Cut the flab: Time for India to acknowledge adverse effects of obesity before it is too late

Cut the flab: Time for India to acknowledge adverse effects of obesity before it is too late

According to a study published in 2017 by the New England Journal of Medicine, India has 14.4 million obese children - to put this in perspective this is greater than the population of ten Indian states.

The global economic cost of obesity is approximately two trillion dollars according to McKinsey Global Institute (MGI). That is 2.8% of the world's GDP and puts obesity in the same league as armed conflict and tobacco. Over 20 countries have acted to counter child obesity. Actions range from raising taxes on certain food products and banning advertising to mandating publication of nutrition information on food packets.

Norway has led the world on health and nutrition issues. The nation first introduced a 'chocolate and sugar products' tax in 1922. They received global attention when the tax was hiked by 83% in 2018. Through this, they aim to reduce each citizen's sugar intake by an eighth (12.5%), come 2021. In 1992, the country banned broadcast advertising aimed directly at children.

The United Kingdom may dither on Brexit and struggle with penalty shootouts. There has been no such indecisiveness with child obesity. Earlier this year, the Government announced a new "sugar tax" on soft drinks. Drinks containing 5-8 grams and >8 grams of sugar per 100 millilitres will be levied tax at 18 pence and 24 pence per litre respectively. The Government has announced plans to direct these additional revenues to sports and healthy breakfasts in schools. Some beverage brands have already cut sugar content in response to the tax.

But what about developing countries? 34% of Chilean children are obese. In December 2015, the World Economic Forum named Chile as the world's largest per-capita consumer of sugary drinks. Its citizens consume 188 calories worth of sugary drinks per person per day. In 2016, the country introduced a policy mandating warning labels on packets containing unhealthy food and introduced restrictions on marketing such food. From 2019, the government intends to ban all advertisements for unhealthy food and drinks between 6 am and 10 pm. Further, sugary beverages are taxed at 18% and Chilean kids can no longer buy junk food in schools.

The second largest per-capita consumer, Mexico, introduced a similar tax in 2013. In the following two years, sugary-drinks purchases reduced by an average of 7.6%. South Africa, which has the highest level of obesity in sub-Saharan Africa, introduced a 'sugary beverage levy' earlier this year. This was targeted at reducing obesity prevalence by 10% by 2020.

Sri Lanka set an example for South Asia with the country's leadership coming out strongly against sugar-sweetened beverages. The Government imposed a tax of 50 cents on each gram of sugar in soft drinks in November 2017. The same month, President Maithripala Sirisena, showed political will of the highest order. He called on a leading global food and beverage company to reduce sugar in one of its products, threatening to personally lead a nationwide campaign against it.

Child hunger and undernutrition in India is well-known. According to a study published in 2017 by the New England Journal of Medicine, India has 14.4 million obese children - to put this in perspective this is greater than the population of ten Indian states.  As per the National Family Health Survey- 4, 2015-16, 26.6 and 31.3 % of men and women respectively in urban India are obese. And, obesity is not just an urban phenomenon. 14.3 and 15% of men and women respectively in rural India are obese.

A special report by the Indo-Asian News Service (IANS) in 2016 revealed that obesity in rural India grew by 8.6 times over the preceding 14 years.  Obesity has severe consequences - it causes cardiovascular diseases, diabetes, kidney disease and failure, some forms of cancer and other disorders like osteoarthritis. It is no surprise that such non-communicable diseases account for over 61% of deaths in India.

There has been some talk about the health ministry and the Food Safety Standards Authority of India (FSSAI) working on a proposal to introduce a 'sugar tax' and packaging regulations. In this context, India levying a 40% Goods and Services Tax (GST) on carbonated beverages was a welcome development. There were reports of beverage manufacturers adding fruit juice to carbonated beverages to be taxed at the 12% slab for fruit juices. While some good work is happening, there are concerns. Recently, a beverage product with high sugar-content tried to ally itself to the government's nutrition awareness campaign, also involving a high-profile ambassador. Many public health experts then urged the ministry and the ambassador to dissociate themselves from the beverage.

So, what can India do to protect its kids against the dangers of obesity?

  • Access: Ban sale of junk food and sugary drinks in and around schools. A related Public Interest Litigation (PIL) was filed in 2010. The courts, in 2011, asked the government to take effective steps to ensure this ban. No action has been taken yet.
  • Advertising: Ban advertising of junk food and beverages which are aimed directly at children. Restrict timings for all advertisements of such products. Ensure that characters and symbols attractive to children are not used in promoting such products.
  • Packaging: Governments should insist on prominent front-of-package display of sugar content, nutrition information on junk food and sugary beverage packages. All hazardous content in the packages must be disclosed.
  • Taxation: Tax junk food and beverages aggressively, close loopholes and make pricing prohibitive for consumers. Governments could also explore incentives for corporations to make healthier food and drinks.
It is time for India to acknowledge the adverse effects of obesity and act before it is too late. More influencers need to join the fight. A 2011 study revealed that presence of sporting celebrities enhances parents' perception of nutritious value of a food item. These influencers have a huge responsibility. When they endorse health claims of sugar-rich products, they are putting lives at risk. Athletes like P Gopichand, Virat Kohli and P V Sindhu have set a great example by turning down lucrative endorsement contracts for sugary products.

Others should follow suit. Schools must crackdown on purchase and consumption of junk products on their campuses. Finally, the fight against unhealthy food and beverages begins at home. Parents owe it to their children, and themselves. The risk of obesity in the near term and serious non-communicable diseases in the long-term is simply too much.