The health crisis that India has been facing is being simplified as a mere story of unhealthy lifestyle choices: excessive sweets, lack of physical activity, excessive decadence and excess of a food culture. Commonly known Indian sweets such as jalebis, laddoos, and gulab jamun are widely attributed to the increasing incidence of diabetes in the country, a fact that adds to the image with which India is known, the Diabetes Capital of the World. Yet this interpretation is not only superficial, but it is a very perilous reworking of the truth. The actual crisis is not in the traditional diets, which were taken in moderation. Rather, it is within the contemporary food system that corporate lobbying, false advertising, and ineffective regulation enable unhealthy and ultra-processed foods to be promoted as healthy and essential to our daily existence.

The sugar-coated Indian health crisis has ceased to be a lifestyle issue and has transformed into a public health crisis that is systemic now. Urbanisation, economic pressure and altered work patterns have transformed the Indian eating pattern over the last 20 years. The high work hours and less time spent at home preparing meals have led to more dependence on packaged foods that are sold as fast, convenient and healthy. The meals have been gradually overtaken by breakfast cereals, flavoured yoghurts, health drinks, protein bars, fruit juices, and digestive biscuits. These products have been masterfully marketed by food corporations as a representation of the modern lifestyle and advancement, even though most of them are not as nutritious as the ones they are substituting.

One of the most significant instruments that facilitates such a deception is the so-called health halo effect. Some of the words on the pack (low-fat, high-fibre, digestive, immunity-boosting or fortified) trigger an immediate health perception. These claims are usually believed by consumers without doubting the ingredient list or the nutritional panel. On most occasions, when people take the fat out of their food items to attract the health-conscious consumers, they use sugar to replace the taste and texture. Consequently, more marketable products seem to be wholesome on the outside, but once they are eaten, they will act like highly sugary snacks. This deception enables the corporations to market the excess sugar in regular foodstuffs without consumer panic.

It is more threatening when these products are sold to children. Most of the so-called health drinks and cereals that are advertised as growth, intelligence, or energy drinks have between 15 and 20 grams of sugar in a single serving. This is almost equal to or more than what is recommended to be consumed by a child per day of sugar. Emotional trust is strengthened by advertising, and caring parents and successful children are pictured, and there is a subordination between sugar-enriched products and love and responsibility. With age, children become highly sensitive to sweetness, and natural and minimally processed foods become less attractive. This early conditioning makes a person more likely to be dependent on sugary foods and beverages their whole life.

Naming habits also aggravate the situation. Sugar is not often marked as she is just sugar. Instead, manufacturers apply dozens of other names which include maltodextrin, glucose syrup, fructose, invert sugar, corn syrup solids or dextrose. Although all ingredients might seem to have small amounts, when one adds them up, they contribute to a great amount of sugar. To the average consumer, all these labels need advanced nutritional knowledge, which most people do not have. This is not a coincidence; it is a calculated move that enables the firms to technically abide by the laws and still be deceptive to the consumers.

Corporate lobbying is very critical to this system, especially in the discussion of Front-of-Pack Labelling (FoPL) in India. Advocacy groups and experts in the field of public health have advocated the use of simple warning signs; clear red signs to show that there is high content of sugar, salt or fat. The example of countries such as Chile and Mexico demonstrates that these labels decrease the consumption of unhealthy food and stimulate manufacturers to re-formulate the products. But these measures have always been resisted by lobbyists in the food industry who are advocating alternatives like star ratings or systems where there is a guideline daily allowance. These systems necessitate the interpretation and usually make high sugar products seem acceptable or even healthy, watering down the effect of nutritional warnings.

This deception particularly has a dire biological effect on the Indian population. Contrary to the Western stereotype of diabetes as a condition that people get mainly due to obesity, most Indians are afflicted with disorders affecting the metabolism, but they look skinny. This is the so-called TOFI Thin Outside, Fat Inside, where the excess consumption of sugar causes the accumulation of visceral fat around the vital organs. This body fat disrupts the activities of insulin, which causes diabetes even in people who are of normal weight. The condition is not easily identified due to low outward signs, and in some cases, the symptoms are not noted until a significant complication sets in.

The most threatening effects of this trend are the increasing rate of Non-Alcoholic Fatty Liver Disease (NAFLD) among young people in India. Previously related primarily to participants of the middle-aged group, NAFLD is currently observed to be diagnosed at an increasing rate among teenagers and young professionals. The consumption of high-sugar beverages and ultra-processed foods significantly contributes to this condition. NAFLD develops silently and, in most cases, without any manifestation, until it enters its advanced stages. Marketing of the sweet products as healthy is especially dangerous, providing a sense of safety and internal harm is out of control.

The economic impact of this crisis is also of a dreadful nature. Families that have diabetes and related conditions also incur life-long medical bills, which cover the use of drugs and frequent testing and visits to hospitals. To middle-class families, these expenses can subtract from savings and downgrade mobility. At a national level, non-communicable diseases impose pressure on the health systems, decrease productivity, and raise the expenditure on health by the population. However, the corporations that profit from the system of unhealthy food seldom have to cover these expenses, which are shielded by regulatory loopholes and marketing discourses.

Finally, to solve the sugar-related health crisis in India, the concept that the problem can be solved only by individual drive should be changed. Although personal responsibility is important, decisions are made in a food environment that has a strong influence of corporate interests. The genuine solutions require more stringent food laws, labelling, prohibition of deceptive health claims and fighting corporate lobbying which favours the interests of profits over the health of the people. As long as India does not address these structural problems, bad food will be sold as good one, and the crisis of health in the country will only worsen, silently, gradually, and on a colossal scale of human and economic damage.

References:

• World Health Organisation (WHO).
• International Diabetes Federation (IDF).IDF Diabetes Atlas (10th Edition)
• Indian Council of Medical Research (ICMR). (2018)
• Food Safety and Standards Authority of India (FSSAI). (2019).
• Early life origins of insulin resistance and type 2 diabetes in India.
• Journal of Nutrition, 134(1), 205–210.
• Obesity and dyslipidemia in South Asians.
• Sugar-sweetened beverages and cardiometabolic health.
• Journal of the American College of Cardiology,
• World Liver Foundation. (2020).
• Non-Alcoholic Fatty Liver Disease (NAFLD) is a global public health issue.
• Source for NAFLD rise among youth and silent disease progression.
• Hawkes, C. (2016).

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