India’s MAPPS II Roundtable: Rethinking obesity through policy, people, and multisectoral action

A foundational theme throughout the roundtable was the urgent need to shift how obesity is understood by clinicians, policymakers, communities, and the public, from a lifestyle disorder or personal failing to a recognised chronic, relapsing disease with complex biological, social, and environmental drivers.

Participants noted that fragmented and moralistic framings of obesity continue to shape clinical encounters, policy design, and public discourse in India, with significant consequences for care-seeking behaviour, treatment access, and resource allocation.

"Convincing patients and sometimes colleagues that obesity is a chronic relapsing disease, not a lifestyle choice, is still something we have to do every day in practice. We need to change the narrative of obesity as tied to only diet and exercise"

Dr Brij.M. Makkar, President Elect, All India Association for Advancing Research in Obesity (AIAARO), Chair - IDF Obesity Task Force

Reduced food quality, aggressive marketing of ultra-processed foods, and the growing accessibility of high-calorie, low-nutrient foods were identified as structural drivers of obesity that require regulatory action rather than individual-level responses.

The need for stronger front-of-pack labelling, regulation of food sold in and around schools, and restrictions on digital marketing of unhealthy foods emerged as clear priorities, drawing on international evidence, including India's own experience with sugar-sweetened beverage discussions.

"There should be diversity in foods sold at airports instead of just fast food and packaged foods. I have never seen fresh fruits sold in popular places or malls. If you are surrounded by fast foods and stale foods, you will end up eating that only.”

Sedentary work patterns, long working hours, stress, irregular meal timings, and limited access to healthy food options in workplace settings all contribute to weight gain, particularly among urban working-age adults. 

Stakeholders emphasised the need to include wider departments such as the Ministry of Labour and Employment to develop structured workplace wellness programmes, help increase access to physical activity facilities, and implement employer-level policies that support healthy behaviours.

"Commercial determinants cannot just focus on individual factors like food consumption patterns and physical exercise, or the availability of open spaces. We also need to understand how livelihood, quality of work, and environmental factors impact health and disrupt wellbeing.”

Dr Nitin Kapoor  , Christian Medical College, Vellore, India

Stigma associated with obesity was identified as a pervasive and largely invisible barrier to care. People with lived experience described experiences of being judged, dismissed, or made to feel responsible for their condition within healthcare settings, contributing to delayed help-seeking, disengagement from care, and significant impacts on mental health, confidence, and self-perception. 

Participants called for the integration of stigma-reduction training into healthcare professional education, learning from the HIV response, the development of gender-responsive clinical guidelines that account for different experiences of obesity among women and men, the provision of appropriate mental health support through services for obesity care and the meaningful inclusion of people with lived experience in the design of health programmes and policies.

“Stigma among healthcare professionals regarding obesity is very high, yet it often remains invisible to those delivering care, who may be unaware of their own weight bias. Removing the bias and stigma around obesity must come from all sectors, including the government.”

Dr Purvi Chawla, Consultant Diabetologist, Mumbai, Secretary of IDF Women and Diabetes

Stakeholders emphasised that effective responses must bring together expertise from people living with obesity, behavioural psychology, medical anthropology, nutrition science, urban planning, education, food systems, and social protection, alongside medical and public health professionals, to develop policies and programmes that reflect the full complexity of obesity.

Discussions also highlighted wider environmental barriers to healthy living, including air pollution, unsafe or inaccessible spaces for physical activity, and broader urban design challenges. There was also strong consensus around the value of community-level interventions, particularly in schools and workplaces, as the most promising and convergent sites for prevention.

"Any NCD issue is a multi-sectoral issue, as just the policy makers cannot tackle this alone, many other stakeholders are required. We want to bring together perspectives across health, research, civil society, government and lived experience champions who are amongst us, looking beyond individual policies to how the system is working in practice.”

Participants emphasised that obesity-related action should not be limited to early life alone, but should span preconception, maternal health, childhood, adolescence, adulthood, and healthy ageing, with greater attention to gender-responsive approaches and transitions across the life course.

Several discussions also highlighted the need to better align obesity efforts with wider strategies to reduce fragmentation and improve continuity of care. Experts also called for universal screening across all ages and for progress to be measured not only through weight or BMI, but through outcomes that matter to people’s daily lives and functioning, as well as to health systems.

"We need to stop measuring success by weight and BMI alone, and start asking what truly matters to people. For many people over 50 or living with other conditions, the real fear isn't dying from obesity. It's losing the ability to live well and independently. It's not being able to carry your grandchildren or join in activities that keep you connected to life. We need approaches that are inclusive of who we actually are."

Mr Devang Gandhi, Lived Experience Advocate, Mumbai

The roundtable also highlighted the paradox of food insecurity and obesity co-existing in the same communities, driven by the relative affordability and accessibility of energy-dense, nutrient-poor foods compared to fresh produce.

Any regulatory response, participants noted, must be grounded in equity and avoid disproportionate harm to low-income populations. Recommendations included the prioritisation of at-risk populations such as children and young people through community-based delivery and social support systems as well as the integration of lived experience and youth engagement.

“We must move beyond episodic care and adopt a life course strategy for obesity prevention and management in women. This means aligning policy, healthcare systems, and community action to support women at every stage of life - because healthier women build healthier societies.”

Dr Hema Divakar, Senior Consultant Obstetrician and Gynaecologist and Division Director Well Women Healthcare, International Federation of Obstetrics and Gynaecology