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Indian diabesity

Mass migration in India: From malnutrition to mass obesity

Migration is also playing a significant factor in driving the diabetes epidemic in India
Shah Ebrahim

According to a recent study published in Plos Medicine, Indians who migrate from rural to urban areas are more likely to become obese compared to individuals who do not move. In addition, it believed that this very migration is also playing a significant factor in driving the diabetes epidemic in India.

In urban areas of India, diabetes has increased from 5% to 15% between 1984 and 2004, and is thought to result from increased consumption of saturated fats and sugar, and reduced levels of physical activity. Moreover, urbanisation has been associated with causing profound changes in diet and behaviour. 


In order to examine how migration has impacted on obesity and diabetes in India, Shah Ebrahim, Director of the South Asia Network for Chronic Disease in New Delhi, India, and colleagues interviewed 6,510 rural migrants working in four factories in central, north and south India and the spouses of these workers if they were living in the same town.

Each migrant worker or spouse asked a sibling still living in the rural area that they were originally from to join the study. Non-migrant factory workers and their siblings from urban areas were also recruited. 


Each participant answered questions about their diet and physical activity and had their blood sugar and body mass index measured. The results showed similar levels of obesity in urban and migrant men (41.9% and 37.8% respectively), in comparison with 19% of men in rural areas. Diabetes also stood at similar levels in urban and migrant men (13.5% in urban and 14.3% respectively), in comparison with 6.2% in rural men. These patterns of obesity and diabetes were similar in women.


"Western populations increases obesity risk by about 3kg (7lbs) at most. In India, migration increases weight by double this amount” Shah Ebrahim

 In addition, half of the migrants had gained an additional 14 pounds (6-7kg) by the tenth year of their relocation, they were also three to four times more likely to be obese than their rural counterparts, more than two times more likely to be diabetic and almost twice as likely to have hypertension.


“We have not looked at the extremes, but half the people who migrated put on about 14lb in weight. This is a dramatic increase. Some people will have put on much more than that. The main reasons for weight gain are eating more calories than you need for the energy you burn up in physical activity. We have evidence that migrants tend to eat more fat than rural people, but other nutrients are quite similar,” said Ebrahim. “The likelihood is that they just eat more of everything because they have more money to spend on food. We have also found that it is not Western foods that are to blame but just ordinary everyday Indian foods.”


 While many scientific studies have linked obesity and diabetes to certain genetic mutations, Ebrahim said migration, lifestyle and environmental factors held far more weight. “The (fat mass and obesity associated gene) in Western populations increases obesity risk by about 3kg (7lbs) at most. In India, migration increases weight by double this amount,” he said.


In urban areas diabetes has increased from 5% to 15% between 1984 and 2004

 “The dramatic increases in obesity across the US over two decades are clearly not genetic. American genes have not changed in this short time period. What has changed is the ability of mass marketing of cheap, high-calorie food and the sedentary US lifestyle to reach the majority of the population. Controls on the growing food industry in India and on the costs of saturated, harmful oils and fats would be useful steps to check the obesity epidemic,” he urged. 


In addition, a new government study shows heart disease accounted for about a quarter of all deaths of those aged between 25 and 69 between 2001 and 2003. This compares with one in 10 for tuberculosis and about one in 20 for diarrhoea. In urban areas a third of deaths resulted from heart disease.

The figures, from the Registrar General of India and the Indian Council of Medical Research, showed malaria, once one of the worst killers, now accounts for only 2.8% of deaths. This shift coincides with rapid economic growth and the huge expansion of cities over the past two decades.


Dr PC Bhatnagar, of the Voluntary Health Association of India, said the country was in an 'epidemiological transition' that will lead to non-communicable diseases such as heart problems accounting for a growing proportion of deaths. Health experts attribute the increased prevalence of deadly lifestyle diseases to sedentary urban lifestyles among the booming middle class, the rise of vehicle ownership and a higher intake of fatty foods. Bhatnagar said there was also concern that Indians may have a genetic predisposition to heart disease.


Potentially deadly conditions such as diabetes and obesity have also risen alarmingly. A recent study by the University of Maryland and the National Council of Applied Economic Research found 22% of Indians living in cities were overweight and 7% were obese. Overweight and obesity were not confined to relatively affluent households. The survey found the proportion of overweight and obese people living in urban slums was lower.


The findings demonstrate that rural-urban migration in India is associated with rapid increases in obesity and diabetes and also indicated that changes in migrant behaviour (such as reduced physical activity) put them at similar risk to the urban population. 


22% of Indians living in cities were overweight and 7% were obese

The Indian Council for Research on International Economic Relations has estimated that ‘modern life’ diseases such as heart diseases, strokes and diabetes could cut national income by US$200 billion in the period 2005-2015.


At the same time, India has the largest number of malnourished and stunted children in the world. About 48% of children are underweight and almost two million under the age of five die each year from preventable disease. These trends mean India faces a paradoxical burden of fighting the problems of mass obesity and malnutrition


India carries the highest diabetes burden in the world, with 41 million cases in 2007, projected to hit 70 million by 2025.

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