HONG KONG, China, Raju, a healthy 14-year-old boy weighing 60 kilograms, goes to a reputed school for the elite in the Indian capital city of New Delhi. "I love sports," he says, meaning he loves watching cricket on television. He hardly plays any games, except during his biweekly physical education class at school.

Raju's father treats him to fast food on weekends and also drives him to school. "Why walk, when I can drive him? My father could not afford these luxuries, but I can," he says. Raju's dad does not notice that his son is overweight because of no sports and too much starchy food.

A team of doctors headed by Dr. A. Sharma at the Nutrition Foundation of India, based in New Delhi, studied 4.000 affluent schoolchildren in the city last May and were shocked to discover that 22 percent were overweight and 6 percent were obese.

There is an alarming rise in overweight and obese people worldwide in the past few decades. The problem is grave in the West and physicians are turning to drugs and stomach surgeries to treat the severely obese. Now the problem is also surfacing in Asia in places like South Korea, Japan, Hong Kong, Singapore and even developing countries like India and China.

Dr. R. B. Singh and his team at the Halberg Hospital and Research Institute of Moradabad studied 6,940 subjects in April last year from five big Indian cities and found that nearly 7 percent were obese and more than 33 percent were overweight. Almost half of them had big bellies and central obesity. When men have waists more than 102 cm and women have waists more than 88 cm, they have central obesity.
 

Obesity, or accumulation of excessive fat, can be subcutaneous (fat deposits under the skin) or abdominal (fat accumulation in peritoneal cavities around organs). Of these two types, abdominal or central obesity is more dangerous as it produces more harmful chemicals that initiate damage to various organs in the body. It also increases risk of a condition called insulin resistance, in which the body needs more insulin to use glucose from the blood. This condition progresses to frank diabetes in an overweight and inactive person.

Indians have a genetic tendency toward less muscle mass and more abdominal fat due to the presence of a "thrifty" gene. By virtue of this gene, they were able to survive famines and long periods of fasting hundreds of years ago when there were food shortages. But times have changed now.

The surging economy has endowed people with enough food and money, especially in urban areas. People eat more fatty food and
less healthy food; sit and watch television more and exercise less; drive more and walk less; drink fizzy drinks and alcoholic beverages more and water less. Lifestyles have changed, and so have waistlines.

Sheela, a 35-year-old housewife who had a baby seven years ago, realized she was 10 kilograms overweight only after her clothes stopped fitting her. "But I don't eat much," she says. A closer look at her lifestyle reveals that she does not like fruit, has a sweet tooth, eats out at least three times a week and "has no time" to go for a walk or to the gym.

Surprisingly, many people are ignorant of the consequences of rising waist circumferences. In April 2005, Dr. D. Mohan and his team at the M.V. Diabetes Specialties Center and the Madras Diabetes Research Foundation, surveyed 26,001 individuals in Chennai, the largest city in southern India. To the question "Do you know of a condition called diabetes?" 25 percent answered, "No." Merely 22 percent were aware that diabetes can be prevented and just 12 percent knew that it was related to obesity. Of those who were already diabetic, less than half were aware of complications from diabetes.

According to the World Health Organization, there are more than 31 million diabetics in India, a result of weight gain and faulty eating habits. An overweight person is one with a body mass index* of more than 25 and an obese person is one with a BMI of more than 30.

"Once BMI crosses 25, there is high risk of numerous physical and metabolic disorders that are central to increased abdominal fat," said Dr. Jorge Plutzky, associate professor of medicine at Harvard Medical School in Boston in the United States, speaking to heart.org. These include hypertension, diabetes, elevated triglycerides, hardening of blood vessel walls, thickening of the blood, kidney diseases, heart diseases and strokes, not to mention gall stones, several cancers, various arthritis and mental problems.

Health providers, schools and municipal corporations need to caution adults and children alike against the hazards of getting fat and urge everyone to eat healthy foods and exercise. More playgrounds and cycling tracks should be built in place of cinema halls and video-game parlors, and healthy low-fat foods should be advertised rather than pizzas and burgers.

The Singapore government has initiated some measures in schools to curb childhood obesity. Rita is an 8-year-old overweight girl who goes to a public school in Singapore. Unlike Raju she plays many sports at school, besides her physical education class, because it is compulsory. "At lunch, I get a different fruit every day and a milk drink from my school cafeteria. I never get chips or coke because the cafeteria doesn't sell any," she says.

"Lifestyle modification is the cheapest, safest and easiest way to combat obesity and prevent diseases arising from it," said Dr. Uberto Pagotto, associate professor in the Endocrine Unit at the Department of Internal Medicine and Gastroenterology at the S. Orsola-Malpighi General Hospital in Italy, speaking to heart.org.

Regular, moderate physical activity, coupled with less but healthy food, causes weight reduction which in turn reduces blood pressure, blood triglycerides and blood glucose levels. This goes a long way in preventing deaths from strokes and heart conditions. "There should be a lifetime approach towards weight control," said Professor John Deanfield, professor of cardiology at the University College of London, also to heart.org.

While obesity is rising in Indian cities, a large population, especially in underdeveloped rural areas, is still suffering from malnutrition. Like other Asian countries in transition in a developing economy, India also suffers from a triple burden of diseases -- the growing prevalence of obesity and physical inactivity co-existing with malnutrition.

Experts fear that by the year 2050, India and China together will house one-quarter of the world's obese population. This is a wake-up call. If fitness and healthy eating become the mantra of every household, this disaster can be averted.