Growing up in a South Asian household meant having a constant supply of delicious food: rotis, parathas, mithais (sweets), mouth-watering curries, and deep-fried goodness during Ramadan, the month of fasting and reflection. But it also meant hearing older relatives talk about their diabetes and blood pressure and discussing the mountain of medications they had to take every morning and night. In South Asia, non-communicable diseases such as type 2 diabetes, cardiovascular diseases, chronic obstructive airway disease, and cancer, among others, account for 52% of mortality and are estimated to account for 72% of mortality by the year 2030.1 These diseases are often associated with obesity, and, as a result, are known as the co-morbidities of obesity. When compared with other Asians in the United States, South Asians have the highest rates of obesity.2 However, obesity in South Asian populations may look different than what first comes to mind when we think about this medical condition. Obesity seen within South Asian populations have certain features such as a greater accumulation of fat within the abdominal area and excess liver fat.3 Furthermore, South Asians often have higher body fat at a given value of body mass index (BMI) as compared to Caucasian populations.3 All of this has led the World Health Organization to lower the BMI standards for Asian populations such that normal weight is categorized as having a BMI of between 18.5 to 23.0 kg/m2, a moderate risk of obesity as having a BMI of more than 23.0 kg/m2, and a high risk of obesity as having a BMI of greater than 27.5 kg/m2.2 This phenomenon has led researchers to consider a variety of potential contributing factors to the complex disorder, including genetic predispositions, urbanization, and lifestyle habits.
Genetic Influences
One reason for explaining this occurrence is the prevalence of insulin resistance and poor insulin secretion due to damaged beta cells in South Asian populations. Many epidemiologic studies have suggested that this population may have a lower ability to release insulin, a hormone that helps transport glucose from the bloodstream into the cells, allowing it to be used in the body.4(p2) Other factors such as lower muscle mass and a propensity for visceral fat–fat accumulation around the abdominal organs–cause a further disruption in insulin among South Asians.4(p2) Insulin resistance, in combination with the aforementioned considerations, can cause an increase in type 2 diabetes in this population.
Urbanization
Another driver of obesity and the diseases that come with it is the urbanization seen within South Asia. In countries such as Bangladesh, Pakistan, and India, urbanization has been rapidly increasing. In 2023, about 36% of the South Asian population lived in urban areas.5 Urbanization comes with many stressors and challenges for individuals. It leads to imbalanced diets, physical inactivity, and long work hours, among other challenges.1 The introduction of more “Western foods”, such as McDonald’s and KFC, and the availability of these foods at lower prices has also contributed to the prevalence of obesity in South Asia. Furthermore, deep-fried fast foods sold by street vendors often use oils that contain high amounts of saturated fats and trans-fatty acids, and these oils are often heated and reheated causing more trans-fatty acid formation.1 Access to such foods is much more common in urban areas, which has been associated with obesity in South Asian populations, particularly in New Delhi, India.1
Cultural and Lifestyle Factors
Cultural and lifestyle factors are also crucial to consider in understanding the prevalence of obesity in this population, and, thus, finding appropriate interventions. For example, there is a common misconception among certain South Asian communities that “an obese child is a healthy child”, and, as a result, justifies excessive feeding to children when they are younger.1 Furthermore, ghee, a type of butter, is also believed to be advantageous for growth, development, and strength.1 The surplus of food and ghee fed at a younger age can contribute to the prevalence of child obesity in South Asian populations. Traditional South Asian foods are rich in spices, carbohydrates, and fats, and combined with the Western influence of foods being high in sugars and saturated fats has led to a diet low in polyunsaturated fatty acids and fiber.6 High intake of fried snacks and sweets are also common, which when combined with low physical activity and a sedentary lifestyle, are associated with abdominal obesity and high blood pressure, blood glucose, and insulin levels.
Recommendations
Firstly, we should move away from BMI to solely judge obesity as it is not accurate to one’s body composition.
Secondly, lifestyle modifications should be undertaken to combat insulin resistance, low lean body mass, and high visceral fat that is prevalent in South Asian populations. For example, consider using less saturated fats, such as ghee, in curries and eating less refined carbohydrates, such as white rice and rotis. Also, consider eating more fiber, such as lentils, and consuming less salt and sweets. Think about incorporating physical exercise into your daily routine. The American Heart Association recommends getting at least 150 minutes of moderate-intensity aerobic activity and/or 75 minutes of vigorous aerobic activity per week.7 Physical exercise does not have to be done every day. Instead, it can be done every other day or twice a week for an extended amount of time, depending on one’s schedule. Furthermore, muscle-strengthening resistance exercises are also recommended to build muscle and combat visceral obesity and low lean body mass prevalent in South Asian populations. A change in lifestyle and the choices that we make can go a long way in crafting a healthy future for ourselves.
Fried food is often a staple in many households during iftar, the break of the fast. Nevertheless, instead of frying your samosas and pakoras this Ramadan, consider baking them or using an air fryer instead of deep frying. While food often takes center stage during this time, it is important to remember that Ramadan is about more than just the physical aspect of fasting. It is an opportunity for spiritual growth, reflection, and connection, and the focus should not solely be on what we eat, but on the deeper purpose of the month.
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