Obesity runs in families or is it because no one runs in families?

According to World Obesity Atlas 2023, over 4 billion people will be living with either overweight or obesity by 2035, if the status quo on policies and programmes continues (Representational image)

Obesity is a growing public health challenge worldwide and is a chronic complex disease that can impair health and cause significant economic impacts. This World Obesity Day also reminds us of obesity as a multifactorial disease that will adversely impact our fragile public health system. The World Obesity Atlas 2023, published by the World Obesity Federation, has predicted the global economic impact of overweight and obesity as a result of the health conditions linked to being overweight, will reach $4.32 trillion annually by 2035 if prevention and treatment measures do not improve. At nearly 3 percent of global GDP, this is on par with the financial impact of the COVID-19 pandemic in 2020.

Overweight and obesity account for four million deaths annually with the global rates having tripled since 1975. According to World Obesity Atlas 2023, over 4 billion people will be living with either overweight or obesity by 2035, if the status quo on policies and programmes continues. The most revealing finding from this Atlas is that childhood obesity rates are redicted to double among both boys and girls by 2035 from the 2020 levels. This translates to an exponential 100 percent increase among boys and a 125 percent increase among girls. The evidence from this Atlas very clearly indicates that obesity is not just a problem of high-income countries or of the rich, and lower-income countries are also facing a rapid increase in the prevalence of obesity.

India is currently tackling a triple burden of malnutrition – undernutrition, micronutrient malnutrition, as well as overweight and obesity. While the evidence is indicating a gradual decline in undernutrition, the rate of increase in overweight and obesity cannot be ignored in public health planning. One-fourth of our population (15-49 years) is classified as obese as per the NFHS-5 (2019-20). The increase in the prevalence of overweight and obesity is also leading to an increase in non-communicable diseases (NCDs) along with high treatment costs and early mortality. Obesity has been related to 28 other illnesses, including type 2 diabetes and several forms of cancer, in addition to lost economic productivity caused by both the inability to work and diminished performance on the job, as well as premature death.

Eleven percent of Indian adults will be obese by 2030, according to projections presented for India in the World Obesity Atlas. The annual increase in adult obesity is projected to be 5.2 percent between 2020-2035 and this increase among children will be 9.1 percent. India is projected to have over 27 million children and adolescents (5 to 19 years) who will live with obesity by 2030, accounting for 11 percent of the worldwide burden. Overweight and obese children are more likely to remain obese into adulthood and are at life-long risks for NCDs, metabolic syndrome, non-alcoholic fatty liver disease, obstructive sleep apnea, polycystic ovarian syndrome, asthma, orthopaedic complications, psychiatric disease etc. A recent estimate of the economic impacts of overweight and obesity indicated that overweight and obesity are costing India Rs 2.8 lakh crore annually! The projections for the total economic
impact of overweight are estimated at $129,326 million, which is 1.8 percent of GDP, by 2035.

Most important to note here is that our health system is not prepared to handle this exponential increase in obesity and its related co-morbidities. The scorecard for India presented in the World Obesity Atlas 2023 indicates India’s global ranking on the country’s Obesity-NCD preparedness is 99 out of 183. What seemed to be a problem among the rich and urban areas in India, has already started showing a reversal of social gradient with its impact visible among urban poor and will soon disproportionately affect the vulnerable lower socioeconomic groups. Prevention of obesity and adopting a population-level health promotion approach is the most cost-effective strategy but it needs to be complemented with action within health systems.

The obesogenic food environment is largely created by aggressive advertising and marketing of Foods High in Fat, Salt and Sugar (HFSS). Advertising and Marketing majorly target children and adolescents and many misleading food advertisements target both adults and adolescents. A recent study by the Public Health Foundation of India revealed higher exposure of HFSS advertisements on children's channels compared to channels watched by young adults in India. Lack of time among working professionals force parents to opt for ultra-processed and ready-to-eat food products. High prices of fruits and vegetables make them unaffordable and unhealthy food items become cheap and easily available options. Lack of space for physical activity, increase in screen time and academic pressure among adolescents further aggravates this obesogenic environment.

This obesogenic environment can be addressed, by using legal frameworks and regulations to protect all, including comprehensive marketing restrictions on HFSS foods, higher taxes on HFSS foods and sugar-sweetened beverages and effective front-of-pack labelling. It is recommended to strengthen the health system, to tackle the triple burden of malnutrition: including clear criteria for providing a continuum of care through health promotion, disease prevention, diagnosis, treatment and management of obesity which is equitably offered and progressively implemented as part of Universal Health Coverage and included within primary health care. Investments and targeted systemic actions to prevent and reduce obesity can substantially reduce the economic impact.