Article 3 : Obesity as a Chronic Disease
Why in News: A recent multi-centre Indian study has urged that obesity be recognised as a chronic disease, projecting a sharp rise in prevalence by 2050.
Key Details
- A white paper by leading diabetologists predicts 17.4% of women and 12.1% of men in India may be obese by 2050.
- Childhood obesity has risen sharply between 1990 and 2022, raising long-term health concerns.
- Experts argue obesity involves complex biological mechanisms, not merely lifestyle choices.
- The study calls for policy-level interventions and standardised treatment protocols.
Obesity as a Chronic Disease
- Medical Recognition: Obesity is increasingly classified as a chronic disease because it involves abnormal metabolic and hormonal processes requiring long-term management, similar to diabetes or hypertension.
- WHO Classification: The World Health Organization included obesity in the International Classification of Diseases (ICD) in 1948, recognising its clinical significance, though policy attention remained limited for decades.
- Beyond Lifestyle Narrative: Experts emphasise that obesity is not merely due to overeating but results from genetic, neurobiological, metabolic, and environmental factors, necessitating a medicalised approach.
- Need for Long-term Care: Like other non-communicable diseases (NCDs), obesity requires continuous monitoring, behavioural therapy, and sometimes pharmacological treatment, rather than short-term dieting.
Rising Burden of Obesity in India
- Projected Prevalence: The study estimates that by 2050, nearly one in six Indian women and one in eight men may be living with obesity, indicating a major public health transition.
- Childhood Obesity Concern: Among children aged 5–19 years, prevalence increased from around 0.1–0.2% in 1990 to over 3% in 2022, amounting to nearly 12.5 million affected children.
- Gender Dimension: Obesity is projected to be 10% higher among women, partly due to hormonal changes, sedentary lifestyles, and socio-cultural factors.
- Indian Phenotype Risk: Indians often exhibit abdominal obesity (“thin-fat” phenotype), meaning even individuals with normal BMI may carry high metabolic risk.
Biological and Health Implications
- Metabolic Dysregulation: Enlarged fat cells trigger chronic inflammation and insulin resistance, increasing the risk of type-2 diabetes, hypertension, and cardiovascular diseases.
- Cancer Linkages: Obesity-related cancers are rising; studies note about 30% increase in pancreatic and bladder cancers, with higher risks of breast and uterine cancers in women.
- Multi-system Impact: Obesity contributes to fatty liver disease, dyslipidaemia, sleep apnea, and osteoarthritis, making it a systemic health disorder.
- Economic Burden: Health costs related to obesity—such as cardiac care, knee replacements, and cancer treatment—are projected to rise 17-fold globally by 2060, stressing health systems.
Drivers of the Obesity Epidemic
- Sedentary Lifestyle: Work-from-home culture, long screen time, and reduced physical activity have significantly lowered daily energy expenditure, especially among urban youth.
- Hedonic Hunger & Emotional Eating: Pleasure-driven eating triggered by stress, depression, and food cues is emerging as a major behavioural factor behind weight gain.
- Food Environment Changes: Rapid growth of food delivery apps, ultra-processed foods, and restaurant culture has increased calorie-dense food consumption.
- Sleep and Stress Factors: Chronic sleep deprivation and high-stress lifestyles disturb hormonal regulation of hunger (ghrelin and leptin), promoting overeating.
Policy and Public Health Gaps
- Lack of Unified Guidelines: India currently lacks a standardised national protocol for obesity screening, treatment, and monitoring in public health facilities.
- Limited Institutional Focus: Unlike diabetes or TB programmes, there is no dedicated nationwide obesity control mission, despite rising NCD burden.
- Insurance and Treatment Barriers: Obesity management, including counselling and medical therapy, is often not adequately covered under health insurance, limiting access.
- School-level Prevention Deficit: Nutrition education, physical activity mandates, and behavioural interventions in schools remain uneven across states.
Government Initiatives and Existing Framework (Static + Current)
- NPCDCS Programme: The National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke includes obesity as a modifiable risk factor.
- Fit India Movement: Launched in 2019, it promotes physical activity and behavioural change, though measurable impact on obesity is still evolving.
- Eat Right India Campaign: Led by FSSAI, it focuses on healthy diets, food labelling, and reduction of trans fats, indirectly targeting obesity.
- POSHAN Abhiyaan: While primarily addressing undernutrition, the programme increasingly recognises the double burden of malnutrition, including obesity.
Conclusion
India is witnessing a rapid nutrition and lifestyle transition that is fuelling an obesity epidemic. Recognising obesity as a chronic disease can help reduce stigma, improve early diagnosis, and strengthen health system response. A comprehensive strategy involving standardised clinical guidelines, school-based prevention, food environment regulation, and insurance coverage is essential. Addressing obesity today is critical to preventing a future surge in non-communicable diseases and associated economic burden.
EXPECTED QUESTION FOR UPSC CSE
Prelims MCQ
Q. Which of the following best explains why obesity is increasingly classified as a chronic disease?
(a) It spreads through infection
(b) It involves long-term metabolic dysfunction
(c) It affects only lifestyle choices
(d) It is always genetically inherited
Answer: (b)