He's fighting on the front lines of an epidemic quietly

sweeping India, driven by a new menace:

junk food.

We reduce the size of the stomach, which is called a sleeve gastrectomy.

We have operated from age of 13 till the age of 74.

Initially, when I joined my practice,

I was seeing maybe one or two patients a month.

Now I am seeing 15 to 20 patients a month.

In India, almost one in four adults is considered overweight or obese.

If nothing changes, the country's obesity rate

is set to increase by more than 80% by 2035.

This is not simply a story of individuals making unhealthy lifestyle choices.

In India, and much of the world, larger economic

and social forces are threatening people's health and prosperity.

Much of India's history has been blighted by famine.

As recently as 1943, the Bengal famine killed up to three million people.

Even now, roughly a third of children suffer from stunted growth.

And yet, over the last three decades, obesity has surged.

And it's set to get worse.

That's been accompanied by a rise

in cardiovascular disease and diabetes.

The economic costs are enormous.

Premature deaths, health care costs

and productivity losses

Premature deaths, health care costs and productivity losses

resulting from an overweight population

are estimated to top

$129 billion by 2035,

are estimated to top

almost 2% of its GDP.

It's a double burden of malnutrition now.

Malnutrition means under and over.

Now we are seeing a lot of overnutrition as well.

Dr. Arun Gupta is a pediatrician and health campaigner.

He is the co-author of The Junk Push,

a report detailing how changing food consumption threatens health.

Since globalization, the marketing of processed and ultra-processed food

has picked up.

That has actually influenced a lot of dietary habits.

One of the major inputs here is unhealthy diet comprising of ultra

ultra-processed foods, high in sugar, high in saturated fat,

or high in salt or sodium.

Throughout the country,

home-cooked meals are losing out to empty calories and sugar.

In the span of a decade,

India's consumption of breakfast cereals and potato chips

have more than tripled,

while confectionary items and soda sales have doubled.

India is a massive emerging market for Western brands.

Sales of ultra-processed snack food and sugary beverages

grew from $6.2 billion in 2009 to $32 billion in 2022.

For companies like Nestlé, Unilever or Kellanova,

sales are growing at double-digit rates.

And who one are of the main targets?

Whenever we go to a party,

suppose a birthday party of one friend, there'll be various

junk food items such as Coke, Pepsi.

I really enjoy Maggi,

and I like noodles and ramen.

Burger King, McDonald's.

Maggi.

Pasta.

Chips.

Burgers.

Pizza.

That is very delicious.

India's new food economy has created a public health conundrum,

with the packaged food and beverages industry increasingly

affecting the diets of 1.4 billion Indians.

One remedy that other countries have turned to is stricter regulation.

Chile, for example, has an advertising ban

on television on certain foods

between 6 a.m. and 10 p.m.

It also has restricted the use of child-targeted imagery

in the marketing of these products.

After these interventions were introduced,

sugary drink sales dropped by 24%,

as well as calorie consumption,

calories from sugar, and calories from saturated fat.

Until now, India has mostly relied on the companies themselves self-regulating

how they convey the nutritional value of their products.

The results, some argue, are misleading.

If you you see the front of the pack, you will see that they claim that

it's like 50% of vitamin D.

Rich in vitamin C, no added preservatives.

And it says very brightly, 20% protein.

But if you look at the back of the label, you find that 46% of it is sugar.

More than 13 grams of sugar.

Stabilizers, colors and flavors.

If you are telling people that it is high in protein,

you very well tell them it is high in sugar and high in fat, also.

Efforts are underway to introduce a more rigorous system.

Throughout 2021 and 2022,

Indian authorities consulted health and consumer rights experts,

and representatives of food companies, about a new labeling system.

While health and consumer rights groups argued for a traffic light system,

used by much of Europe,

which signals red for products

high in sugar, fat or salt,

the eventual conclusion by the authority was for a Health Star Rating,

which assigns star ratings for a product's overall nutritional value.

Not everyone was happy.

Health Stars only point that this food is

either healthy or less healthy.

It doesn't tell people that it is unhealthy.

For example, a pack of cookies may have a very high amount of sugar.

But, if the manufacturers add nuts, it could get awarded a star

for containing fiber.

Getting that regulation right

has been evading us in the country.

So that is one part of the story.

But what we are missing out is

working at community level,

with children, with parents, families

to create an environment for healthy eating

and sustainable food environments.

Pawan Agarwal runs the Food Future Foundation,

a nonprofit that seeks to educate schoolchildren about healthy eating.

The foundation runs programs in schools like this one

in order to educate children and parents.

It is so important to focus on preventive strategy

and use diet and lifestyle as the entry point for this intervention.

Government or any regulatory body cannot reach out to individual citizens

at all mealtimes.

So at the end of the day, this is about individual choices.

While nutrition advocates seek tighter regulation,

that may run at odds with Prime Minister Narendra Modi's

strategy to attract more investment from multinational companies.

The fear among health experts is that the burden will ultimately fall

upon people to make healthy choices on their own,

with little guidance from the government.

One of the tactics they use is putting the onus on the people.

That it is the people who are choosing to eat wrong foods.

It's not us.

Which, probably is one of the strategies

which they have been using for tobacco, also.

That people are smoking by their choice and not because

of the marketing.

What cigarette do you smoke, doctor?

The brand named most was Camel.

Smoke Camels. The cigarette so many doctors enjoy.

The tactic is: industry will become a part of the solution.

They want to be a part of the solution.

They enter into policymaking bodies.

Of course, the government

allows them to do so,

as stakeholders.

Strict regulations and education

have driven down smoking rates across the globe.

Imposing controls on the food industry may be necessary

to fight India's surging obesity rates and the illnesses that it causes.

Diabetes, hypertension, joint pains, back pain, varicose veins, gallbladder stone,

hernia, cancers, infertility, chest problems, heart problems.

It is putting an enormous strain on our economy.

A country once blighted by too few calories,

must face a new battle with too many empty ones.