Once considered a sign of affluence, obesity has become one of India’s most serious public health challenges. Rapid urbanization, processed food consumption, and sedentary lifestyles have created a paradox — a country still tackling undernutrition now faces a surge in overnutrition. This dual burden drives escalating rates of diabetes, cardiovascular diseases, and other non-communicable diseases (NCDs).
The Growing Burden
According to the National Family Health Survey (NFHS-5, 2019–21), 24% of Indian women and 23% of men aged 15–49 years are overweight or obese — a sharp increase from NFHS-4. Urban adults, especially women, show higher prevalence (~35%), while rural rates (~19%) are steadily rising. Among children under five, overweight prevalence doubled from 1.9% in NFHS-4 to 3.4% in NFHS-5.
India, therefore, faces a growing “nutrition transition” — from traditional, fiber-rich meals to calorie-dense, ultra-processed foods — coupled with declining physical activity.
A Disease, Not a Lifestyle Choice
Globally, the World Health Organization (WHO) and World Obesity Federation classify obesity as a chronic, relapsing, multifactorial disease. However, in India, it is often still seen as a lifestyle issue rather than a medical condition, leading to poor diagnosis and limited structured management.
Notably, because Asian Indians have higher body fat and metabolic risk at lower body mass indices, India uses lower thresholds — BMI ≥ 25 kg/m² indicates obesity (vs. ≥ 30 kg/m² under global WHO criteria). This underscores the need for early detection and intervention.
Health Impacts and the “Diabesity” Link
Obesity significantly increases the risk of type 2 diabetes, hypertension, cardiovascular disease, stroke, certain cancers, sleep apnea, and polycystic ovarian syndrome (PCOS).
The link between diabetes and obesity — now termed “diabesity” — is particularly concerning: India already has over 101 million people living with diabetes, as reported by the ICMR–INDIAB 2023 study.
Policy Gaps and Challenges
India’s National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) indirectly addresses obesity through NCD risk factors, but interventions remain fragmented.
Challenges include:
Limited obesity screening and management in primary care
Few specialized obesity clinics or trained professionals
Weak enforcement of food labeling and marketing regulations
Insufficient school- and community-level nutrition programs
Management and Global Lessons
Effective management demands a multi-pronged approach:
Lifestyle modification: balanced diets emphasizing traditional grains and portion control, and ≥150 minutes/week of physical activity.
Pharmacotherapy: agents such as orlistat, liraglutide, and semaglutide hold the promise of weight reduction and metabolic benefits.
Bariatric surgery: recommended for severe obesity (BMI ≥35 kg/m² or ≥30 with comorbidities).
Digital tools: Health apps, wearables, and teleconsultations improve adherence and access.
Globally, countries such as the UK, Japan, and Mexico have implemented policies like sugar taxes, front-of-pack labeling, and national weight-management programs, offering models India can adapt.
The Way Forward
Obesity prevention must be viewed as an investment in India’s health and economic future. Key priorities include:
Recognizing obesity as a chronic disease in national health policy
Integrating weight-management services into primary care and NPCDCS
Developing India-specific clinical guidelines and research capacity
Promoting public awareness and destigmatization
With coordinated, evidence-based action, India can slow the obesity epidemic before it becomes irreversible.
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