The nouveau obese

Originally published in Himal Southasian, August '09

International health experts are calling for a lower threshold for being overweight and obese among British Southasians – for the blunt reason that they are more likely than their white neighbours to contract heart disease and diabetes. Racial profiling, perhaps, but a conclusion based on core genetic differences.

The call has been directed to Southasians the world over; international standards are currently based solely on research on Caucasians in Europe and America. India has already lowered the prevailing markers based on body mass index – 25 for those overweight and 30 for the obese – to 23 and 25 respectively, on top of lessening thresholds in waist circumference measurements. As a result, an extra 70 million Indians have become 'overweight' or 'obese' overnight. In practice, this means that doctors are obliged to intervene earlier, with drugs or surgery if necessary.

GPs in the UK concur that a better system is needed for the NHS, one sensitive to racial difference. A distressing proportion of sufferers arrive at diabetes clinics too late to prevent lasting damage – a trend fast increasing among British Southasians. But opinion in Britain is divided over the Indian system. Dr Ponnusammy Saravanan, from the South Asian Health Foundation, called for caution, stating that only limited evidence exists concerning the introduction of drug treatment and bariatric surgery at a lower threshold for Southasians; more studies are needed. Yet the Royal College of GPs is backing a new system – eloquently named 'Qrisk2' – to identify the patients in greatest need of help; a computer-based risk-assessment machine, collating such information as BMI and ethnic background.

Obesity has seen a sharp increase in Southasia itself over the last few years, in tandem with rapid industrialisation and the shift away from outdoor, rural livelihoods – particularly in 'Shining India.' In 2006, the UK-based (and ridiculously named) International Obesity Task Force reported that Southasian countries are seeing rises in childhood obesity congruent with that of Western countries. Consequently, diabetes is rocketing, the majority of sufferers contracting type 2, commonly associated with being overweight. The consequences of Southasia's expanding waistline could prove dire to its social and economic stability, and burden its already-struggling health services to the point of collapse.