India's metabolic health is under severe strain, driven by a dramatic shift toward processed foods, increasingly sedentary daily routines, and rising stress levels, according to Dr. Kalapala, Consultant Gastroenterologist and Director of the Centre for Obesity and Metabolic Therapy at Asian Institute of Gastroenterology (AIG Hospitals), Hyderabad. Speaking on Tuesday, 4 August, the specialist warned that obesity must no longer be treated as a standalone condition but recognised as a complex metabolic disease with systemic consequences from head to toe.

The Processed Food Problem

Dr. Kalapala pointed to the dominance of heavily processed foods across both urban and rural Indian markets as a primary driver of the crisis. These products, he noted, are typically high in refined carbohydrates, unhealthy fats, and added sugars — while being critically low in protein.

'The processed food itself will increase cravings because of delayed satiety,' said Dr. Kalapala, who serves as Vice Chair of American Bariatric Endoscopy and is a Fellow of American, European and Japanese Endoscopy Societies. 'Once you consume these foods, which have high carbs, high fats, and that too bad fats with no proteins, this will take a toll on the metabolic health of the body, leading to weight gain, fatty liver, diabetes, and other systemic involvement.'

Fatty Liver: The Silent Threat

A particularly alarming dimension of the crisis, according to Dr. Kalapala, is the silent progression of fatty liver disease. He emphasised that even individuals who are strict vegetarians and abstain from alcohol and tobacco are not immune to metabolic disorders.

'Because of this food change, sedentary lifestyle, and widespread stress, it leads to metabolic changes, mainly fatty liver,' he explained. 'The liver, when it contains fat, remains silent until detected through ultrasound or liver function tests. By the time a person knows, the liver is already damaged.'

This comes amid growing clinical evidence that non-alcoholic fatty liver disease (NAFLD) is rising sharply across South Asia, with India increasingly at the epicentre.

Stress and the Gut-Brain Axis

Dr. Kalapala also highlighted the role of chronic psychological stress in worsening the metabolic outlook. Through the gut-brain axis, stress not only increases appetite and cravings but also actively discourages physical activity — creating a compounding cycle that accelerates weight gain and metabolic dysfunction. 'Stress is something which will precipitate and make people crave more and eat more,' he noted.

Childhood Obesity: The Crisis Starts in the Womb

Citing data from ICMR and the National Family Health Survey, Dr. Kalapala flagged that childhood obesity rates in India have reached between 15 and 18 percent — a figure that underscores the intergenerational nature of the problem.

Crucially, he argued that the roots of childhood obesity often begin before birth. 'If the mother is overweight during pregnancy, the same thing transmits to the fetus, and then the child who is born — from then itself childhood obesity starts,' he said. Children then face compounding pressures: academic stress and a lack of physical infrastructure such as school playgrounds push them into their teenage years already carrying significant metabolic burdens.

As India's processed food market continues to expand and screen time rises across age groups, experts warn that without urgent public health intervention, the metabolic disease burden could overwhelm the healthcare system within a generation.