Obesity: India’s big problem

We’ve all been there. A pair of pants that suddenly feels too tight. A flight of stairs, once an easy climb, that seems like a monumental trek. Your knees, hips and back hurt, and you’re tired all the time. 

These are all signs that your weight is creeping up. Yet, very few of us realize that as we gradually pile on the kilos, we’re growing closer to becoming an obesity statistic. Data released in October by the World Obesity Federation, a community of organizations dedicated to solving the problem of obesity, shows that the percentage of Indian adults living with obesity is set to jump to around 5% by 2025, from 3.7% in 2014. Urban Indians are getting fatter, and, if you don’t check yourself in time, you’ll have a big problem on your hands. 

Unfortunately, experts say that weight gain is not taken seriously in India until it becomes a serious problem. Usually, people who are aware that they are overweight, lumber on until an annual health check-up reveals high cholesterol, blood pressure or pre-diabetes. “Overweight people are shocked when a doctor tells them they are obese,” says Tina Sapra, a Gurugram-based nutritionist and founder of the DoctorDiet clinic. What they don’t realize is that a minuscule increase on the weighing scale may seem harmless at the time, but, unchecked, can balloon into a problem. “If you don’t watch what you eat or don’t exercise, you can cross over from overweight to obese in just a month,” says Sapra. 

Gaining insight 

Why are we becoming fat? An inactive lifestyle and unhealthy diet are the main culprits. “White bread, white rice, phulkas...the overall intake of simple carbohydrates is huge. The widespread availability of fast food is also a problem,” says Ambrish Mithal, chairman and head, department of endocrinology and diabetes, at Medanta, the Medicity, Gurugram. The higher people rise in the social order, the less they work by hand. “Whatever little movement we do is paid activity, like going to the gym or yoga,” says Sapra. Taking a 1-hour exercise class lulls us into thinking we’ve done enough when we actually should be turning our entire day into a mini-workout if we want to maintain a healthy weight. 

A bad lifestyle is the key cause of obesity; contrary to popular belief, the experts we spoke to say genetics or metabolic disorders such as thyroid do not play a significant role. “People are getting metabolic problems because they are obese, and not the other way round,” says Dr Mithal.

Gagan Priya, senior consultant, endocrinology department, at the Fortis hospital in Mohali, dismisses the idea of a single fat gene. “Risk for obesity is determined by several different genes, such as those that regulate appetite, satiety and metabolic rate,” she says, adding that familial risk of weight gain is strongly influenced by lifestyle factors. 

With childhood obesity on the rise—India has the second highest number of obese children in the world after China, according to a study published in The New England Journal Of Medicine—it has become imperative for people find a way to control their weight before they hit age 30. Dr Mithal explains: “As the years pass, a person’s metabolism (the process by which the body converts food into energy) slows down and the body collects more fat. For the same level of diet and activity, we tend to put on more weight. This happens everywhere, but Indians experience it more acutely because we don’t maintain a level of physical activity as we get older.”

From overweight to obese 

In many Western countries, fat acceptance is now gaining ground. In India, some people fret about gaining a kilo, while others are nonchalant about carrying a body weight that is higher than the ideal. “I've met patients who go from 100kg to 95kg, and their families complain that they look weak,” says Dr Mithal. 

It’s much easier to tackle a weight problem in the early stages, but people are largely indifferent when they put on half or 1 kilo. Experts say minor gains are a crucial turning point. “The idea is to take quick measures to stop the weight gain in its tracks and not wait to cross a limit to take action,” advises Dr Mithal. 

To cultivate that mindset, you first need to determine whether you are, in fact, overweight. The most common measure is calculating your body mass index (BMI), which will tell you whether you are a healthy weight range for your height. While World Health Organization (WHO) guidelines classify a BMI of 25 as overweight, the unofficial Asian cut-off point is 23. A BMI of 30 and above is universally considered obese. “Overweight or obese, it’s just a gradation. You are unhealthy either way,” says Sapra. 

Today’s guidelines for measuring fitness also take into account the body’s fat percentage. While there is no ideal measure, Sapra says a “healthy” number for women would be 25% and lower; for men, it’s 28% and below. There are several ways to size this up, including measuring waist circumference and waist-to-hip ratio, a full body scan, and using callipers to measure skin folds. The former is especially important for Indians, who are susceptible to central obesity, or belly fat.

Tallying BMI and fat percentage can get tricky, especially since a person with a normal BMI (say, 22) can be categorized as unhealthy because s/he has a high body fat percentage (35%). But excess fat is what you need to reduce to remain healthy. In fact, Sapra believes the terminology should change from weight loss to fat loss. “Fat shows up quickly on the body, but, ironically, does not tip the weighing scale. It can also be very stubborn, which is why people who follow a balanced diet, exercise, and overall lead a healthy lifestyle often find they are unable to lose even 2-3kg on their own,” she explains.

Monitor your weight 

The easiest way to keep your weight in check is to keep a check on it. Weighing yourself on a scale fortnightly or monthly is one option. If the scales seem constant but you find your clothes tighter, or your daily activities tire you out more than usual, it could mean that you are gaining fat. People with a family history of obesity, blood pressure, heart disease and diabetes should be especially vigilant. “You may be genetically prone to these diseases, but weight gain will unmask them,” says Dr Mithal.

Given that a weak metabolism is an important reason for weight gain, find ways to give yours a boost, like eating small meals through the day,  doing at least 30-45 minutes of cardio and maintaining an active lifestyle. While it’s never too late to gain control of your weight, to err on the side of caution is always best

How to assess your weight

Body mass index (BMI): It’s a calculation that classifies your weight status from underweight to obese. It’s computed by dividing your weight in kilograms by your height in metres, and then dividing the sum by your height again. There are several apps and online calculators that can do the math for you.

Waist circumference: Start at the top of your hip bone, and keep your tape measure level with your belly button. Don’t hold your breath while measuring. A measure of 90cm (men) and 80cm (women) signals abdominal (central) obesity in Asians.