Indian pot belly: From status symbol to silent killer

The Indian pot belly - once a badge of prosperity, indulgence and aging respectability - has long been a target of satire and social commentary. In literature, it quietly signalled comfort or complacency; in films, it became a shorthand for the lazy official, gluttonous uncle, or a corrupt policeman. Cartoons exaggerated it to mock politicians. In rural settings, it was once considered a status symbol - a sign that "this man eats well". But what was once dismissed or even celebrated is now raising alarm bells. The obesity crisis in India is ballooning - and the seemingly harmless pot belly may be a far bigger villain than we think. India had the second-highest number of overweight or obese adults in 2021, with 180 million affected - behind only China. A new Lancet study warns this number could soar to 450 million by 2050, nearly a third of the country's projected population. Globally, more than half of all adults and a third of children and adolescents are expected to face the same fate. At the heart of this issue in India lies the pot belly, or in medical terms, abdominal obesity. This form of obesity refers to the accumulation of excess fat around the belly and doctors say it's more than a cosmetic concern. As far back as the 1990s, studies showed a clear link between belly fat and chronic conditions like Type 2 diabetes and heart disease.

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Obesity isn't just abdominal. It appears in different patterns, depending on fat distribution: peripheral obesity affects the hips, thighs, and buttocks, while generalised obesity involves fat spread more evenly across the body.

The numbers on abdominal obesity in India are already troubling. According to the latest National Family Health Survey (NFHS-5) - which, for the first time, measured waist and hip sizes - about 40% of women and 12% of men in India have abdominal obesity.

Abdominal obesity, based on Indian guidelines, means a waist over 90cm (35 inches) for men and 80cm (31 inches) for women. Among women aged 30 to 49, nearly one in two already show signs of it. Urban populations were found to be more affected than rural ones, with high waist circumference or waist-to-hip ratios emerging as a key red flag.

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So why is belly fat such a big deal? mmm

One reason is insulin resistance - a condition where the body stops responding properly to insulin, the hormone that helps regulate blood sugar. Abdominal fat disrupts how the body uses insulin, making it harder to control blood sugar.

Studies have found South Asians, including Indians, tend to have more body fat than white Caucasians at the same Body Mass Index. (BMI is a simple measure of body fat based on a person's weight in relation to their height.)

It's not just how much fat you have - it's where it goes. In South Asians, fat tends to collect around the trunk and under the skin, but not always deep in the abdomen as visceral fat.

Though South Asians may have less of the more harmful deep abdominal fat around organs like the liver and pancreas, studies show their larger, less efficient fat cells struggle to store fat under the skin. As a result, excess fat spills into vital organs that regulate metabolism - like the liver and pancreas - raising the risk of diabetes and heart disease.mmm