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In order to tackle this growing epidemic, Dr. Abhishek Katakwar emphasises the role that lifestyle and medical interventions play, the way that obesity contributes to metabolic illnesses, and the significance of awareness campaigns such as PM Modi’s obesity challenge.
Obesity is not just about excess weight—it’s a critical health crisis linked to diabetes, heart disease, and NAFLD.
Millions of people worldwide suffer from metabolic illnesses, which are largely caused by obesity. In India, 25% of obese adults are at increased risk for cardiac disease, and more than 50% have non-alcoholic fatty liver disease (NAFLD). According to Dr. Katakwar, insulin resistance and type 2 diabetes are caused by the release of inflammatory chemicals by excess adipose tissue. NAFLD is caused by hepatic fat accumulation, whereas systemic inflammation raises the likelihood of arterial plaque building, which has an immediate effect on heart health.
Excerpts from the conversation:
How does obesity directly contribute to metabolic diseases like diabetes, non-alcoholic fatty liver disease (NAFLD), and heart disease?
Obesity directly contributes to metabolic diseases by disrupting normal body functions and creating a state of chronic low-grade inflammation. Over 50% of obese adults in India suffer from non-alcoholic fatty liver disease (NAFLD), and 25% are at higher risk of developing heart disease. Obesity leads to increased fat tissue, which releases inflammatory substances, leading to insulin resistance and type 2 diabetes. Excess fat also accumulates in the liver, causing NAFLD. Similarly, this systemic inflammation contributes to plaque buildup in arteries, increasing the risk of heart disease. The increased stress on the heart muscles from carrying excess weight also strains the cardiovascular system directly.
As obesity rates rise, so does the prevalence of diabetes, as excess body fat is a major driver of insulin resistance. Diabetes is significantly more common in people who are obese or overweight, and India, often referred to as the “Diabetes Capital of the World,” is seeing an alarming surge in cases. Within the age group of 20–79 years, India had 74.9 million diabetics in 2021, projected to increase to 124.9 million by 2045.
With obesity and metabolic diseases rising post-pandemic in India, what urgent steps are needed to improve metabolic health?
The rise in obesity post-pandemic is alarming. As per the 2019–2021 National Family Health Survey (NFHS-5), around 24% of women and 22.9% of men were obese in India. Before COVID, we were not taking it seriously, but then we had data during the pandemic that highlighted its impact—if somebody’s BMI was more than 35% and they contracted COVID, the severity of the illness was significantly higher compared to those with a lower BMI. In fact, people with a BMI of over 35 had seven times more chances of landing on a ventilator compared to a normal individual.
The reason is that obesity compromises lung function in multiple ways. Firstly, it leads to conditions like sleep apnea and hypoapnea, which reduce breathing efficiency. Secondly, obesity itself is an inflammatory state, making individuals more susceptible to severe respiratory complications. That is why it is so dangerous—when combined with infections like COVID, it significantly increases the risk of severe illness and critical outcomes.
Addressing the obesity crisis requires a multifaceted approach. Public health campaigns emphasizing nutrition, physical activity, and lifestyle changes are critical. Early screening and timely intervention for metabolic diseases should be a priority. Additionally, we need to improve access to affordable, nutritious food and ensure that urban planning includes safe spaces for exercise. Equally important is training primary care physicians to proactively identify and manage metabolic risks before they escalate into severe conditions.
How can India tackle obesity at its root? Can a mother’s diet during pregnancy influence her child’s future risk of obesity and metabolic diseases?
Obesity prevention must begin early, right from pregnancy. Maternal nutrition plays a crucial role in developing a child’s metabolic health. Poor maternal diet can lead a child to have obesity and related metabolic disorders in future. Therefore, early interventions should not only target individuals but also focus on prenatal care, childhood nutrition, and lifelong healthy habits. Strengthening education around maternal health, promoting breastfeeding, and encouraging balanced diets in early childhood can significantly reduce future obesity risks.
What are the biggest misconceptions about obesity, and how do they prevent people from seeking timely treatment?
A major challenge in tackling obesity is the stigma surrounding it. Many perceive obesity as a result of poor lifestyle choices and subject individuals to harsh judgment, making them hesitant to seek medical help. When someone is obese, instead of receiving understanding, they are blamed for their condition, reinforcing guilt and discouraging them from seeking the medical attention they need.
But the truth is that it is a complex medical condition caused by several genetic, hormonal, and environmental factors contributing to a surge of other metabolic diseases like diabetes, non-alcoholic fatty liver disease (NAFLD), and cardiovascular diseases. Another major misconception is that bariatric surgery is merely a cosmetic procedure, when in fact, it is a scientifically backed, medically necessary intervention for severe obesity and metabolic disorders. Robotic-assisted bariatric surgery with advanced technologies like the da Vinci has revolutionized obesity treatment, offering greater precision, faster recovery, and better patient outcomes. Bariatric surgery can dissolve NAFLD in the majority of patients with up to 90% and substantially reduces their risk of developing heart disease by almost 70%.
What lifestyle changes and medical interventions are most effective for preventing and managing obesity?
Lifestyle changes that can be implemented in this regard include a balanced diet, regular exercise, and stress management, which is needed for proactive obesity management. However, for individuals with severe obesity or metabolic disorders, lifestyle changes alone may not suffice. Medical interventions, including bariatric surgery, provide effective long-term solutions. I have been doing such surgeries by using advanced da Vinci robotic technology for many years, and from my experience I can say that it enhances surgical outcomes, reduces complications, and fastens recovery. I believe that it is one of the preferred approaches in treating complex cases with severe obesity and associated conditions like diabetes. However, the best outcomes arise from a combination of lifestyle modifications and appropriate medical interventions tailored to each individual’s needs.
PM Modi recently initiated a challenge to broaden India’s fight against obesity. What are your thoughts on the same?
I strongly support Prime Minister Narendra Modi’s initiative to raise awareness about obesity and unhealthy eating habits. As obesity is a growing public health crisis in India, this campaign has the potential to reach millions and drive real behavioral change.
From a medical standpoint, tackling obesity requires a multi-pronged approach—education, lifestyle modification, and policy support. Many people underestimate the health risks associated with excessive consumption of oil, sugar, and processed foods. A nationwide awareness drive, led by influential personalities, can help dispel myths, promote healthier dietary choices, and encourage regular physical activity.
Moreover, obesity-related illnesses place a significant burden on India’s healthcare system. Preventive measures, such as this campaign, can reduce hospitalizations and medical costs, ultimately improving the overall well-being of the population. With strong public participation and policy backing, initiatives like this can pave the way for a healthier and more productive India.
With responses by Dr. Abhishek Katakwar, Consultant Bariatric and Metabolic Surgeon at the Asian Institute of Gastroenterology (AIG) Hospital, Hyderabad
