Unique attributes of obesity in India: A narrative review

Abstract

Obesity has become a burgeoning epidemic in India, even though the country is still dealing with undernutrition. As a significant determinant of the Metabolic Syndrome (MetS) and non-communicable diseases (NCDs) such as type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD), understanding the Indian context of the problem and learning how to deal with the obesity epidemic in this country has gained paramount importance. This narrative review points to the unique features of the obesity epidemic in India and its associated contributing factors, including the evolving nature of the Indian diet, the peculiarity of the increased adiposity at lower BMIs, unique obesity-associated genetic variants in Indians, the contribution of the gut microbiome, the impact of chronic inflammation and the role of ambient air pollution, and the contribution of decreased physical activity levels concerning the rapid urbanisation and the built environment. We believe that disseminating our insights into these unique features influencing the development of obesity in India will help increase global awareness and pave the way for better control and management of this obesity epidemic.

Keywords: India; body mass index; epidemic; obesity.

Figure 1. Prevalence of overweight and obesity (BMI ≥25 kg/m²) in select Indian states.

Prevalence of overweight and obesity (BMI ≥25 kg/m²) in select Indian states with high or low change in prevalence (% per year) between 2005 and 2019 (National Family Health Survey NFHS 3 – 5)(–11). Jammu & Kashmir, Sikkim and Tripura had the highest (A) and Punjab, Gujarat and Meghalaya had the lowest change in the rate of prevalence (B) amongst men. Manipur, Tamil Nadu and Odisha had the highest (C) and Gujarat, Rajasthan and Punjab had the lowest change in the rate of prevalence (D) amongst women.

Figure 2. Scatter plots of correlations between state-wise mean monthly intakes and prevalence of overweight and obesity (BMI ≥25 kg/m²).

Scatter plots of correlations between state-wise mean monthly intakes of (A) oil, (B) cereals, (C) spices, (D) meat and egg, (E) pulses and (F) sugar and prevalence of overweight and obesity (BMI ≥25 kg/m²) in men (open squares) and women (filled circles)(35). Monthly intake values labelled as imprecise in the TATA-NIN dashboard(35) were removed from this analysis.

Figure 3. Framework of obesity in India.

Overall framework of obesity in India and its risk factors.