Obesity in India: a major health concern

In this article about obesity, Dr Shifalika Goenka talks about how over the recent years obesity has increased in both rural and urban areas in men and women posing a major threat to the health of those people. She further talks about how instead of blaming the system and individuals the problem of obesity can be prevented by spreading public awareness about obesity and its health consequences.

Hyderabad: 4th march we celebrated the world obesity day. Obesity overall has doubled in 10 years both in urban and rural India, in majority of the Indian states according to the National Family Health survey- 4, done by the government of India(NFHS4).

For example in men it increased from 15 to 32 percent in Goa, from 14 to 28% in Tamil Nadu, 11-20% in Gujarat, from 10-20% in Haryana and even in Bihar it increases from 6 to 12 %. In women too, it increased from 17 to 33% in Andhra Pradesh, 8 to 18 % in Arunachal Pradesh, 13-26% in Manipur, 13- to 28% in Himachal Pradesh and so on and so forth.

In India, obesity’s damaging potential is even more. We all know that we are on a war footing with diabetes. Obesity continues to be the most important risk factor for diabetes in India. For every 100 obese adults (age > 20 years) in India, there were 38 adults with diabetes, compared with the global average of 19 adults in 2016.

Although a BMI greater than 25 is considered as obesity, there is a huge population which has covert obesity that means, not overtly obese but still have a high proportion of fat in the body and a lot of fat around the abdomen.

A waist circumference of more >= 90 cms in men and => 80 cms in women is considered abdominal obesity which significantly increases the risk of diabetes, high blood pressure, high cholesterol and heart attacks and strokes.

We would like to draw an analogy with the current Covid-19 virus. Towards the prevention of the Covid-19 virus the transport systems, economic, social and food systems play a huge role.

Additionally we know that the vanishing forests and increasing proximity of humans to animals has played of role in the origin of these zoonotic viruses like Covid -19 and SARS. We can’t and should never blame individuals for it.

For “obesity” too, stop blaming individuals, and mend the transport, economic and food systems which are the origins and perpetrators of it. The “Smart cities” first need to be obesity preventing, rather than obesity promoting. Obesity preventing features in a city also have the co-benefits of pollution lowering.(Incidentally, what everyone should know is that air- pollution in itself is also a risk factor for obesity especially childhood obesity).

Most importantly, the fiscal, food and agriculture policies which enable healthy foods and beverages- fresh fruits and vegetable, pulses, whole grains, nuts the cheaper, more accessible available and affordable option for each and every individual across the lifespan, in daily living across, all socioeconomic groups needs to be embraced.

Control on marketing of unhealthy foods and beverages especially to children is critical. So are mandatory inclusion urban forests and urban agriculture in all planning.

Physical activity in daily living has a huge role in preventing obesity of populations; We continue to applaud the Honourable Prime Minister for launching “Fit India movement”. Fitness can be achieved by providing an environment which creates fitness - Fit environments-. ‘Fit cities’, ‘Fit transport- which should include Fit pavements, Fit roads’, Fit recreation, ‘Fit-schools’, ‘Fit worksites’. Fitness in India has to be “make in India”

A ‘fit transport’ included ‘Fit pavements’ and ‘Fit roads’. Wide pavements which are as wide as the road not more than 6 inches high, with ramps, are ‘fit- pavements”. Lush green canopies on either side of the roads and pavements should act as “natural air-conditioners” and “oxygen cylinders” that provide comfort in the scorching heat to children, women, youth and elderly. Also, comfortable walking with frequent benches, water fountains for drinking water.

Fit- roads require limiting the number of motor carriageways of “in-city” roads to 1-2 carriageways only, with frequent zebra crossings, adequately timed signals for people of all ages and ability to comfortably crossover is the other imperative for ‘fit- roads’.

Limiting the number of motor carriageways to 1-2 is known to improve pedestrianism, pedestrian dignity and attract people to walk, cycle and be on the feet most of the day. It also supports equity, ethics, and justice (we must now allow the multi-lane roads).

Fit transport also requires quality, adequate capacity public transport which is known to increase fitness among its users. People using public transport walk 8-33 minutes, more, each day. Fit recreation require urban forests/large parks within 0.4 m radius, of every individual to encourage people to take up fitness pursuits for recreation and fitness in all age groups.

Fit buildings require, adequate set-offs, greenery, trees, emphasis on wide comfortable staircases with railings, lighting with other attractions as the ‘centre point’ (rather than in the back end of the building) Fit- social norms should make walking, fitness aimed pursuits socially desirable. Art and cultural centres and dance schools with opportunities in all towns and villages in India will promote fitness and fit- recreation, in all age groups.

Fit- schools need large playground and facilities, dance facilities- teachers and incentives for participation in play and dance as well as mandatory physical training and dance periods. Fit-worksites need to support physical activity through their built environments and policies.

Fitness needs to be age-sensitive and disable friendly in design. Doing so will make us truly developed and equitable in our vision and pursuits.