Is India too fat?

Air India’s new policy about obese crew members raises some interesting issues for a country dealing with a growing epidemic. The airline recently tested over 3,000 employees and found that approximately 20% of them were overweight. These employees were recommended diet and exercise before being reconsidered for employment.

In the United States, you can only imagine how many discrimination lawsuits would have surfaced against any employer who threatened to fire their employees because they were overweight.

This is not to say that obesity isn’t a national health care crisis in India, the Unted States, China or other countries. But incidents of obesity among Air India’s flight attendants may be indicative of a bigger problem.

1. Junk food consumption on the rise

You would think that in a country where poverty and malnutrition is still wildly prevalent that obesity cannot be an issue. To the contrary, though, India is where the United States was in the 1970s and ’80s. There has been a massive increase in the consumption of junk food, alcohol and smoking.

In fact, according to a study published in Lancet in 2013, India and China accounted for 15% of the world’s obese population.

2. Lack of adequate health insurance

There has always been an argument about whether a carrot or a stick is the best incentive for driving healthy behaviors. The challenge Indians face with rising rates of obesity, heart disease and diabetes, is that they have poor access to the health care system. A basic necessity, like health insurance, has only really taken off in the past several years.

However, even though more people are now purchasing health insurance, their policies only cover costs for hospitals, not doctors’ visits. One, therefore, has to wonder how the Indian population is expected to get the right care when they have inadequate access. Most people pay out of pocket for their health care and this makes quality care accessible only for those who can afford it.

3. Where are all the doctors?

In a country with over a billion people there are approximately 800,000 physicians, which is the equivalent of one doctor per 1,200 people. Clearly, that is an insufficient number of providers to care for people who really need it.

4. Bollywood has an influence

In India, more than any other country, vanity and good looks are the mainstream of marketing and entertainment. In a country where fat women and men without six-pack abs never make it to the screen, obesity is more or less a taboo topic. Despite the fact that people don’t have insurance and pay out of pocket there are a rapidly growing number of people who opt for weight-loss surgeries. There were over 18,000 weight-loss surgeries performed in India just last year, which is up from 800 five years ago.

Even Indian Finance Minister Arun Jaitley had weight-loss surgery recently as a way to control diabetes. India’s rising middle class is splurging on unhealthy processed food and then opting for the latest quick fix from bariatric surgery. Even more unusual, in a country where health insurance is still not widely prevalent, the Indian government covers bariatric surgery for its 3 million employees. Maybe Air India should consider the same.

5. Too much sitting, not enough moving

The most concerning increase in obesity is among teenagers, who are less physically active than their predecessors and spend most of their time studying behind computers or on their gadgets. While the number of gyms across India is growing, there needs to be a greater emphasis on the importance of daily physical activity for young and old.

The best example of how sedentary lifestyles are impacting the health of the population is among younger workers in call centers supporting global companies. These employees often work the night shift and engage in unhealthy eating habits, smoking and sedentary lifestyles that trigger the rise of obesity.

Air India’s action against its overweight employees is probably not the most pragmatic approach to solving the issue, but it should be a wake-up call to all of India that the population is literally on the verge of bursting at the seams.

Dr. Sreedhar Potarazu, an ophthalmologist and entrepreneur, is the founder and CEO of VitalSpring Technologies Inc., a software company focused on providing employers with applications to aid in purchasing health care. He is the author of a book Get Off The Dime: The Secret of Changing Who Pays For Your Health Care. The opinions expressed in this commentary are solely those of the author.

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