 17.4% of women and 12.1% of men will be living with it. Obesity in women is projected to be 10 per cent higher than men. Childhood obesity is the most worrisome as the prevalence in children and adolescents (between five and 19 years) has gone up 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.
“Therefore, we are seeking a policy push to change the narrative around the emerging obesity spiral in the country, by looking at it as a chronic disease rather than just another lifestyle condition. This will also help demolish stigma attached to body weight,” says Dr Jothydev. The multi-centre study includes findings by AIIMS, Delhi; Christian Medical College, Vellore; Fortis Memorial Research Institute, Gurugram; and Jothydev’s Diabetes Research Centre, Thiruvananthapuram. It has been published in the International Journal of Clinical Obesity, the journal of the World Obesity Federation. Over to Dr Jothydev:
Why should obesity be considered a disease?
Obesity is not just about genetics. It is a complex, multi-faceted condition driven by genetic, metabolic, neurobiological and environmental factors. It involves impaired metabolic pathways, specifically signalling issues with hunger, satiety and energy balance. Enlarged fat cells trigger inflammation that in turn leads to insulin resistance, heart disease, cholesterol and fatty liver disease, and insulin resistance.
What many may not know is that obesity-related cancer is on the rise. Pancreas cancer has gone up by 30 per cent as have urinary bladder cancers, their incidence linked to obesity-related metabolic changes and liver fat accumulation. Colorectal cancer is rising too. Among women, elevated estrogen levels from body fat are triggering breast and uterine cancers.
In fact, the World Health Organisation (WHO) included obesity in the International Classification of Diseases (ICD) in 1948. While this marked the formal recognition of obesity as a disease, it was not widely accepted or treated as such by the medical community for many decades. Given India’s burden of non-communicable diseases (NCDs), including type 2 diabetes, cardiovascular disease and cancers, we need to look at treating obesity, which has spiralled in the last four decades.
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What’s triggering the obesity spiral in India?
It has got to be emotional eating or what we call hedonic hunger. It is a pleasure-based desire to eat palatable foods in the absence of physiological hunger, based on exposure to food-related cues, like sight, smell and access. Food is the easiest way of pleasure-seeking given our stressful and sleepless lifestyle. In various cross-sectional studies, emotional eating was linked to depression and obesity. With the restaurant boom, easy access through food apps and social-meetups, emotional eating is the easiest way to enhance moods. Anybody relying on emotional eating now is guaranteed to develop obesity in a decade.
Besides, the health costs of obesity are steep, be it for knee replacement, heart disease and cancer therapies. Tackling obesity is crucial as the economic burden is projected to increase 17-fold by 2060.
What does policy change mean? How can it prevent obesity?
Policy change will mean standardised treatment and monitoring guidelines. Right now, there is no unified code for managing obesity or preventive measures. There should be obesity clinics at public healthcare facilities. There should be school interventions for diet and behaviour change although sugar boards in central schools have just taken off.
Indians mostly have abdominal obesity, which means belly fat. They may have a normal body weight with decreased muscle mass and look skinny but have a protruding stomach, the common risk factor for all non-communicable diseases. Indians need to rethink their diet and their dependence on carbs. Portion control of carbs, spacing meals to neutralise hunger cues and correcting sleep patterns are no longer a matter of choice given our sickness burden. They don’t need any exercise but strength training. A work culture must incorporate taking breaks every 30 minutes after prolonged sitting. Women, for example, need to watch their diet and exercise very closely in the perimenopause years, the transitional decade before menopause, to avoid hormone-induced weight gain.
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All of this calls for standardising medical management, including training healthcare providers and potentially covering obesity treatments through insurance. It also means having an all-round national campaign that’s implementable on the ground.
What about the increasing dependence on weight loss drugs for therapy?
No doubt drugs like GLP 1 receptor agonists have proved effective in trials but their high costs and sustainability continue to be a concern. A preventive module addresses obesity across the population.
