Globally, prevalence of overweight and obesity is on a rise, such that obesity rates have now overtaken hunger rates in many countries. World-wide 39% of the adults, population 18 years and above, are overweight and 13% are obese (WHO, Global Health Observatory Data). Last 2 decades have also seen a rise in overweight and obesity numbers in developing countries as they have begun to adopt western lifestyles. Concerns around overweight and obesity are not only limited to adults but has also impacted children and adolescents. Percentage of children, between 5 to 19 years of age, that were over-weight across the world was 18% in 2016.
Turning towards India, proportion of overweight adults, that is adults with BMI between 25 and 30, has been constantly rising. As per the WHO Global Health Observatory data, that is available from 1975 to 2016, 19.3% of adults were overweight in India in 2016. This number has doubled in the last 20 years. Between 1975 to 2016, average annual growth rate of the proportion of adults that are overweight has been 3.4%. Based on this growth rate, nearly 22.7% of adults in India are expected to be over-weight in 2021 and 50% by 2045. United States with one of the highest cases of overweight adults stood at 70.2% in 2016. India is expected to reach this mark by 2055.
What is alarming is that based on growth rate numbers of United States, we can see that US took 94 years to cover this gap from 19.2% (current level of overweight adults in India) to 70.2% (current level of overweight adults in US), which India is expected to cover 2.5 times faster, in 39 years. While this is not a precise estimate, it reflects the disturbing rate at which overweight adults in India are increasing. Figure 1 compares the growth rate of overweight adults for the 42-year period between 1975 and 2016, between countries that currently have the highest percentage of overweight adults with that of India. This figure shows that proportion of adults that are overweight in India is rising between 2.4 to 3.1 times faster than in developed nations.
Obesity in adults, which has a stricter definition of BMI greater than 30, has increased in India at an average annual rate of 5.6% in the last 20 years and stood at 4% in 2016. As with overweight adults, if obesity trends in India continue to grow at the same rate, 5% of Indian adults would be obese by 2021, 12% by 2036 and 37% by 2057 – obesity mark where United States currently stands. With this, nearly 28% of Indian adults are expected to be either overweight or obese in 2021.
How are other Developing countries, with similar food habits and income level as that of India, performing?
To see this, we compare India’s performance vis-à-vis other developing South Asian countries, that is, Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka. In terms of South Asian countries, India seems to be performing well, with the second lowest percentage of adults that are overweight or obese. Maldives has the highest percentage of overweight and obese adults at 28.5% and 8.6%, respectively. However, given India’s sheer population size, India has the maximum number of overweight adults, at approximately 18 lacs, contributing to 73% of overweight adults in South Asia.
What is tragic is that on the other end of the spectrum, 23.3% of adults in India were underweight in 2016. This was the highest across the world, amongst 191 countries! Combining the two numbers of overweight and underweight adult population, 42.6% of the adults lie outside the acceptable BMI range.
The analysis above shows that overweight and obesity are no longer a rich-country problem. Rather, for developing countries, that are categorized with low per-capita incomes, overweight and obesity trends bring out a paradox – high proportion of underweight adults, low-income levels and high growth rates in overweight and obesity numbers. Developing countries that are already strained under the weight of poor healthcare infrastructure and spread of other infectious diseases, in the near future, would also have to face the burden of ailments like cardiovascular diseases, diabetes, hypertension etc, which are typically correlated with unhealthy body weight, if this trend is not arrested in time. While at an individual level, lifestyle changes are warranted, greater impact would be achieved if health improvement/ regulation programmes and behavioral change initiatives targeting the right audience are promoted by the government.