Fat lot of good

Obesity is on the rise, and it may be because of our rising income levels and modern lifestyle.

Everywhere you look nowadays there are signs that India is becoming more health conscious.

There are gyms on every street corner, shows about working out and eating healthy on every channel, restaurants are introducing diet menus and everyone we see in the paper (on Page 3 anyway) is perpetually looking as though they have skipped not only last night's dinner, but dinner for all of last week as well.

Despite this, however, obesity figures are still stubbornly on the rise "" according to an AIIMS report of last year, 31 per cent of urban Indians are either overweight or obese.

Indians as a nation are fatter now than at any point in our history; and, more seriously, this is leading to high numbers of obesity-related diseases.

Why is this? If we're becoming more conscious of our appearance, surely we should also be getting slimmer? To some, this is explained away by simple economics.

Weight management consultant Shikha Sharma is pragmatic: "Although the health drive is rising, so is the convenience food drive. Nowadays, you can get aerated drinks everywhere, even in small cities, and the reach of colas is greater than the reach of the health drive," she says.

"In the US, there's 60 per cent obesity and here in India it's 40 per cent in urban areas, which is staggering given that fifteen years ago, we weren't thought of in those terms at all. We were never even on the bandwagon."

However, the story goes beyond economics. Sometimes, researchers say, it could be the very societal pressures to conform to a certain body type that's contributing to the rise in unhealthiness.

For instance, according to Dr Neeru Kanwar, a general therapist and psychologist, "Role models nowadays are very slim. This encourages people to obsess about food and leads sometimes to obsessive compulsive disorders. People who are prone to anxiety especially tend to internalise all these problems "" their self-image is very fragile and easily destroyed. Teenagers are especially susceptible to this."

This is obviously not a primary cause of obesity, but it should nevertheless be taken seriously. "All the images society projects onto us lead to a false impression that if you're thin, you're also healthy, whereas this is absolutely false," agrees Dr Subhash Wanganoo, an endocrinologist at the Apollo Clinic.

"This sort of thinking can lead to depression and build anxiety neuroses. People don't realise that weight is about your body mass index (BMI), not your body image. Even if you are 100 kilos, if you don't have an excess of central deposit (the fat around the waistline), you can be as healthy as someone who weighs 80 kilos."

BMI is the key concept here. For identical body mass indices, Indians have a 25 per cent higher body fat than Caucasians.

According to Dr Wanganoo, whereas we in India are considered overweight at a BMI of 23, Caucasians are considered overweight at a BMI of 25. This genetic disposition to fat leaves us more vulnerable to metabolic complications such as diabetes, high cholesterol and so on.

Unfortunately, obesity is just not seen as a medical issue. According to Sandhya Pandey, a dietician with Max Healthcare, "Adults come to me with problems of diabetes and high blood pressure for instance, and even kids have problems like hypertension. Despite the fact that obesity itself is a disease, when they come to me it's not for the weight gain, but the medical implications that the weight gain has brought. It's very frustrating; I always want to ask them why on earth they've waited so long to come see me!" she says.

It's probably because weight is associated more with glamour and fitting into those new Levis than health. And similarly, weight loss is never associated with hard work, healthy eating and long term fitness routines, but miracle diets, complicated weight loss 'machines' and the odd casual work-out.

"People expect a magic bullet "" it's taken 20 years to put on the weight, but people expect to be able to lose it in two months!" says Pandey.

This is a sign of the times. We eat fast food, we have instant coffee, instant photos, instant pudding, and so on, and we've become impatient.

And it's not just this insistence on a fast solution that's a sign of modernity; the very cause of our obesity seems to have grown from our economic development, our transition from a traditional society to a modern one. The onslaught of fat has hit our shores at the same time as higher disposable incomes, and this is no coincidence.

Fast food and aerated soft drinks are obviously the worst offenders (more so because of the strength of their attractiveness to children), but other aspects of our lifestyle need to be scrutinised as well.

For example, we can also blame an increasing concern about our safety, which is inhibiting us from sending our children out to play as much as we used to, the invasion of video games, the Internet, working hours that tire us out and cause us to sink in front of the TV after a long day, and the fact that nowadays family outings consist of going to the movies or going out to dinner "" in short a sadly sedentary lifestyle.

But calling it a simple lifestyle problem suggests that remedies are simply a matter of changing the way we live, whereas the problem could be far more deep-rooted and lie beyond our conscious control.

Food has gone from a necessity to a commodity that we are safe in taking for granted "" we use it as entertainment when we're bored; we use it metaphorically (say some psychologists) to fill up any emptiness in our lives; and, more commonly today, we use it as a stress and tension buster; we manipulate it to feel that we have the endorsement of a society that seems to value slimness above all.

Thus, as India progresses towards economic development, the thriving middle classes have to take the rough with the smooth. We have to know that, along with our better pay packages and company cars, we also get longer hours, unhealthy food, and this may lead to obesity.

A sudden burst of guilt and two weeks of going to the gym, or a trip to one of the numerous "health farms" which offer miracle cures, is not going to cut it.

We need a holistic approach to weight loss "" to look at it in terms of our health (before we are forced to) and the numerous factors that go into this, such as our body mass index, medical history, the food we eat, and how much exercise we incorporate into our lifestyle.