Book Review: Addressing the Obesity Crisis in ‘Fight With Fat’

Dr Kamal Mahawar’s latest book ‘Fight With Fat’ raises serious questions about India’s obesity crisis.

‘Fight with Fat’ By Dr Kamal Mahawar

(Photo:Dr Kamal Mahawar)

Book: Fight with Fat

Author: Dr. Kamal Mahawar

Obesity receives the opprobrium of popular perception as the disease of excesses. In a country where large numbers live (and die) in abject hunger, the knee-jerk reaction to any talk about its public health implications is a resentful frown upon the affluent section and a righteous dismissal of obesity as a serious and immediate national health concern. No wonder that a public system with a dismal track record in dealing with a scenario of basic deficiencies and lack of everything from food to drugs, comfortably sidelines this so-called problem of excesses as one of secondary importance.

But the numbers testify that this attitude could prove to be an awful gamble. According to a report by the World Economic Forum and the Harvard School of Public Health, India is set to lose 4.5 trillion dollars, double the current Indian economy, to Non-Communicable Diseases (NCD) by 2030 – and two out of its four major culprits, namely cardiovascular diseases and diabetes, owe directly to obesity.

The fact that nearly one-fifth of all adults in India are undernourished doesn’t help that we are, in absolute terms, the third most obese nation on earth.

And the fact that obesity now straddles a large swathe of the middle- and even the lower-middle class and exposes them to catastrophic health expenditures should be enough to, as Immanuel Kant would put it, ‘awaken us from our dogmatic slumber’.

Dr Kamal Mahawar’s ‘Fight with Fat’

It is in this context that Dr. Kamal Mahawar’s book ‘Fight with Fat’ sets out to empower the lay reader and instill a sense of urgency about fighting obesity at the individual level, while clamouring for greater responsiveness from the government and Indian society at large. The book aims to appeal mainly to the general readership and serve as a ready reckoner for the layman on obesity and associated ills.

Mahawar’s work begins with disproving the widely held myth that obesity afflicts only the affluent sedentary section, as he demonstrates how the changed socio-economic milieu affording easy and inexpensive access to junk and processed foods embraces even the commonest of Indians today. A cogent case is made of how the so-called cosmetically displeasing effects of obesity are just the tip of the iceberg, while the damages incurred to nearly every organ system of the body lurk underneath.

Mahawar carefully weaves the role of social and cultural factors into the fabric of the scientific treatise, touching upon areas from nationalism to education in explaining our vulnerability to obesity. In doing so, he ensures a seamless and engrossing synthesis of fascinating ‘larger issues’ of common interest and the otherwise unexciting scientific facts and details.

In his book, Mahawar is assiduous about presenting scientific aspects in as simple and interesting a manner as possible. He gives a perspicuous explanation of the factors and bodily mechanisms involved in the genesis of obesity, along with expert commentaries on such topics as weight management, balanced eating, adequate physical activity, and healthy cooking practices.

What emerges, in short, is a jargon-free guide that can be of great help to anyone wishing to develop their own ‘anti-obesity’ arsenal without impinging on their busy life.

Busting Myths About Diet

Throughout the book, Mahawar also takes on a number of prevailing fallacious notions about obesity. He settles the facts about calorie counting and the counterproductive effects of ‘yo-yo’ dieting; tackles myths about genetic and psychological bases of obesity; warns against the blandishments of magic pills and esoteric cures; and gives unprejudiced opinion on existing modalities of obesity treatment.

The importance of inculcating healthy habits since childhood has been rightly highlighted, and a separate chapter is devoted to childhood obesity.

Mahawar’s emphasis all along on primary prevention being the most important tool in countering obesity and averting its exorbitant cost implications, putting aside his competing interests as a specialist, is highly commendable.

The book also doesn’t shy away from critically attacking our social and political apathy towards obesity in particular, and the state of social services in India in general. Mahawar raises how the negative portrayal of obese persons in the garb of humour creates a stigma difficult to shake off. Without doubt, this is an indictment of a society that proudly speaks against body-shaming. In calling upon greater political responsiveness towards the problem, Mahawar stresses on the importance of publicly recognizing obesity as a disease and suggests a number of measures related to fast food regulation and taxation, transport, school and workplace health, and focus on research and development.

The reader may find the book to meander and digress on certain occasions, especially when the author contemplates broad social underpinnings. At places, the discussion slips into being a full-fledged discourse on India’s socio-cultural backwardness with only remote links to the main plot, vastly based on the author’s opinion, some of which can be contested. However, the author undoubtedly succeeds in stirring up some very important questions we must ask ourselves as a nation – and while a few suggestions on these issues may seem slightly casual, they leave a lot to ponder on.

Overall, the book is a significant addition to the repertoire of knowledge on obesity that is highly accessible to the lay reader. While it will be of immense help to anyone wanting to know and avert this deadly illness, one wishes that the wider concerns expressed in the book reach the upper echelons of our administration and policy-making circle

(Soham D. Bhaduri is Editor, The Indian Practitioner, a healthcare commentator and columnist, and a medical doctor based in Mumbai.)

(The author of the book, Dr. Kamal Mahawar, is a consultant bariatric and general surgeon practising in the United Kingdom. His first book, The Ethical Doctor, was published in 2016 by Harper Collins. )