Obesity is rising almost everywhere, spurring a rise in chronic disease

This shows MyThali (My Plate), a new campaign of Arogya World to show urban Indian women a healthy diet in order to fight obesity and associated non-communicable diseases. Photo: Arogya World

This was originally published on Global Health TV on April 27, 2018.

The picture above shows the ideal, healthy plate of food for an urban adult woman in India – one cup of vegetable, one cup of rice, one and a half pieces of chapatti, one cup of protein (meat, lentil or sambar) and a half cup of yogurt. 

But too often this is not the typical meal of an Indian. Some people eat too much and become overweight or obese, particularly in urban areas. Obesity increases people’s likelihood of developing diabetes, to which Indians are predisposed. Meanwhile, some people, particularly rural adolescent girls, eat too little putting themselves at risk when they become pregnant at an early age.

So Arogya World, a U.S.-based organization committed to changing the course of non-communicable diseases (NCDs) in India, created MyThali (“My Plate”), inspired by the U.S. Department of Agriculture’s “My Plate” campaign and using the guidelines from India’s National Institute of Nutrition to encourage them to make healthier choices. Arogya World is aggressively implementing this campaign in workplaces across India.

India and China continue to have the largest number of underweight people in the word, according to the Times of India, but they also have broken into the top five countries in the world in terms of obesity, The Lancet has found. This double burden of disease is becoming more common not only in India and China but also in sub-Saharan Africa and other low- and middle-income countries (LMICs). In fact, most of the world now lives in countries where overweight and obesity kill more people than underweight, according to the World Health Organization (WHO).

Worldwide obesity has tripled since 1975. In 2016, the WHO estimated that more than 1.9 billion adults – a quarter of the entire population – are overweight and 650 million of these were obese. 

Obesity is becoming more common in LMICs like Ghana and Zambia as growing economies cause people to develop habits for fast food and soft drinks, become more sedentary and buy food from supermarkets rather than growing it themselves.

NCDs first achieved a global platform when the first UN High-Level Meeting on NCDs was held in 2011. In 2013, global health leaders enacted the Global Action Plan for the Prevention and Control of NCDs, 2013-2010, which had nine voluntary global targets. One of them was to “halt the rise of diabetes and obesity.” 

“We’ve failed badly [in achieving that target],” said Johanna Ralston, chief executive of World Obesity, which represents professional members of the scientific, medical and research communities from over 50 regional and national obesity associations. “Things are getting worse, and obesity is growing, especially in low- and middle-income countries. Childhood obesity has increased ten-fold in the past four decades. This represents a failure of civilization because obesity is so driven by how we live and work and move.”

Ralston says that obesity is inextricably linked to a variety of NCDs. It is a disease itself but also a major risk factor for cardiovascular disease (the leading cause of death in the world), diabetes, many cancers and other NCDs, according to the WHO. “If you don’t address obesity, you won’t address NCDs. And if you do address it, a lot of lives can be saved and health improved.”

But obesity is not just a health problem; it’s also an economic problem. “If we don’t take urgent action, the annual global medical bill for treating the diseases that follow directly from obesity is expected to reach $1.2 trillion in 2025, according to the World Obesity Day website.

The only country Ralston could think of where obesity is falling was Venezuela, which is afflicted with political crisis and food shortages, “but that’s not the way you want to solve obesity.”

Ralston also sees glimmers of hope on an otherwise bleak landscape of obesity. In 2014, Mexico imposed an 8% tax on junk foods. Recent evidence suggests that the tax has led to decreases in purchases of junk food by unhealthy people. Consumption of sugary beverages is doing down and childhood obesity is starting to plateau, she says. Last year, India levied a tax on soft drinks and flavored waters that reaches as high as 43%.

Similarly, Chile mandated packaging redesigns and labeling rules to help people make decisions about food in stores. The law prohibits the sale of junk food in school and from being advertised on TV programs or websites focused on young audiences.

Although obesity is no longer limited to rich countries, the rates of adult obesity are still higher in high-income countries of the Americas and Europe than in LMICs. In the U.K., more money is spent fighting obesity than on the police and fire services combined.

This month, The Lancet declared that “2018 must be the year for action against NCDs.” “Since 2011, and despite much exclamatory rhetoric, momentum behind efforts to mobilise action against NCDs has stalled (and that is putting it mildly),” writes The Lancet. In September 2018, the UN will have its Third High-Level Meeting on NCDs.

Public health messages about diet, calorie intake and physical activity are important but The Lancet says it is not enough. “A great disconnect remains between policy makers who issue recommendations and communities themselves that struggle with obesity — specifically, communities living in low-socioeconomic settings or suffering high levels of unemployment and social deprivation … What is sorely needed is political advocacy and action to disrupt entrenched cycles that maintain poverty and prevent ready access to healthy choices.”

But Dr. Nalini Saligram, the founder & CEO of Arogya World, the group that developed MyThali, believes that education also has an important role to play.

“I really believe we can change the way Indians think about food,” says Saligram. “Food is such a cultural thing – you feed your guests, you celebrate cultural festivals, you do so many things with food. And, in India, food is largely carbohydrates. But we can’t fight this chronic disease epidemic by wringing our hands and saying the problem is too big. We can start with something completely fundamental and, in 10 years, maybe we can make a difference.”