India's pot belly epidemic: A health crisis in the making

Arab Times

14-04-2025

NEW DELHI, India, April 14: Once seen as a symbol of prosperity, aging respectability, or indulgence, the Indian pot belly is now at the center of a growing health crisis. Traditionally featured in literature and cinema to depict comfort, laziness, or corruption, and even considered a rural status symbol as evidence of abundance, the protruding belly has long been part of India's social landscape.
However, what was once laughed at or admired is now cause for serious concern. India is facing a sharp rise in obesity, and the once-harmless pot belly is turning out to be a dangerous sign of deeper health issues.
According to a Lancet study, India had the second-highest number of overweight or obese adults in 2021—about 180 million—trailing only China. That number is projected to surge to 450 million by 2050, nearly a third of the country's expected population. Globally, more than half of adults and one-third of children are predicted to face obesity by mid-century.
The core of India's obesity crisis lies in abdominal obesity, or the buildup of fat around the belly. Doctors stress that this is more than a cosmetic issue. As early as the 1990s, researchers linked belly fat to chronic illnesses like Type 2 diabetes and heart disease.
Obesity appears in different forms: peripheral obesity (fat on hips, thighs, and buttocks), generalized obesity (even fat distribution), and abdominal obesity, which poses the highest risk.
Data from the National Family Health Survey (NFHS-5)—the first to include waist and hip measurements—reveals alarming statistics: nearly 40% of women and 12% of men in India have abdominal obesity. Among women aged 30–49, nearly half meet the criteria, which is defined as a waist over 90 cm (35 inches) for men and 80 cm (31 inches) for women. Urban residents are more affected, with high waist circumference and waist-to-hip ratios being key risk indicators.
So why is belly fat so dangerous?
A major reason is insulin resistance, a condition where the body doesn't respond properly to insulin, which regulates blood sugar. Belly fat interferes with insulin function, making it harder to control blood sugar levels.
Interestingly, South Asians tend to carry more fat than Caucasians at the same Body Mass Index (BMI). More importantly, it's about where fat accumulates. In South Asians, fat often gathers around the trunk or under the skin, but their fat cells are less efficient at storing it safely. When these cells reach capacity, fat overflows into critical organs like the liver and pancreas, increasing the risk of metabolic diseases.
Though the exact biological causes are still unclear, one theory suggests an evolutionary link. Centuries of famines and food scarcity may have trained the Indian body to store fat efficiently for survival. The abdomen, being the most expandable area, became the default storage zone. But as food availability increased in modern times, this storage function turned harmful.
Dr. Anoop Misra, head of Delhi's Fortis-C-DOC Centre for Diabetes and Metabolic Diseases, supports this theory. 'It's speculative but plausible,' he says, though no specific gene has been consistently linked to this fat storage pattern.
In response, the Indian Obesity Commission last year updated its obesity guidelines for Asian Indians, going beyond BMI to focus on fat distribution and health risks. They proposed a two-stage system:
Stage One includes high BMI without abdominal obesity or related diseases, where lifestyle changes like diet and exercise usually suffice.
Stage Two involves harmful belly fat and is often linked to diabetes, joint pain, or heart issues. This stage requires intensive treatment, including newer weight loss drugs like semaglutide and tirzepatide.
'As surprising as it sounds, even people with normal weight can have dangerous levels of belly fat,' warns Dr. Misra.
Physicians attribute the rise in abdominal obesity to lifestyle changes: high consumption of processed foods, takeaways, and calorie-dense home cooking. Between 2009 and 2019, India, along with Cameroon and Vietnam, saw the fastest growth in ultra-processed food sales.
Experts now believe Indians need stricter health guidelines than their Western counterparts. For example, while 150 minutes of weekly exercise may be enough for European men, South Asians may require 250–300 minutes to manage fat more effectively.
'Our bodies simply aren't built to handle excess fat like Western bodies can,' Dr. Misra adds.
The pot belly is no longer just a cultural trope—it's a serious health warning. With obesity on the rise, India is facing a looming public health crisis, and urgent action is needed before it spirals out of control.