Exporting America’s Diet: A Peek Into South Asia’s Growing Diabetes Problem

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A recent NY Times article discussed the ‘volcano of diabetes’ upon which India is sitting. The cause? A population predisposed to Type 2 diabetes, that has increasing access to America’s favorite diabetes-linked consumables such as junk food, fast food, and soda. This is a new and growing problem, but luckily India’s cultural relationship to ‘Western’ Big Food favorites differs greatly from America’s—in India, American fast food exists as a luxury or choice as opposed to a necessity. Combined with the growing awareness of the Indian population’s unique predisposition to diet-related disease, India could pave a different path than we’ve seen in the US, bending the curve in favor of public health sooner and more quickly.

 

The state of the state:

India is facing a growing diabetes problem—familiar news to American ears. The Times reports that since 1990, the percentage of children and adults who are overweight or obese has tripled. By 2040, the International Diabetes Federation projects that the number of Indians with diabetes will soar to 123 million. South Asians are more likely to develop the disease for many reasons, including body type (often referred to as thin-fat), smaller arteries, and a more sedentary lifestyle—a myriad of factors that some chalk up to ‘evolution.’ But that doesn’t mean diabetes is inevitable. Instead, South Asians need to be more mindful of lifestyle factors that lead to increased risk, such as diet and exercise.

Which is why India’s recent influx of Western fast food restaurants and junk food, two of the primary culprits in America’s diabetes epidemic story, is causing waves. Big food companies such as McDonald’s, Coca-Cola, and Domino’s view India as a huge market opportunity, but public health advocates are fighting back—with mixed results. As Ushakant Thakkar, a South Asian Nephrologist from Southern California, put it, “Well-intentioned public health advocates will operate at a slower pace because Big Food has deep pockets. Big Food executives with good intentions get carried away because of their shareholder targets to show performance, and there they find a suitable shelter of ‘feeding the world.’” This David vs. Goliath story is all too familiar to public health leaders in America.

The Times’ piece discusses one man’s fight to ban junk food around schools. This effort is currently stalled in a bureaucratic vortex, highlighting the growing influence of big food on public health policy in India—similar to the US. As Sahil Khanna of New Dehli notes, “One of the biggest issues India faces is the very patchy implementation and execution of the rules and policies already in place.” But at the same time, India has had notable victories, including a proposed a 40% tax on soda. The U.S. soda tax fight has only had a handful of local victories thus far, so perhaps this is an indication of what’s to come in India’s fight to curb the diabetes epidemic—perhaps an accelerated trajectory is possible in India.

 

Why is the ‘diet’ problem different in India?

An Indian woman myself, I turned to several family members who have personal experience with Type 2 diabetes and junk food to understand the dynamics.

 indian street food

  1. India’s love of fast food is not new. Before there was Domino’s, there was (and still is!) ‘vada-pav.’ Major cities in India already have Indian ‘fast food’ staples available on most street corners. Unlike NYC hot dog carts which are rarely frequented by locals, the average Bombay-ite (including me when I visit) will gladly indulge in a fried spicy potato ball smashed between two pieces of white bread, or a host of other street-side fast food options. The entry of Western fast food hasn’t created a new habit, it has only expanded the options for an existing behavior.
  2. The ‘cool’ factor. The cultural role of Western fast food and junk food is different in India than in the US. In the US, fast food and processed food are perceived to be the only option in food deserts and low income communities. In India, fast food restaurants are considered an outing—a place to take your family for a nice meal. This is due in part to the general glorification of all things ‘Western.’ Bansari Thakkar, a South Asian millennial, says, “Going to these Western type restaurants is the ‘cool’ thing to do, no matter how much it costs. Many people complain about 20 rupees ($0.30) for vada-pav, but don’t mind paying 70-80 rupees ($1.25) for a burger at McDonald’s or 200+ rupees ($3.15) for a personal pizza at Dominos.” As a result, India’s fast food habit is much more a social experience than in the US. Rajeev Kakkad of Bombay says, “If you went to a large mall on a weekend, the fast food spots have huge lines, filled mostly with the aspirational crowd.” Sahil Khanna of New Dehli notes “Eating out is a social thing here, and fast food chains with their reasonable prices and standardised meals are looked upon as a safe bet. Customers partaking in it regularly are mostly in the top 10% of the country’s income groups.” Ushakant Thakkar remembers, “When we were young, advertisements for Coca-Cola always featured a very handsome young man. You would think ‘If you eat this food, you’ll look more handsome.’ It’s a similar strategy as the Marlboro man for cigarettes. And in India, I think this strategy is really working.”
  3. But Indian food and flavors still win. While Indian street food is largely unhealthy, classic Indian staples are more balanced and fresh, and in many cases, preferred. According to Rajeev Kakkad, roughly 70% of his office will get the standard Indian meal for lunch at his office cafeteria—including a roti (whole grain tortilla), subzi (vegetables), daal, and rice. The fact that India has such a rich and diverse food culture works to its advantage—people love and embrace the flavors.
  4. South Asians can count on the youth. In addition to the recent NY Times article featuring Rahul Verma’s crusade, school-based education programs and public health initiatives are helping limit unhealthy eating, even in adult populations. Rajeev Kakkad says he has seen a “significant drop in children pestering for junk food, cola, or crackers” due to the education children receive in schools. “Coaching children may have a bigger impact [than taxes or fees],” he says. “For example, one my friends’ sons doesn’t allow his father to have cola and frowns if his father consumes one.”

 

Even though fast food and junk food are growing quickly in India, resulting in increased lifestyle-related disease, the public health fate of India looks to be on a different path than that of the U.S., and hopefully for the better. Most of my family members have already curbed their fast food and junk food consumption based on new knowledge of the link between diet and the onset of Type 2 diabetes and other diet-related diseases. Rajeev, Ushakant, and Bansari all report reducing how much fast food and soda they and their families consume.

The irony of it all is that that while many South Asians glorify Western food, American wellness experts are now highlighting South Asian kitchen staples as the ticket to lifelong health. Turmeric and lentils have recently been categorized as ‘superfoods’  in America, but these ingredients have long made daily appearances in most South Asian homes. I grew up drinking ‘turmeric lattes’ and eating daal. So while some South Asians think that noshing on a burger and fries is ‘cool,’ perhaps they should reconsider. The ingredients for good health—the coolest thing of all—have been sitting in their pantries all along.

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