India's Junk Food Boom and the Fight Over Who Should Curb It

The report opens with a bariatric surgeon in New Delhi who describes his work as fighting an epidemic driven by junk food. His main procedure is a sleeve gastrectomy, which reduces the size of the stomach. He says he has operated on patients from age 13 to age 74. When he started his practice, he saw perhaps one or two such patients a month. He now sees 15 to 20.

The video then gives the wider picture. Almost one in four Indian adults is considered overweight or obese, and if nothing changes, the country's obesity rate is projected to rise by more than 80% by 2035. The narrator says this is not simply a story of individuals making unhealthy lifestyle choices. Larger economic and social forces, in India and elsewhere, are threatening people's health and prosperity.

The report places the trend in historical context. Famine has marked much of India's history; the Bengal famine of 1943 killed up to 3 million people. Even today, roughly a third of Indian children suffer from stunted growth. Yet over the past three decades obesity has surged, along with cardiovascular disease and diabetes, and the report expects it to get worse.

According to the estimates cited, premature deaths, healthcare costs, and lost productivity linked to an overweight population could exceed $129 billion by 2035, almost 2% of India's GDP.

Pediatrician and health campaigner Dr. Arun Gupta calls this a "double burden of malnutrition." In his framing, malnutrition covers both undernutrition and overnutrition, and India now has a great deal of the latter alongside the former.

Gupta co-authored The Junk Push, a report on how changing food consumption threatens health. He traces the shift to globalization, after which marketing of processed and ultra-processed foods picked up and began to change eating habits. He names a diet built on ultra-processed foods high in sugar, saturated fat, or salt as a major contributor.

The narrator says home-cooked meals are losing ground to empty calories and sugar, and gives figures to back this up:

• Within a decade, India's consumption of breakfast cereals and potato chips more than tripled.
• Confectionery and soda sales doubled.
• Sales of ultra-processed snack foods and sugary drinks grew from $6.2 billion in 2009 to $32 billion in 2022.

India is a large emerging market for Western brands. The report says companies such as Nestlé, Unilever, and Kellanova are seeing sales grow at double-digit rates.

Children are presented as a main target. One child describes birthday parties where Coke and Pepsi are standard. The child lists favorites including Maggi noodles, ramen, Burger King, McDonald's, pasta, chips, burgers, and pizza, and says these foods "taste very delicious."

The narrator describes India's new food economy as a public health dilemma: packaged food and drink companies increasingly shape the diets of 1.4 billion people. One remedy other countries have used is stricter regulation.

Chile is the main example. It bans television advertising of certain foods between 6 a.m. and 10 p.m. and restricts child-targeted imagery in marketing those products. The report says that after these measures, sugary drink sales fell 24%. Total calorie consumption also dropped, as did calories from sugar and from saturated fat.

The video says India has so far relied mostly on companies to regulate themselves in how they present nutritional value, and some argue the result is misleading. One speaker holds up a breakfast cereal package as an example:

• Front of the box: claims of 50% of vitamin D, "rich in vitamin C," no added preservatives, and a prominent "20% protein."
• Back label: 46% of the product is sugar, more than 13 grams, plus stabilizers, colors, and flavors.

The speaker's point is that if a company advertises a product as high in protein, it should equally disclose that it is high in sugar and fat.

The report describes efforts to bring in a stricter system. During 2021 and 2022, Indian authorities consulted health and consumer rights experts and food industry representatives about new front-of-pack labels.

Health and consumer groups pushed for the traffic-light system used in much of Europe, which flags products high in sugar, fat, or salt in red. The authority instead chose a health star rating, which scores a product's overall nutritional value with stars.

Not everyone accepted this. One critic in the video argues that health stars only show whether a food is healthier or less healthy. They never tell people a food is unhealthy. The narrator gives an example: a pack of cookies may contain a lot of sugar, but if the manufacturer adds nuts, it could earn a star for fiber content.

Another voice says that getting regulation right has eluded India, and that something else is also missing. That missing piece is work at the community level with children, parents, and families to build healthier eating habits and sustainable food environments.

Pawan Agarwal runs the Food Future Foundation, a nonprofit that teaches schoolchildren about healthy eating through programs in schools aimed at both students and parents. He stresses preventive strategy, with diet and lifestyle as the entry point. His reasoning is that no government or regulator can reach every citizen at every meal, so "at the end of the day it is about individual choices."

The report notes that nutrition advocacy tied to regulation may conflict with Prime Minister Narendra Modi's strategy of attracting more investment from multinational companies. Health experts fear the burden will end up on individuals, who will have to make healthy choices with little guidance from the government.

One health advocate directly challenges the emphasis on personal choice. In this view, putting the onus on consumers is an industry tactic: the companies say people choose to eat the wrong foods, so the companies are not responsible. The advocate compares this to tobacco, where the argument was that people smoke by choice and not because of marketing. The video then plays an old cigarette commercial: "What cigarette do you smoke, doctor?… Smoke Camels, the cigarette so many doctors enjoy."

The same speaker describes a second tactic, in which industry presents itself as "part of the solution." Companies join policymaking bodies, and the government lets them participate as stakeholders.

The narrator observes that strict regulation and education have pushed smoking rates down around the world. Controls on the food industry may be needed to fight India's rising obesity and the diseases it causes. The New Delhi surgeon lists the conditions he sees: diabetes, hypertension, joint and back pain, varicose veins, gallstones, hernias, cancers, infertility, and chest and heart problems. He says they are putting enormous strain on the economy.

The report ends without settling the debate between regulation and personal responsibility. Its closing line is that a country once marked by too few calories now faces a new battle against too many empty ones.