Rich gorge as poor in India starve

The wealthy in India are getting fat while the poor are undernourished. Picture / Reuters

INDIA - Six months ago, Vijay Chawla weighed more than 171kg. He couldn't walk up a single flight of stairs, and his feet swelled from a size 9 shoe to a size 11 from the pressure of supporting his weight. He had a 1.65m waist, and had to have his clothes specially made. In his desperation to lose weight, Chawla resorted to surgery to reduce the size of his stomach.

Chawla's is a story that has become all too familiar in Western countries grappling with the problem of obesity. But he is not a fast-food junkie from smalltown America, or one of Britain's growing army of the obese.

Chawla is from India, a country better known for images of stick-thin, undernourished children than it is for fat people.

But hidden among its starved millions, India has a serious and growing epidemic of obesity.

The figures make alarming reading: 76 per cent of women in Delhi suffer from abdominal obesity. Even more disturbing is the rate of childhood obesity: almost 33 per cent of 15- to 17-year-olds in India's cities are now clinically overweight.

"It's a tsunami that is going to come upon us suddenly, after five to seven years, when these children grow up," says Dr Pradeep Chowbey, one of India's leading obesity surgeons. "Suddenly we will find we have an adult obesity problem that is at Western levels."

Even worse, Chowbey fears Indians may be at greater risk from obesity than Westerners - precisely because of their history of undernourishment.

One theory is that generations of hunger and deprivation have made Indians develop so-called "thrifty genes" that store more fat than those of people who have been well fed - which makes them more prone to obesity.

Chowbey, based at Delhi's Sir Ganga Ram hospital, is one of a growing number of specialist surgeons answering the demand for stomach-reducing surgery in India. Hospitals offer the operations in 15 cities.

Yet malnourishment is still very much a problem in India. Only two years ago it emerged that several children had starved to death in villages in West Bengal state.

More than 45 per cent of Indian children are malnourished, according to the World Bank, a statistic that seems hard to reconcile with the rate of childhood obesity, until you realise that it illustrates the ever-widening gulf between the rich and the poor.

Childhood obesity is a problem of the cities, the business centres that have transformed India into the second-fastest growing economy in the world.

Most of the malnourished live in the villages, in the great hinterland of rural India that has barely been touched by economic growth.

In the West, we are used to thinking of obesity as a problem of the poor, but in India it is a disease of the rich.

"The critical thing is that India is going to be facing a double-edged problem," says Chowbey. "We're going to have to deal with an epidemic of undernutrition and an epidemic of overnutrition at the same time."

Chawla is a typical case. He lives in a plush apartment block in the modern Delhi suburb of Rohini, with uniformed guards at the gate. Inside, Chawla's apartment is floored with white marble. He lives a life his parents, ordinary Delhi traders, couldn't dream of.

Chawla founded a company making television speaker parts. Its success is part of the economic transformation taking place all over India.

His profits have allowed him a lifestyle very different from his traditional upbringing. "My parents never touched alcohol," he says, "but until six months ago I used to have five or six drinks in an evening - wine, beer, whisky.

"My parents only ever ate traditional homecooked Indian food. But I used to eat a lot of junk food - pizza, chips, deep fried food."

Western-style fast food has become popular in India, which had few Western brands until recently. The likes of McDonald's and Pizza Hut are considered fashionable places to eat, crowded with rich young professionals who can afford to pay prices which are beyond the pockets of the poor.

"When I was in my 20s the traditional belief was still that it was healthy to be fat," says Chawla.

A pot belly used to be considered a sign of prosperity. But in a society bombarded with the same images from Hollywood and American television as the rest of the world, those beliefs have died out, leaving people like Chawla overweight and unenvied.

Chowbey says there is more to it than changed eating habits. "More and more evidence points to the existence of 'thrifty genes' in Indians and other populations who have been undernourished," he says.

The idea of a genetic propensity to gain weight is a theory that has not yet been conclusively proven, but it has many adherents around the world, including in the US and Britain.

"These genes were originally helpful for survival," says Chowbey. "What they do is convert eaten food into storage as fat. It starts with people who were undernourished or premature babies. Their descendants adapt by developing 'thrifty genes' to cope with undernourishment.

"But if that new generation has access to plenty of food they store too much fat. What this means is that countries where there were decades of undernourishment, like India, are facing a much bigger problem with obesity than other countries."

Indian society has other factors. For the wealthy, it is possible to take almost no exercise at all. It is not just, as is the case for Chawla, that many are able to drive to work and park outside the office. Many of the small everyday activities that force people in the West to take some exercise are taken care of by someone else in India.

Where the average Westerner carries shopping bags on a fairly regular basis, the rich in India almost never do.

Not only large supermarkets, but even the local grocery store, will take an order for shopping by telephone and deliver to your door. In fact, it is possible to almost never go shopping in India.

Even furniture stores and jewellers will send a delivery boy with a selection of their merchandise to choose from in the comfort of your home.

It all comes down to India's vast army of the poor - the country has a huge supply of cheap labour.

Domestic servants take care of almost every chore. Drivers mean parking is never a problem - giving rich Indians little incentive to walk to the metro station in summer temperatures that are regularly over 40C, with humidity that soaks your shirt with sweat in minutes.

Many wealthy Indians even get their domestic servants to walk their dogs for them.

Prateek Sawhney is another of Chowbey's patients. A real estate developer, he lives in Delhi's upmarket Defence Colony, a neighbourhood known for its restaurants. He weighs over 133kg and is 1.8m tall.

"The problem is lifestyle," he says. "I want to lose weight but I just don't do the things I'm supposed to. I eat out five or six days a week at very upmarket hotel restaurants, food with a lot of calories.

"What people don't realise about Indian food is if you eat the traditional homecooked food it is very healthy, but you don't get the same sort of food in restaurants.

"It was the British who started it - they added all sorts of cream to the traditional recipes, and it tastes great but it's not so healthy.

"I eat out because I'm socialising. You see, the thing is in the West you eat first, then you play. Here in India it's the other way round, we play first then we eat. We typically eat dinner at the end of an evening out, around midnight, then go home."

Obesity is causing other problems too. Like 33 million other Indians, Sawhney suffers from diabetes, which he developed about eight years ago.

India has the largest and fastest-growing diabetic population in the world, and obesity is believed to be one of the causes. The number of diabetes sufferers in India has grown tenfold since 1971.

The obesity epidemic is also leaving more Indians with heart problems, and other health disorders.

Chawla says that at his heaviest, he began to suffer constant pains in his legs and feet from the pressure of supporting his weight. That was when he turned in desperation to Chowbey for surgery.

"Once people reach a certain body mass index [the ratio of their weight to their height] they can't lose weight by dieting," says Chowbey. "Their stomach has grown so much that if they reduce how much they eat their body will still feel hungry."

So what Chowbey offers is an operation to tie a tight band around the stomach, effectively blocking off most of it so that food is digested only in a small part. It is widely available in the West, but in India it is far cheaper.

At first Chawla approached a clinic in New York for the operation. He was told it would cost US$12,500 ($20,000). That was when he turned to Chowbey, who did the same operation for US$3000.

Over the past six months, Chawla has lost 31kg. His blood pressure, which was dangerously high, has reduced to healthier levels. These days he walks down the three flights of stairs from his apartment, when he used to take the lift.

- INDEPENDENT