Noncommunicable diseases (NCDs) are a major cause of premature and preventable deaths worldwide. According to a WHO Global Survey Report “Assessing National Capacity for the Prevention and Control of Noncommunicable Diseases Global Survey 2019”, NCDs currently account for almost 71% of global deaths; majority of which occur in low- and middle-income countries. India too is not untouched by this. India is in the midst of an epidemiological transition and is shifting from a predominantly communicable or infectious disease pattern to a predominantly NCD pattern. Obesity was earlier regarded as a disease exclusive to the affluent countries. This no longer holds true. Obesity is now rapidly emerging as a significant public health problem in developing countries, including in India. 

A study was conducted to examine the trends in the prevalence of overweight and obese individuals in the country in the decade between National Family Health Survey (NFHS)-3 (2005-06) and NFHS-4 (2015-16). A total of 1,98,754 and 8,11,808 eligible respondents participated in the two rounds. Data from the two rounds of the survey were used in the analysis. The BMI cut-offs to categorize overweight and obesity, as per the World Health Organisation (WHO), are 25–29.9 and ≥ 30 kg/m2, respectively; however, this study used Asian cut-offs to categorise overweight (23–24.99 kg/m2) and obesity (≥25 kg/m2). Underweight is universally classified as BMI <18.5 kg/m2.

The results show an overall high prevalence of overweight and obesity across the country, among men and women, people residing in the urban areas and the educated people. 

The prevalence of overweight and obesity was found to be higher than the national average for males and females in all states from North (except Rajasthan), west, south and most of North-eastern states. The prevalence was lower in the central and eastern states. 

The percentage of overweight/obesity in both men and women showed a rise, which was prevalent across all the socio-demographic and population categories. The prevalence was higher in males than in females. A total of 8 states showed a relative increase of more than 100% in prevalence of overweight and obesity for males, compared to national average increase of 83% for males. An upward trend was noted in most states when compared with earlier NFHS reports. Age ≥ 40 years, marital status, having higher education, belonging to richest wealth quintile, and living in urban area were factors strongly associated with higher prevalence of obesity among men and women.

More people living in the urban areas were overweight or obese vis-à-vis their rural counterparts.

The rising prevalence of overweight and obesity in the country is a product of the interplay of multiple factors, which as per the study include: 

• Change in physical activity patterns e.g. mechanisation of agriculture, increasing trend of hiring people for domestic help
• Sedentary lifestyle, including desk jobs for the educated
• Increased access to energy-dense foods and sugary drinks
• Levels of urbanization
• Higher per-capita income than the national average
• Social acceptance of alcohol and tobacco in the community

India is also undergoing a process of nutrition transition i.e. shifts in dietary patterns due to economic development, modernization and urbanization. This means higher consumption of energy-dense foods (containing saturated fats and trans fats) and less expenditure of energy (a sedentary lifestyle), which is driving the epidemic of NCDs in the country. India is also facing the triple burden of malnutrition comprising of undernutrition, micronutrient deficiencies (hidden hunger) and overnutrition. Overnutrition can lead to obesity.

An alarming trend was observed in this study; the number of overweight and obese men and women increased during the 10 years of the study from NFHS-3 to NFHS-4. The study also highlights the rising prevalence of obesity in the Indian population in both rural and urban areas. 

The rise in obesity parallels the rise in NCDs. Hence, preventing obesity will prevent development of NCDs.

The findings of this study have public health implications. They underscore the need to not only formulate new policies or amend existing policies but also ensure their strict implementation to reverse this trend. 

For instance, the Food Safety and Standards Authority of India (FSSAI) announced early this year that all edible refined oils, vanaspati, bakery shortening, margarines, vegetable fat spreads and mixed fat spreads may only contain ≤3% trans fats by January 2021 and ≤2% trans fats by January 2022. The WHO has called for global elimination of trans fat by 2023. 

Some countries have increased taxation on sugar-sweetened beverages (SSBs) and also printed health warnings on them (J Family Med Prim Care. 2020;9:2350-8). There is evidence to show that a tax on SSBs reduces obesity by decreasing consumption of SSBs (BMC Public Health. 2013 Nov 13;13:107). India has yet to decide on and implement a “sugar tax”.

(Source: Madhur Verma, Milan Das, Priyanka Sharma, Nitin Kapoor, Sanjay Kalra. Epidemiology of overweight and obesity in Indian adults - A secondary data analysis of the National Family Health Surveys. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. Available online 11 June 2021)