Opinion Obesity calls for a wider and more complex debate
Critics of the medicalisation of obesity argue that a large spectrum of ‘naturally occurring bodily diversity’ is today being pathologised
How to devise environments that address obesity's immediate causes? The recent approval of Ozempic for diabetes treatment in India has triggered conversations on the “obesity market”. The global weight management market was estimated at $142.58 billion in 2022 and is projected to reach $298.66 billion by 2030. The anti-obesity pharma market in India has grown nearly five times in the last half-decade. A combination of the non-communicable diseases epidemic and wellness culture has led to India’s corporate tertiary care hospitals offering diagnostic and treatment services for obesity on the one hand and preventive services on the other.
The WHO characterises obesity as a “chronic, relapsing disease,” because of the complex interactions between genetics, neurobiology, eating behaviour, access to a healthy diet, market forces, and the broader environment. For adults, a BMI (body mass index or the measure of weight relative to height) greater than or equal to 25 is considered overweight, and a BMI greater than or equal to 30 is considered obesity. Obesity is now seen as a global crisis. Its prevalence among adults has doubled in the last three decades, and among adolescents it has quadrupled. Currently, 35 million under-five children and about 400 million in the five-to-19-year age group are estimated to be overweight. India’s National Family Health Survey 5 (the current round) data show that nearly 1 in 4 adults is overweight.
When obesity is seen as a chronic lifestyle disease, its treatment or management encompasses a range of practices and interventions: Healthy eating habits, regular exercise, behavioural changes and medicines for weight or bariatric surgery in severe cases. This individual-centred approach ignores the social determinants that encompass a variety of interactions between a person’s physical and social environments. Poor housing, inadequate budgets for healthy food, physical activity and overall health create an obesity risk. So do workplace stress, social hierarchies, adverse childhood experiences and discrimination. The noisy environment in some low-income neighbourhoods affects sleep quality. Race, caste and religious discrimination have a bearing on food choices. These adversities get gendered in multiple ways, making women more vulnerable to obesity.
Critics of the medicalisation of obesity argue that a large spectrum of “naturally occurring bodily diversity” is today being pathologised. The failure to maintain an “ideal weight” is often seen as an individual failure – a failure to adopt a healthy lifestyle (diet or exercise). This approach, the critics say, ignores the structural drivers of the condition as well as other complexities, such as the role of genetic factors in obesity.
At the same time, there are potential benefits to medical and surgical therapy for conditions when obesity is a co-morbidity. Perceiving obesity as a disease, and beyond individual control, can also help destigmatise it to an extent. Addressing obesity needs a richer debate. Is medicalisation and an overt reliance on tertiary care the way forward? How to devise environments that address obesity‘s immediate causes? In any case, improving the quality of people’s lives and working conditions is the first step to address the crisis.
The writer is professor and chairperson, Centre of Social Medicine & Community Health, JNU
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