Obesity in India: How ‘pot belly’ went from status symbol to silent killer

The Indian pot stomach has long been the target of comedy and social criticism, having previously been a symbol of wealth, indulgence, and aging legitimacy.

It slowly signaled comfort or complacency in literature, and in movies, it degenerated into the slang for the obnoxious, crony, or crooked policeman. Cartoons made fun of officials by exaggerating it. It was once viewed as a status symbol in remote areas as a sign that” this man eats well.”

But what was previously dismissed or perhaps celebrated is now ringing the alarm. The obesity issue in India is growing, and pot belly, who appears to be innocent, may be a bigger criminal than we think.

India had the second-highest number of overweight or obese adults in 2021, with 180 million affected – behind only China. A new Lancet study warns this number could soar to 450 million by 2050, nearly a third of the country’s projected population.

More than half of all adults and a fourth of children and adolescents are expected to experience the same fate on a global scale.

The dish belly, or chest overeating, is at the center of this problem in India.

Doctors claim this type of fat is more than just a cosmetic issue because it causes the formation of extra fat around the stomach. Studies have established a direct relationship between tummy fat and serious diseases like heart disease and Type 2 diabetes as far back as the 1990s.

Fat does not just refer to the abdomen. It manifests in various patterns, varying in large supply: external obesity affects the hips, thighs, and buttocks, while generalized obesity results in large spread across the body more consistently.

The numbers on abdominal obesity in India are already troubling. According to the latest National Family Health Survey (NFHS-5) – which, for the first time, measured waist and hip sizes – about 40% of women and 12% of men in India have abdominal obesity.

According to Indian guidelines, abdominal obesity means a waist of more than 90 cm ( 35 inches ) for men and 80 cm ( 31 inches ) for women. Almost one in two women between the ages of 30 and 49 now exhibit symptoms of it. High neck diameter or waist-to-hip numbers emerging as a vital red flag were found to be more prevalent in urban populations than rural ones.

Why is tummy fat for a big deal, then?

One explanation for this is insulin resistance, a condition in which the body stops working properly when the body stops producing the testosterone that controls blood glucose. Blood glucose is weakened because abdominal fat interferes with the body’s hormone production.

Studies have found South Asians, including Indians, tend to have more body fat than white Caucasians at the same Body Mass Index. (BMI is a simple measure that assesses a person’s weight in relation to their height.)

It’s not just how much overweight you have; it’s also where it goes. In South Asians, overweight may accumulate under the body and around the tree, but not always as intense fat in the stomach.

Studies show that South Asians ‘ larger, less effective fat cells fight to keep fat under the skin, despite having less of the more dangerous deep abdominal fat around tissues like the liver and pancreas. In consequence, extra large is released into important organs that control metabolism, such as the liver and pancreas, increasing the risk of heart disease and diabetes.

Scientists continue to be unsure of the genetic causes of the large transmission patterns. No one gene has regularly explained this inclination, despite the numerous genetic studies that have been conducted.

An adaptive underlying is provided by one concept. Centuries in India have been forced to live on poor nutrition because for centuries it has been plagued by droughts and persistent food shortages.

The human body evolved to survive in such circumstances in a world of serious lack.

The abdomen, which is the most flexible area, became the perfect storage location for this energy because the body needed a depot for it. This large business continued to grow over time as food became more plentiful, finally reaching dangerous levels.

Anoop Misra, who leads Delhi’s Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, describes it as a conceptual but realistic biological idea, one that doesn’t get proven but makes sense.

Last year, in a paper doctors belonging to the Indian Obesity Commission redefined obesity guidelines for Asian Indians, moving beyond BMI to better reflect how body fat relates to early health risks.

A two-stage clinical system that takes into account physical function, related diseases, and fat distribution was developed.

High BMI is present in stage one, but there are no abdominal obesity, metabolic disease, or other physical problems. Lifestyle modifications, such as diet, exercise, and occasionally medication, are typically sufficient in these situations.

The harmful visceral fat in stage two often comes with health problems like diabetes, knee pain, or palpitations, as well as abdominal obesity. This stage indicates higher risk and calls for more in-depth management.

This classification determines the intensity of the treatment. Early detection is crucial when belly fat starts to appear; doctors claim that new weight loss medications like semaglutide and tirzepatide have shown to be effective at reducing it.

Even people with a normal weight can have dangerous levels of belly fat, says Dr. Misra.” As shocking as it may sound, even people with a normal weight can have dangerous levels of belly fat,” she says.

According to Indian doctors, abdominal obesity is rising as a result of lifestyle changes, including more fast food, takeaways, and greasy home cooking. According to research, Cambodia, India, and Vietnam saw the fastest increase in per capita sales of ultra-processed foods and beverages between 2009 and 2019.

What needs to be done then?

Experts say Indians need tougher lifestyle changes than Western norms recommend. While 150 minutes of weekly exercise may suffice for their European men, their South Asians counterparts need around 250–300 minutes to offset slower metabolism and less efficient fat storage, studies show.

Dr. Misra points out that “our bodies aren’t as good at absorbing extra fat.”

In essence, the pot belly is more than just a punchline; it’s a warning sign. And India is resting on a ticking medical time bomb.

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