Obesity in India: A Call for a Broader and More Complex Debate
The recent approval of Ozempic for diabetes treatment in India has sparked significant discussions around the burgeoning "obesity market." Over the past five years, India's anti-obesity pharmaceutical sector has expanded nearly fivefold, reflecting a growing focus on this health issue.
The Rising Tide of Obesity: A Global and National Crisis
Obesity is increasingly recognized as a global crisis, with alarming trends in India. According to data, the prevalence among adults has doubled over the last three decades, while among adolescents, it has quadrupled. Currently, estimates suggest that 35 million children under five and approximately 400 million in the five-to-19-year age group are overweight. India's National Family Health Survey 5 (NFHS-5) reveals that nearly one in four adults is overweight, highlighting the scale of the problem.
A combination of the non-communicable diseases epidemic and the rise of wellness culture has led corporate tertiary care hospitals in India to offer both diagnostic and treatment services for obesity, as well as preventive measures. This shift underscores the medicalisation of obesity, where it is often viewed as a chronic lifestyle disease requiring interventions such as healthy eating habits, regular exercise, behavioural changes, and in severe cases, medications or bariatric surgery.
Critiquing the Individual-Centred Approach
However, this individual-centred approach has drawn criticism for overlooking the complex interplay between a person's physical and social environments. Critics argue that a wide spectrum of "naturally occurring bodily diversity" is being pathologised, with the failure to maintain an "ideal weight" often stigmatized as a personal shortfall in adopting a healthy lifestyle.
This perspective ignores structural drivers that contribute to obesity, including:
- Poor housing conditions and inadequate budgets for healthy food, which limit access to nutritious options.
- Workplace stress and social hierarchies that can lead to unhealthy coping mechanisms.
- Adverse childhood experiences and discrimination based on race, caste, or religion, which influence food choices and overall health.
- Noisy environments in low-income neighbourhoods that disrupt sleep quality, further exacerbating health risks.
These adversities are often gendered, making women more vulnerable to obesity due to societal pressures and roles. Additionally, genetic factors play a significant role in obesity, a complexity that is frequently sidelined in mainstream discussions.
Balancing Medical Benefits and Structural Solutions
While there are potential benefits to medical and surgical therapies, especially when obesity is a comorbidity, perceiving obesity solely as a disease beyond individual control can help destigmatise it to some extent. This recognition can foster empathy and support rather than blame.
Addressing the obesity crisis requires a richer and more nuanced debate. Key questions include:
- Is an overt reliance on tertiary care the most effective way forward?
- How can we devise environments that tackle the immediate causes of obesity, such as improving living and working conditions?
Ultimately, enhancing the quality of people's lives and working environments is a crucial first step in mitigating this public health challenge. By moving beyond medicalisation to address structural inequalities, India can develop more holistic and sustainable solutions to combat obesity.
The writer is professor and chairperson, Centre of Social Medicine & Community Health, JNU.
