|Year : 2016 | Volume
| Issue : 1 | Page : 1-2
Socioeconomics of obesity: A need for a national policy and a professional vigilance council
Ashok D.B. Vaidya
Chief Editor, Journal of Obesity and Metabolic Research, 102, Vasudha Clinic, Madhuvan C.H.S., Santacruz (W), Mumbai, Maharashtra, India
|Date of Web Publication||16-Jun-2016|
Ashok D.B. Vaidya
Chief Editor, Journal of Obesity and Metabolic Research, 102, Vasudha Clinic, Madhuvan C.H.S., Santacruz (W), Mumbai, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Vaidya AD. Socioeconomics of obesity: A need for a national policy and a professional vigilance council. J Obes Metab Res 2016;3:1-2
When one accesses "Google" for the search words - "Commercialization of weight management" - one gets about 291,000 results.  The same search words on the PubMed yield 1045 results.  The discrepancy suggests that there is much lesser discussion on the problem in the academic space. There is a "YouTube" piece labeled, "How commercialization of weight loss has changed the way dieticians work?" added by the "World Antiaging Network" on September 27, 2015.  It is not surprising that, in 6 months, there have been only 12 views of the video so far, including one by your Editor. Trivedi, in that talk, only refers to the "commercial" approach of dieticians and their errors. He is completely quiet on the escalating socioeconomic costs to the nation, the exorbitant contractual fees by the commercial centers, the surgical/ancillary charges by the bariatric experts, and on the rampant unethical advertisements promising sure weight loss.
The Saudi Journal of Obesity, Vol.3/Issue 2/ July-December 2015 has an article, from Nigeria, showing that, unlike in the developed countries, some developing nations have increased prevalence of overweight/obesity in children from the lower socioeconomic class.  However, the data from India show that the urban children are more obese than the rural ones.  There is also a study, from Delhi (Northern India), which reported a 5.59% of childhood obesity prevalence in the higher versus 0.42% in the lower socioeconomic strata.  Another study, from Chennai (South India), showed overweight - 22% in the higher, 15% in the middle, and 4.5% in the lower socioeconomic groups.  The authors state that the urban children who are "well off have the highest risk of obesity." With the lacunae in diverse surveys, it is desirable to correlate the prevalence of obesity with several variables, their intake of calorie-dense foods, and the activity status. Even the studies in the adult population need to consider these variables which determine the degree of overweight and obesity. But the time for more and more surveys is now gone. Even a common man can see that there is a widespread increase in obesity and as a consequence, an increased risk of many diseases. Despite the efforts of some bariatric experts and organizations, the Government of India, notwithstanding the WHO, has not as yet declared obesity as a disease. As Todkar announced recently, at a major program at Mumbai, there has to be a sustained campaign to bring obesity prevention and care as a central concern.  She appealed that everyone concerned regarding obesity has to serve as a foot soldier for the war effort.
In the US, the estimated medical care costs of obesity were around $147 billion.  There is a paucity of such data in India for the direct and indirect costs for obesity, despite the epidemic of cardiovascular diseases (CVD) and diabetes mellitus. A recent study by Agrawal and Agrawal, from New Delhi showed that the average monthly health expenditure increased with higher BMI; it was Rs. 68 for the normal, Rs. 132 for the overweight, Rs. 143 for the obese, and Rs. 224 for the morbidly obese.  However, the studies on noncommunicable diseases (NCD) have shown that, in India, the total out-of-pocket expenditure for NCD has jumped up to over $9 billion.  From 2005 to 2015, it was projected that India will lose international $237 billion (1.5% of GDP) as a result of CVD and diabetes.  Thakur et al. state, "Most of the estimates suggest that the NCDs in India account for an economic burden in the range of 5-10% of GDP which is significant."  Hence, there is an urgent need of a National Policy Council for Obesity Control (NPCOC) to address this grave challenge. This can be initiated by the Department of Health Research, Ministry of Health and Family Welfare, Government of India, in collaboration with representation from several professional academic organizations. As the challenge has to be handled by many measures, in a trans-system and trans-disciplinary manner, the NPCOC has to operate in an inter-ministry mission mode. The very fact that several central cabinet ministers, governors, chief ministers, and business leaders face their own overweight and obesity as formidable challenges should make the establishment of NPCOC easy. But this is easy said than done. In the Union Budget of 2016-2017 (India), only 38,000 odd crores is budgeted for health from the total 19.5 lakh crores.  While dialysis has rightly featured as a focus for every district hospital, hardly a word is said about obesity, which is a major risk factor for diabetes and hypertension leading so often to chronic renal failure. There are no policy statements on how the Indian government, unlike the US, plans to meet with the challenge of obesity and its dire consequences.
There are strong business groups which would try and guard their vested interests in obesogenic fast foods, colas, and TV/mobile phone/games habits. There are relatively a few groups actively engaged in a social fight against obesogenic agents. But on the contrary, there has emerged a big fitness industry that has hardly any ethical or regulatory guidelines, unlike that the food industry is often squirming under the new regulations of FSSAI of the Government of India. But, the advertisements of weight-reducing recipes have tall claims, most often unsupported by scientific evidence, as to their safety or efficacy. There has to be professional periodic overviews of such products as to their evidence base and their labeling and advertising integrity. There have been infrequent overviews of the markets of weight-control drugs. However, these constitute only minor fractions of the total money spent on overweight and obesity. There is also a need to encourage more research on the drug discovery and development of natural products of traditional medicine which have shown an early promise of safety and activity in humans.  This approach, through reverse pharmacology, can add new modalities in the management of obesity. However, currently, there is not much organized R&D in the field. A professional body may be of value to address several issues cited (vide supra).
A Professional Vigilance Council, for obesity, is a crying need, both nationally and internationally, for the following reasons: (1) To develop guidelines for the bariatric profession for ethical and economical practices and norms (2) To liaison with the government, industry, and legislature for the policy, products, and laws relating to obesogenic influences (3) To develop awareness and training programs in the schools and community so as to take the preventive steps for obesity (4) To encourage and develop support for crucial high-impact R&D programs and projects to control obesity and (5) To acquaint the public media and press on how the domain of obesity impinges not only on health, but also on development and economy. We request the leaders in the field to initiate steps to constitute NPCOC and PVR at the earliest.
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