Kerala’s big fat truth: NFHS-6 shows high obesity levels in men and women

In Kerala, a 'pot belly' has long been considered a prosperity indicator, at least in jest. However, the old 'status symbol' has proven to be a worrying health indicator over time. According to the latest National Family Health Survey-6 (NFHS) for 2023-24, the state now has 46.7% obese adult women, arguably the highest in the country. 

This is significantly higher than the 38.2% in NFHS-5 (2019-21) and the national average of 30.7%. Men too aren't far behind - approximately 37%, and are third in the country after Andhra Pradesh (47.9%) and Tamil Nadu. Adults with a Body Mass Index greater than or equal to 30 kg per sq metre are considered obese according to the World Health Organisation (WHO).

Why Kerala?
Kerala is a state with a high Human Development Index, with higher health indices than other parts of the country. Dr Rashmi H Poojara, Assistant Professor in the Department of Home Science at St Teresa's College, Kochi, says that in this scenario, our access to and availability of food are much higher. “ We mostly consume high-carb, high-fat foods throughout the day. We also have maximum infiltration of global food culture. We wouldn't see so much shawarma-manthi-type food available even in our neighbouring states. Moreover, people now tend to consume those foods more than the traditional, homemade foods."

The frequent eat-out culture is a major culprit here, she explains. "The way a food is prepared also decides how healthy it is. A dosa prepared at home and at a restaurant can have massive differences in terms of the oil and the quality of ingredients used, which can add to the calorie count, eventually resulting in obesity," explains Dr Rashmi.

At the same time, Kerala doesn't have enough free spaces for our women (or men) to walk or exercise regularly, observes former IMA Cochin President Dr Rajeev Jayadevan. "I'm not talking about those who can afford to go to gyms, but about the average Kerala woman who is juggling household work, parenting and profession. Besides, when individuals fail to prioritise their own health, other tasks invariably consume all available time. When that happens every day, the weight piles up, a few grams at a time. Our culture of 'encouraging' new mothers to gain excessive weight and overfeeding them with ghee and other high-calorie foods is not a scientific practice. Women being told to avoid physical exercise after delivery is also to blame for excessive weight gain. A woman's waist circumference shouldn't be above 80 cm," he explains. 

But aren't these scenarios true across the country? Dr Rajeev says, "The food availability factor makes the difference here, as compared to the rest of the country. In Kerala, even the lowest-earning segment isn't deprived of food, which isn't always the case elsewhere."

'Obese' age group
The NFHS-6 doesn't provide an age-wise breakdown of obesity among women in Kerala. However, previous surveys indicate that it is highest among ages 15-49. Dr Mumtaz Ismail, a Kochi-based nutritionist, says she observes it most among adolescents and menopausal women. 

As for women of menopausal age, which is 45 to 60, hormonal changes coupled with a lack of enough activity are to blame, she says. “Their metabolic rate slows down at this time. If they don't increase their physical activity at this stage, they will gain weight. Even osteoporosis can set in," she says. As for adolescent women, one of the main reasons for obesity is PMOS or Polyendocrine Metabolic Ovarian Syndrome, which was formerly known as PCOD or PCOS (Polycystic Ovarian Syndrome), the doctor says. "Their metabolism is often compromised due to low intake of fibre and high intake of saturated fats and sugars," says Dr Mumtaz.

From age 40, women tend to accumulate more fat mass and lose muscle mass, even when they eat less, says Dr Manju P George, Chief Dietitian at VPS Lakeshore Hospital. "Couple this with more white-collar, sedentary jobs our women increasingly do, which do not offer any scope for muscular activities. Abdominal or central obesity often worsens in this scenario. This also adds to the post-pregnancy weight gain in many women, leading to obesity," she explains. While this factor might be true in other places too, Kerala's improved transport facilities take out the scope for any activity during the margins of the day as well, the doctor observes. South Indian women's genetics are also more prone to obesity, she adds.

Risks of obesity in women
Dr Deepak Davidson, Chief Interventional Cardiologist at Caritas Hospital and Heart Institute in Kottayam, said that obesity is associated with many health risks.  “The incidence of heart attacks is higher in the Southern states, in women as well. One reason is genetic makeup, combined with many other factors. Regardless, obesity, triggered by a sedentary lifestyle and poor eating habits, contributes significantly to heart attacks, high blood pressure, and obstructive sleep apnea, which lead to heart diseases, high blood pressure, and heart attacks. Besides, this can lead to diabetes and cholesterol,” he said. “Obese people are more prone to liver diseases as well. In women, one major reason for non-alcoholic fatty liver disease is obesity,” he adds.