PICTURE SPEAK

FUTURE FAT: A generation of latchkey kids spend their time in front of the telly, while their metabolic rates go for a toss

India ranks among top 10 obese nations of the world 120 Million urban Indians are seriously obese 50% Urban women above 35 have unhealthy body shapes One out of every 10 urban Indian children is overweight 45% of males and 55% of females in Delhi are obese

Not surprisingly, a slew of activist-physicians are engaged in a battle to beat the bulge. They organise surveys, engage in awareness drives with NGOs and in schools, walk the corridors of power to sensitise the nation's high and mighty, and alert international health bodies. "There are clear and hard facts in urban areas that things are as bad as they could be," says Dr Anoop Misra, an obesity expert involved with anti- obesity drives initiated by AIIMS. The first Asia Pacific Obesity Conclave took place in Delhi in March. Chowbey, the driving force behind the conclave, is also laparoscopic surgeon to the President of India. "I made a presentation to President A.P.J. Abdul Kalam in January," says Chowbey. What better way to start a campaign? "I've never seen a President with such ideal weight," he laughs. "Dr Kalam has promised to help us out with the anti-obesity awareness drive."

FIGHTING FAT

ASHOK ANAND, 54, Weight: was 110 kg Retired resident of Gurgaon I loved food and ate through the day. Meals, umpteen cups of tea, namkeen, sweets, alone or with guests. My wife and children used to beg me to stop eating. Finally, I had to go for bariatric surgery. I've given up everything today, even pan masalas and cigarettes. "Before dinner, I would stuff myself with kebabs and tikkas to complement my peg of whisky. No longer." NILA BAGCHI, 51, Weight: 105 kg Sari boutique owner, Kolkata and Santiniketan So many things are forbidden to me! But I follow health instructions to the T and there's nothing really that I can't do. I run my shops, look after my home, take the train to Santiniketan every week. And I can sit crosslegged on the floor for my daily puja. "It's not easy to lead a life of constant discipline, but I just made up my mind to stay upbeat and active."

These are just two among millions of Indians who are discovering that fat is not just ugly, it is dangerous as well. The major victims of obesity are among the 300 million-strong Indian middle class, with around 35 per cent-or 120 million-reaching dangerous levels of obesity. Last year, an AIIMS survey conducted on 35,000 people in 10 industrial cities revealed that waistlines had grown rotund by more than 30 per cent. In Delhi, 17 per cent of all schoolchildren were found to be overweight. Changes in lifestyle and affluence has led to a richer and unhealthy diet. According to the UN's Food and Agriculture Organization, meat consumption has more than doubled in India since the 1970s, so has the intake of fat and sugar since the 80s. Gandhian frugality is, obviously, passé. Contemporary changes in work, lifestyle and urban society have together adversely affected what dieticians call Body Mass Index (see graphic).

The obvious, almost frivolous, reason behind the emerging obesity crisis is that we are eating too much high-calorie food and not burning it off with adequate exercise. Food and the culture of eating sumptuously have always been an integral part of the Indian society, but until recently, most ate home-cooked food. Then came the Dominos, Pizza Huts and McDonald's and a veritable race to pamper the tastebuds ensued. Fast food restaurants witnessed a dramatic growth-both in the number of outlets and customers served. Intense competition for market share led to increased portion sizes-for instance, the calorie count for French fries served by McDonald's has jumped from 200 to over 600. In addition, the average meal comes with free add-ons like soft drinks, adding to calorie intake.

Pounds and Perils Medical experts are warning about the dangers of obesity among Indians. Some major talking points.

1 Fat is just a cosmetic problem Not at all. Obesity is a chronic disease of excessive fat deposition in the body. Being overweight is not a disease, obesity is. And the line differentiating the two is quite thin. 2 Don't go by the weighing machine Doctors define obesity by a rough-and-ready measurement called the Body Mass Index (BMI)-weight in kilograms divided by the square of the individual's height in metres (kg/m2 ). A BMI between 18.5 and 25 kg/m2 is considered nor-mal; up to 30 kg/m2 is overweight; up to 40, obese; and beyond 40, morbidly obese. 3 Childhood obesity on the rise Nearly 40 per cent of urban children are obese. Chances are almost 80 per cent will grow up to be obese adults. Childhood fat is not only carried over into adulthood but also give rise to more severe forms of obesity. 4 Indians are particularly vulnerable to obesity Blame it all on 'thrifty genes'. Our bodies are perhaps too metabolically efficient to deal with more food on the platter. 5 Obesity is the source of all your worries Stroke, hypertension and sleep apnoea Breathlessness Heart diseases, high blood pressure and cholesterol levels 6 A global epidemic One out of every five is overweight or obese in the world.

Apple shapes at higher risk of heart diseases than pear shapes Waist-to-hip ratio of 0.91 and above leads to three-fold risk of cardio-vascular diseases (CVD)

Increased CVD risk in men with waist-to-hip ratio more than 0.90 Increased CVD risk in men with waists measuring more than 101 cm Increased CVD risk in women with waist-to-hip ratio more than 0.85 Increased CVD risk in women with waists measuring more than 89 cm

What is cause for more concern among medics is that most Indians consider obesity a cosmetic problem, not a disease. The truth is, obesity is a chronic disease-of excessive fat deposition in the body. Being overweight is not a disease, but obesity is. And the line differentiating the two is quite thin. "Obesity is simply bad news-for both body and mind," says Dr Rama Vaidya, president, All India Association for Advancing Research in Obesity, Mumbai. When a person is carrying extra weight, it's harder to keep up with friends, take part in sports, or just walk any distance. It is also associated with breathing problems-asthma and sleep apnoea. "There can be more serious consequences as well," points out Vaidya. Obesity can lead to high blood pressure, high cholesterol levels, high blood sugar levels, liver disease, type 2 diabetes, heart diseases, stroke, problems with the bladder, the reproductive system and a greater risk for certain cancers.

Approximately 85 per cent people globally contract the type 2 diabetes, and of these, 90 per cent are obese or overweight. India has the world's largest population of diabetic and heart patients. Alarmingly, adolescent and childhood obesity is shooting up. "Junk food, physical inactivity, little outdoor activity and excess time spent in front of the television have led to this," says Vaidya. Childhood fat is not only carried over into adulthood but also gives rise to severe forms of obesity. Unfortunately, most of us confuse obesity in children as 'puppy fat'.

WHY THE FAT IS IN THE FIRE

Each year, a greater percentage of the population spends its entire workday behind a desk or computer, getting virtually no exercise. In the kitchen, the microwave oven has seen sales of unhealthy frozen convenience foods skyrocket and encouraged elaborate snacking. Fast food restaurants have seen a dramatic growth. Intense competition for market share has led to increased portion sizes, as well. Urban sprawl, less walking space and dynamic growth of two-wheelers and four-wheelers provide less incentive for burning the fat. Obesity tends to flourish as a disease of affluence in countries that are developing and becoming westernised.

Yet, most Indians seem ignorant of the dangers of obesity. Consider Mumbai. The snacking capital of India is famous for an array of eateries and snack bars that cater to all types of pockets and tastebuds. And a sneak peek into family food-logs reveals the reality behind the scenes. "Eating out has gone up for us over the last five years," says Sanjay Patel, owner of Shringar Jewellers in Matunga. He doesn't mind shelling out Rs 6,000 every month on this. Similarly, Kishore Jadhav of Aashray Developers, can't resist those yummy snacks, and spends around Rs 100 every day while at work. "We eat a lot more junk food than we used to. The easiest thing to do is to order a pizza home," he says. For Lalit Jain, who owns the Real Choice gift shop in Bandra, storing up a lot of junk food at home has become the norm ("My children almost live on those"). He adds, "Eight years ago, when there were fewer places to eat out, we spent half of what we do today."

PICTURE SPEAK

GORGING ON THE GOOD LIFE: Eating out and eating erratic may actually lead to obesity

Indian men appear to be especially prone to a pot belly-also called apple-shaped obesity. Blame it largely on unhealthy diets-rich in starchy foods and low in fruits and vegetables-and lack of physical activity. For women, the news is equally bad. More women, especially those over 35, are overweight than men in India. According to a study by AIIMS last year, about 55 per cent women in Delhi are overweight or obese. After the 40s, female hormones start withdrawing and the body tends to put on weight. Indian dresses hide the layers of fat so well and for so long that women don't realise the enormity of the problem till it's too late. Women also go through three physiological transitions-menarche (the first menstrual period), pregnancy-lactation and menopause-and, at each of these thresholds, they tend to put on weight.

"Just consider the scenario," says Dr Aggarwal of VLCC, "more women are stepping out into the public sphere and they do not wish to get married early. And it's pretty common these days to come across women entering their first pregnancy when they are 30-plus." Contraceptive pills, full of steroids and water-retentive hormones, she believes, also tend to make women fat. At the same time, there's the additional strain of balancing work and home, with traditional support systems falling apart. "With so many pulls and pressures on them, I am not surprised that the 35-plus brigade is becoming easy victims," she adds.

Emotions can fuel obesity as well. People tend to eat more when they are upset, anxious, sad, stressed out, or even bored. Then, after they have eaten too much, they may feel bad about it and stuff themselves some more to quell those bad feelings-creating a vicious cycle. Take the case of Akila Iyer of Anna Nagar, Chennai. Slim, pretty and sporty, she had moved to Chennai from small town Kumbakonam post marriage. "My problem started during my first pregnancy," she says, "and I became huge during the second." Something else was happening to her, too. She was becoming home-bound and bored. "I started losing interest in myself," Iyer muses. Food made her happy and she started binging. That created a vicious cycle of guilt. The more spicy and fried food she consumed, the more guilty she felt, and to perk herself up she would eat more. Then she crossed 90 kg and developed sugar. "My husband and my father were terribly concerned. But some people used to poke fun at me. They would not lose one opportunity to call me a tub of lard," she adds. Finally, last November Iyer went in for a bariatric operation.

Hardly surprising then that obesity should spawn a rapidly mushrooming diet and slimming industry. VLCC, for instance, has over 100 centres across 46 cities nationwide. In the last five years, the company recorded a compounded average annual growth of 30 to 40 per cent. Not to be left behind, food and drug companies are meanwhile selling magic potions to melt away those pounds. Weight loss medicines, like Sibutrex, are very popular. Gastric bypass surgery (bariatric surgery) on patients suffering from extreme obesity has also caught on. (Ganga Ram Hospital has done 65 such operations-the highest in the country.)

Obesity can run in families, but just how much is due to genes is hard to determine. Small parts of the DNA that people inherit from their parents, and that determine traits like hair or eye colour, can play a vital role in weight gain. Some genes tell our body how to metabolise food and how to use extra calories or stored fat. Then again, some people burn calories faster or slower than others because of their genes. But genes alone cannot be held responsible for an individual's body fat as is evident in families whose members have vastly different physique. This, despite all of them eating the same food, indulging in the same habits (like snacking in front of the TV), and thinking alike when it comes to weight issues (like urging children to have a hearty dinner in order to grow "big and strong").

A World Health Organization (who) study suggests that Asians show a marked vulnerability to the effects of gaining weight. Some scientists theorise that children who are undernourished in the womb (not uncommon in much of Asia until recently) develop unusually high levels of abdominal fat as adults if they're exposed to above-normal calorie levels. This puts them at greater risk for obesity-related illnesses. Others believe, Asians evolved a so-called 'thrifty gene' after living for thousands of years under near-famine conditions. That may have left them with bodies that are, paradoxically, too metabolically efficient to deal with the relative abundance of modern life. It's a genetic trait-a survival instinct-that benefited them in the past when food was often scarce, but when food is plentiful it becomes detrimental.

Simply put, the once familiar image of India as a land of poverty, hunger, malnutrition, scarcity and famine has been turned on its head. While it may have once made fat respectable, the new-liberated economic growth has clearly left more food on India's plate than it can healthily handle.

-with Aditi Pai in Mumbai

Index