India's new urban worry — rising overnutrition

The Hindu

27-05-2025

A recent article in Nature that studied the prevalence of Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD) among IT employees in Hyderabad had alarming findings: 84% of the participants had fatty liver, indicating MAFLD, and 71% were obese. This striking statistic underscores a larger, more insidious public health crisis that is emerging in tandem with the growth of India's urban economy. The underlying drivers are chronic stress, excess salt intake, disrupted sleep patterns, and prolonged sedentary routines, particularly among those in the technology sector. IT companies often tether employees to their desks by offering free kiosks stocked with snacks that fall short of nutritional standards.
Urban India's crisis
India is grappling with a paradoxical nutritional landscape. While undernutrition remains a concern in many regions, overnutrition is now rapidly escalating in urban centres. In 2021, India ranked second globally in overweight and obesity prevalence. The trend is particularly evident in metropolitan IT corridors, where professionals are unwittingly becoming the face of a silent metabolic crisis. India's double burden of malnutrition — rampant undernutrition coexisting with overnutrition — is reflected in its low ranking on the Global Hunger Index.
According to the World Health Organization (WHO), noncommunicable diseases (NCDs) were responsible for 74% of global deaths in 2019 (it was 61% in 2000). These diseases disproportionately affect low- and middle-income countries, including India. WHO's 2024 World Health Statistics warns that NCDs and obesity are increasingly prevalent in the most economically productive segment of society. Without substantial policy interventions, regions such as South-East Asia are unlikely to meet the 2030 Sustainable Development Goal (SDG) targets to reduce premature mortality from NCDs.
In Tamil Nadu, the 2023-24 STEPS Survey paints a stark picture: over 65% of deaths in Chennai are attributable to NCDs. While the NCD cascade of care has shown improvement, there are significant gaps.
Among those receiving treatment for hypertension, only 16% have achieved blood pressure control, and for individuals aged 18-44, this drops to just 9.3%. Among diabetics in the same age group, only 9.8% manage to maintain glycaemic control. The prevalence of overweight and obesity stands at 31.6% and 14.2%, respectively. Additionally, 94.2% of respondents reported inadequate fruit and vegetable consumption, while 24.4% reported insufficient physical activity.
Tamil Nadu's Makkalai Thedi Maruthuvam (MTM) programme, deserves mention for its multisectoral approach to NCD control. From January 2024, 3,79,635 employees have been screened through workplace interventions. The eight-kilometre health walk and the 'Eat Right Challenge' were introduced to encourage behavioural change and nutrition awareness. However, the unchecked growth of fast food outlets in metros remains a formidable obstacle.
The National Family Health Survey-5 shows that obesity steadily rises with age, from 7% among men (15-19 years) to 32% among those aged 40 to 49 years. The prevalence of overweight or obesity rises from 10% in the lowest wealth quintile to 37% in the highest wealth quintile.
The widespread prevalence of overweight and obesity across age groups and income levels underscores that this is not an isolated occupational hazard, but a population-wide health crisis in the making. These trends align closely with data for women. Waist-to-hip ratio (WHR), another NCD risk marker, also increases with age: 46% to 65% in women and 28% to 60% in men (ages 15 to 49). In Tamil Nadu, urban areas report a higher NCD prevalence when compared to rural areas. Overweight or obesity affects 46.1% of urban men and 43.1% of urban women, compared to 35.4% and 31.6%, respectively, in rural areas.
The 18 to 59 age bracket which contributes to Tamil Nadu's majority working force is most vulnerable to early-onset NCDs, also compounded by a growing dependence on ultra-processed foods, alongside other established factors.
A Lancet article (2025) estimates that India's overweight and obese adult population could touch 450 million by 2050 (180 million in 2021). Simultaneously, childhood obesity has surged by 244% over the past three decades and is expected to climb another 121% in the next three.
Focus on manufacturing and marketing
While nutrition awareness at the consumer level is growing, it remains insufficient. The greater responsibility lies with regulators, producers, and policymakers. The market is saturated with ultra-processed foods that offer convenience but little in the way of nourishment. Consumers are frequently left choosing from options that are inherently unhealthy.
To address this, the Eat Right India movement, led by the Food Safety and Standards Authority of India (FSSAI), promotes safe, healthy, and sustainable food. It includes hygiene ratings, certification programmes, and campaigns such as 'Aaj Se Thoda Kam,' which encourages consumers to gradually reduce their intake of fat, sugar, and salt. In partnership with the Indian Council of Medical Research and the National Institute of Nutrition, the FSSAI advocates labelling high-fat, salt, and sugar (HFSS) foods, empowering consumers to make informed choices. In 2022, the FSSAI proposed the Health Star Rating (HSR) aimed at clearer nutritional information on packaged foods. However, the HSR system has sparked debate among medical practitioners and nutrition experts, on its effectiveness.
The Supreme Court of India recently directed an FSSAI-constituted expert committee to submit scientific and technical advice on food safety matters, which includes recommendations on food labelling norms.
However, these efforts must be backed by stricter enforcement and broader multisectoral coordination. Nutritional regulation must extend beyond messaging campaigns to influence what is manufactured, marketed and made available.
The Saudi Arabian model
Saudi Arabia offers a compelling model. As part of its Vision 2030 initiative, the kingdom has embedded NCD prevention into its national policy framework. It enforces calorie labelling in restaurants, imposes a 50% excise tax on sugar-sweetened beverages, and levies a 100% tax on energy drinks. It has instituted sodium limits in processed foods. Saudi Arabia is among the few nations meeting WHO's sodium reduction best practices and recognised for eliminating trans fats. Its success lies in the coherence of its strategy — integrating health, regulatory oversight, industry compliance, and civic engagement.
Meanwhile, India's urban landscape continues to evolve rapidly. Bengaluru, Hyderabad, Pune and Chennai have become economic engines, powered by the technology sector. To accommodate global operations, IT companies are embracing flexible and extended work hours. This transition has resulted in a considerable rise in demand for late-night eateries, cloud kitchens, and food delivery services. However, the vast majority of these offerings are energy-dense, nutrient-poor food products. As a nightlife culture expands in parallel with economic ambitions, so too does the risk of a nutrition-driven public health crisis. While the numbers among IT professionals are eye-catching, the escalating burden of NCDs extends well beyond this sector.
The message is clear: reversing the tide of NCDs demands not just awareness but action. Regulatory reforms, especially those addressing the food industry, are imperative.
Imposing taxes on foods high in sugar and salt — or those failing to meet nutritional standards — could be a logical next step. After all, if there is one thing India has never shied away from, it is introducing new taxes. Why not one that promotes health?
Dr. A. Chandiran Joseph is a doctor who is currently pursuing his post-graduation in community medicine in Chennai. The views expressed are personal