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India loses stomach for the pot belly


By Rajini VaidyanathanBBC News, Mumbai

Beggar in New Delhi
India has long battled with malnutrition but rising incomes and changing diets have meant obesity and diabetes are growing problems too, challenging the long-held notion that a paunch is an indication of health.

In a surgery in South Mumbai (Bombay) a patient is being measured up by a doctor.

“I’ve lost more than 30kg (66lbs), I’ve had to change my clothes six times,” he says, smiling as the tape measure touches his tummy.

Balancing on a set of scales isn’t the sort of setting you’d expect to see a politician in, but Nitin Raut, a cabinet minister for the Indian state of Maharashtra, isn’t ashamed to tell the world he took action to lose weight.

“Before, when I was coming before the camera I was looking so bulky. Now some people barely recognise me.”

Mr Raut underwent surgery to lose his bulging belly, having a procedure known as a gastric band, which effectively shrinks the stomach and the appetite.

Nitin Raut, before and after weight lossPre-gastric band, Mr Raut was 30kg (66lbs) heavier

Dr Muffazal Lakdawala, the surgeon who operated on Mr Raut, says he has fitted gastric bands to more than 20 Indian politicians in the past two years, and blames their erratic eating patterns, long hours and lack of exercise for the high numbers passing through his surgery.

The operation has a price tag of about $12,000 (£7,472) and takes up to four hours. In 2005 when Dr Lakdawala began the treatment he performed two operations, now he does more than 300 a year.

Many of his patients are coming to him to treat not only obesity, but related type 2 diabetes, “diabesity”. India has one of the highest levels of type 2 diabetes in the world and South Asians are four times more likely to be diabetic than their European counterparts.

How I slimmed down Mumbai’s police

A businessman can lose weight easily but for a policeman who is working 12 hours and is dieting, it’s much harder. They need to be motivated and know the merits and demerits of weight.

I talk to them and tell them about the dangers of heart disease and medical problems and that motivates them. Explaining the possible health problems is really important as is involving the entire family. They’re not just looking after themselves but their families.

I sometimes call up their wives too, to make sure their husbands lose weight and motivate them. When the family is backing them they’ll definitely lose weight. In terms of food, I make sure they eat a high protein diet, and low carbs and get regular exercise and proper sleep.

Javed Ansari is a personal trainer who works with Mumbai’s police

“I think India somewhere is paying a price for its growing affluence,” says Dr Lakdawala of the recent jump in cases. “Compared to the Western countries where junk food is cheaper, in India, the upper strata of society is getting afflicted because there is a lack of exercise, there is a tendency to eat more junk food and so they are putting on more weight and becoming obese.”

The correlation between rising incomes and waistlines is in research from the OECD which looked at the health patterns in emerging economies. While India still has the lowest incidences of obesity among so-called Bric nations – Brazil, Russia, India and China – almost one in five are overweight, which amounts to a large overall number in a country of 1.2bn people.

One of the biggest concerns for weight gain in India are fat depositions around the abdomen and belly, known as central obesity, says Dr Prabhakaran, a cardiologist and epidemiologist, and the director of the Centre for Chronic Disease Control. But the pot belly, or paunch, hasn’t always been seen as a huge problem in India.

“There is a cultural belief that being a little on the heavier side is considered healthy, or is a sign of prosperity,” he says.

“In Punjab for example, people on the fatter side are seen as healthy… that’s a cultural belief because historically in India people were underweight and were encouraged to put on weight because of rampant undernutrition.”

Police paunch

But more action is being taken to deal with growing waistlines among officials. A growing 24-hour media culture, coupled with increasing awareness of heart disease and diabetes are moving people’s perceptions away from the idea that heavier is healthy, although in more rural areas, that perception is still commonly held.

Board in doctor's surgeryGastric bands are advertised in doctors’ surgeries

In Mumbai, as well as fighting crime, policemen are being forced to fight the flab. Many of the city’s officers have been spotted with a paunch on patrol, which is why a few years ago gyms were installed in every police station in the city, and healthier food served in the police canteens.

“All police officers have to work out for their health,” says Sharad Bourse, the senior inspector at Versova police station. “They need to take time to exercise for their health and for their life.”

The gym at his station houses a running machine, weights, bench presses and an exercise bike. Most officers say they spend 20-30 minutes a day working out, and that the results are paying off. More than 1,000 officers have lost weight as a result of this programme, say officials.

“I’ve lost 10 kilograms since I started working out,” says Ashok Mohite while lifting weights. “Before I didn’t have the time to exercise after a long day, but now the gym is here at work, I can.”

A survey from The National Rural Health Mission (NRHM) in the Southern state of Kerala suggested that half of the officers there were overweight or obese, while it was reported that nearly half of the policemen in the northern city of Chandigarh were also too fat to do their job.

India has long grappled with mass hunger and malnourishment, so research on obesity in India is still relatively limited.

But many medical experts say that waking up to the problem in the first place is the only way India can adequately deal with it.

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