Rural India turning obese

Obesity and overweight recorded an 8.6-fold increase in India’s rural areas over 14 years, compared to a 1.7-fold increase in urban areas over 20 years. In the rural areas of Krishna district of Andhra Pradesh where we’ve been working, we found that 40 per cent of reproductive-age women are overweight or obese (with a body mass index, or BMI, of 25 or higher; 18 to 22.9 is considered healthy in women).

This rate of obesity is nearly three times higher than underweight prevalence, higher even than the average prevalence in Punjab, which leads all Indian states. It appears clear to us that the problems of overweight and obesity are no longer limited to the urban rich in India, one of three major contributors, along with the US and China, to the world’s heaviness epidemic.

The two of us have been working on under-nutrition in India and other countries for more than 30 years. We have seen plenty of overweight and obese persons, but we generally dismissed the issue as one of the consequences of urban, upper-income plentitude and one of little importance in India’s overall development.

With such numbers, and the strong association of overweight with cardiovascular disease, diabetes, high blood pressure and some cancers, India can no longer be lax about the problem. Obesity plagues India’s affluent, as IndiaSpend reported in December 2015. This is happening as India fights a losing battle with the bulge, hosting as it does the third-most number of obese people in the world - 61 million and growing.

No exception
Some of the overweight increases among the poor are surely due to what’s come to be known as the “thrifty phenotype” or the “Barker” hypothesis (after a late British epidemiologist), a now-proven postulate that persons who are undernourished during the foetal period, or the first two years of life, suffer biologic dysfunction as adults, including an inability to properly oxidise fat.

Commonly seen photos of an overweight mother feeding her undernourished child often suggest that the mother herself had been malnourished in her early years. But, additionally, some of the same factors precipitating overweight and obesity in more affluent individuals also have a role with low-income families: the tendency to calm a crying child with sweets, the insidious effect of omnipresent processed foods filled with sugar and transfats and their aggressive advertising (a downside of India’s continued integration into global food markets), alcohol, tobacco, and a more sedentary lifestyle than had earlier been the case.

Although there is no reliable national data, there is evidence from local studies that childhood obesity is growing in India, with poorer children as affected as richer children. These trends have proven difficult to reverse, even in countries which have addressed them seriously. Yet some promising developments in these countries may have relevance for India.

Change champs
One pre-requisite to engineer change appears to be finding a champion, preferably more than one. Such a champion in the United States has been its first lady, Michelle Obama, who has made the reduction of childhood overweight and obesity the primary goal of her years in the White House, with some positive results for the Let’s Move! campaign she designed.