India’s burden of rising obesity, the hefty cost to pay

In the last two decades in India, a major epidemiological transition has happened that has not captured sufficient public attention — the challenge of overweight and obesity. The National Family Health Survey round 5 (NFHS-5, 2019-21) suggests that nearly one in every four men or women is obese. The proportion of those who are overweight and obese ranges from 8% to 50% across States, in both men and women, and in rural and urban settings. The World Obesity Federation estimates that India’s annual increase in childhood obesity is one of the world’s steepest. Overweight and obesity in adults and children have doubled in the last 15 years and tripled in the last three decades. A nationwide study by the Indian Council of Medical Research in The Lancet Diabetes and Endocrinology (2023) had estimated that amongst adults over 20 years of age in India, one in every third ( 35 crore) has abdominal obesity, one in every fourth person (25 crore) has generalised obesity and one in every fifth person (21 crore has high levels of blood cholesterol.

Why the subject needs urgent attention

Being overweight and obese is often considered to be a personal issue. Also, the general societal attitude in India normalises obesity or being overweight. Over the past few decades, India has made another positive epidemiological shift: from being a ‘food or calorie deficient’ to becoming ‘food or calorie sufficient (with inequitable distribution) nation. Yet, the ‘State of Food Security and Nutrition in the World’ report (2024), estimated that around 55% (78 crore) of India’s population could not afford a healthy diet and that nearly 40% of people fall short of an adequate-nutrient diet. In the last two decades, easy and low-cost availability of high fat, salt, sugar (HFSS) and the ultra-processed food (UPF) has compounded the challenge. Urbanisation has led to a sedentary lifestyle for many. A recent World Health Organization (WHO) report says that 50% of Indians fail to meet recommended physical activity levels.

The ‘thin fat Indian’ is a scientifically validated hypothesis: that Indians even with normal body mass index (BMI) often have higher body fat. The ‘common soil hypothesis’ highlights obesity as a cause and risk factor for diabetes (one in every fourth Indian adult, or 25 crore Indians, is either diabetic or prediabetic). Overweight and obesity are associated with an estimated 3.4 million deaths annually in the world. This, inter alia, WHO and the professional association of doctors and endocrinologists across the world have recognised that obesity is both a risk factor/lifestyle challenge and a complex and chronic disease. The global obesity observatory estimates that the annual economic cost of obesity and being overweight in India in 2019 was $28.95 billion (₹1,800 per capita), or 1.02% of India’s GDP. These costs are linked to health-care expenditures and lost productivity, among others. Without sufficient interventions, it is estimated that the economic burden is likely to increase to ₹4,700 per capita by 2030 (or 1.57% of GDP). India’s Economic Survey 2024-25 takes note of obesity as an emerging health challenge, recommending higher taxation on UPF.

Yet, unlike undernutrition, there are not enough programmatic initiatives to tackle obesity. Though, the national government promotes the ‘Khelo India’, ‘Fit India Movement’ or ‘Eat Right India’ campaigns, and there has been public discourse also for a reduction in cooking oil use in households, these are initiatives which place far too much of a responsibility on the individual, even as and the responsibility of most other stakeholders is underplayed.

Policy and programmatic solutions

Tackling obesity needs a multipronged approach.

First, start a nuanced societal dialogue, and a structured science communication and public awareness campaign to highlight that obesity is a disease with rising burden and which contributes to other diseases such as diabetes, hypertension and liver disorders. Obesity needs prevention, care and management, just like any other health condition.

Second, more must be done to promote and facilitate regular physical activity. There needs to be better urban planning and urban infrastructure development with place for bicycle lanes, free access to parks and other public spaces and open gymnasiums.

Third, HFSS and UPF products are major contributors to the rising burden of overweight and obesity. These food items need to be taxed at a higher rate, with subsidies for healthier food items including fruits and vegetables and actions to ensure their easy and widespread availability. The food industry should volunteer to adopt ethical practices in food marketing.

Fourth, the ‘weight, height and waist circumference’ measurement has to be an integral part of all health visits and preventive health check-ups. Discussions regarding optimal weight should be done in every engagement with health-care providers. People need to know basic information such as what one’s optimal weight or waist circumference should be. A very generic but useful parameter to know one’s ideal weight is the height in centimetre minus 100 for males and minus 105 for females. The waist circumference of more than 80 cm in women and 90 cm in men is unhealthy.

Fifth, anti-obesity medicines are being licensed in various settings. There is a need for developing and widely disseminating clinical practice guidelines about the ideal candidates for anti-obesity medicines, which need to be used as per medical indication.

Sixth, every office and workplace needs to raise awareness about ‘unhealthy weight’ in the workforce and make weighing scales easily available. There must be regular awareness campaigns about obesity prevention. Body fat and composition analysis should be made routine practice.

Seventh, schools and colleges should be engaged in knowledge sharing on healthy eating habits and healthy diets. School canteens should serve healthy food. The proven good practices such as health promoting schools need to be adopted in India. The learnings from countries such as Japan, where dietitians are a part of every school network, should be explored.

Coordinated interventions

Eighth, obesity prevention requires multiple ministry engagements (health, finance, education, agriculture, urban planning and development) to work together. One of the learnings from implementing feeding and nutrition programmes is that isolated interventions make a limited difference. India’s nutrition intervention programme needs to be reimagined as ‘Suposhan Abhiyan’ with a focus on not just feeding but also ‘mindful under-feeding’ and ‘rightful micronutrient supplementation’.

Ninth, the research community, medical and public health professionals need to generate additional evidence including epidemiological data on overweight and obesity. This evidence needs to be communicated in easily comprehensible messages for the general public. The professional association of doctors needs to build the capacity of health-care providers in tackling overweight and obesity.

Tenth, in India, eating healthy is becoming more expensive than eating junk food. The food industry, especially online food delivery platforms, must facilitate healthy eating. Corporate social responsibility funds from this sector should be earmarked to promote a health lifestyle and eating habits.

Obesity is a public health challenge, waiting for holistic, multipronged and comprehensive interventions. Tackling overweight and obesity is a sine qua non for a healthy, economically prosperous and developed India.

Dr. Chandrakant Lahariya is a practising physician, who has worked with the World Health Organization and other United Nations agencies for nearly 17 years. He is the author of ‘Obesity care in India: a national white paper’

Published – March 04, 2025 12:16 am IST

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