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India's battle with the bulge.

What happened to my neighbor, SK, typifies to some extent the rise of obesity in India and how slimming clinics are cashing in on it.

A computer-engineering student in Bangalore, he is 23 years old but weighs 115 kilos; a full 25 more than that recommended for his height according to the widely accepted height-weight table suggested by the Life Insurance Corporation of India (LIC accounts for 90% of India's health insurance coverage). Some weeks ago while watching TV, SK suddenly keeled over on the sofa. His chest heaved and his eyes glazed. We rushed him to the local hospital. His blood pressure had shot up to a dangerous 170/110. He was in intensive care for three days. Now he has to take a pink tablet, amlodipine besilate, every day to control his blood pressure.

He said that the weight problem began when he was ten years old. "I just grew fat. I can't seem to reduce. It looks like a hormone problem. I don't eat much fatty foods and I don't touch alcohol." The doctor advised him that medication combined with exercises would help. SK says he hasn't the time to go to a slimming clinic.

His shy sister, NK, has a similar problem. Only 17 years old, she weighs 76 kilos, seven more than what is recommended for her height. "I don't have high blood pressure. But I plan to do some serious slimming next year. My friends say that I would look more beautiful."

Both SK and NK declined to be photographed for this article. Their mother, who has a normal build, said that there was no history of obesity in the family. She was confident her daughter would lose weight. "Girls, especially in our Muslim community, worry they may not get married if they are fat. About my son, I am not so sure. Boys don't bother much about their weight."

It's a view supported by Anita Faria, Marketing Manager of Vandana Luthra's Curls & Curves (VLCC). She looks after the company's southern India and Sri Lanka operations. "More than 60% of our clients are women. Men don't pay as much attention to their bodies; their excuse is lack of time. It was the same with women some years back. They had their husbands, their homes, their children. So, why bother about being trim? But that's changing rapidly. The media and the workplace are motivating today's urban woman towards a good physique." Then, with a laugh, Anita confessed that recently, after watching the perfectly shaped actor Aishwarya Rai in a Bollywood movie, she herself has started spending an hour or so everyday at the gym. "I have a slight bulge," she said, patting her tummy.

Started in 1989 by a Germany trained cosmetologist, Vandana Luthra, with a tiny capital of Rupees 50,000 ($ 1000), VLCC has grown to become the biggest in the slimming and beauty business in India. A staff of 4000 manages more than 100 centers spread over 48 towns and cities. Revenues are in excess of Rupees 3 billion ($66 million).

The slimming market in India, including gyms and food supplement clinics, is estimated to be about Rupees 11 billion ($250 million) and growing at 13% yearly to cater to an urban population of about 300 million. Increased incomes in both white and blue collar jobs, aggressive marketing of fast foods, and a proliferation of restaurants and pubs have combined to transform the once weekly custom of eating out, into a daily event for the urban population. In short, bulging pay packets have resulted in bulging waistlines. It's only in recent years that the media has woken up to this phenomenon and created some awareness of the dangers of obesity.

Anita says that VLCC adopted a blend of the franchise route as well as running its own centers to keep pace with the rising demand. "We started franchise operations in mid 2006 in Nepal, Bangladesh and Sri Lanka. In India, we give more emphasis to franchises in towns where we don't have our own centers."

Slimming centers alone are expected to grow at 40 to 50%--a figure supported by a survey conducted by the premier All India Institute of Medical Sciences of New Delhi. The study covered 35,000 people in ten industrial cities of India including Delhi, Bangalore and Ahmedabad. 43% were found to be overweight.

Manoj Khanna, a cosmetic surgeon in Calcutta, stated in a newspaper interview that when he started liposuction about a decade ago he didn't have even one patient in a month. "Now, I have more than two every week. Seven out of 10 are women."

Swaroopa Srinivas, Chief Nutritionist at Sagar Apollo Hospital in Bangalore, concurred by saying that the number of obese patients seeking treatment has gone up by 50% in the last decade. A study in Delhi by AIIMS revealed that 27% of children were overweight with 7% obese. Bangalore's Children Hospital, which earlier saw an obese child only rarely, has three to four obese children coming in every week for consultations.

VLCC's clientele comprises mainly the 30 plus age group some years back but girls as young as 15 years are also enrolling. Bangalore's booming software and call centre industries have contributed to obesity in the young. Much of the staff is straight out of college. They have no qualms about working night shifts. And night shifts mean odd food timings. "You have dinner at 2 in the morning and breakfast in the afternoon. Mostly junk food," says Anita.

Weight reduction packages at VLCC start from Rupees 3750 ($ 85) for a five-kilo loss spread over four sessions and go up to Rupees 150,000 ($ 3300) to cover an entire family for a year. The majority of clients opt for packages that cost less than Rupees 20,000 ($450). "One would presume that only the upper middle class and above can afford our treatments," says Anita. "But that isn't always so. I remember one client who looked like he couldn't afford us. I worked out the rock bottom price of Rupees 15,000 ($330) for a program. I thought he would simply walk away. Imagine my astonishment when he turned to one side, dug into a secret pocket in his trousers and brought out a bundle of notes. He worked as a chauffeur for a business executive."

VLCC has ten centers in Bangalore. "The health industry is a very serious business," says Anita. "Staff, equipment, and products have to be of the highest standards." Individual staff members maintain detailed reports on the progress each assigned client makes. Bedside counseling is done even as the client is undergoing therapy because he or she has to rush off for other appointments.

VLCC also offers its own weight reducing products like fiber rich wheat flour, herbal honey, hunger-diminishing Isabgol, and anti-cellulite cream. A special team goes around doing surprise checks at every center to see if everything is up to the mark. Anita recalled a news report about one self styled slimming clinic which used cooking oil for massage for tummy tuck when in fact an anticellulite cream needed to be used. "Such short cuts can ruin our reputation."

Their center in Koramangala district in southern Bangalore has spacious therapy rooms equipped with advanced machines like the EMS-24, Carpo 02, and Cello Therm for muscle toning and increasing metabolism. Attractive posters about healthy foods and physiological conditions were displayed on every wall. As I prepared to leave, Anita glanced at my ample tummy. "You should do something about that," she quipped.

At the other end of the slimming center spectrum is a fairly new slimming center called Inspirations in Indiranagar, a posh suburb in south Bangalore. The company had released advertisements in The Times of India offering a 12-kilo weight reduction for the cost of a 5-kilo weight reduction--Rupees 2000 ($ 45). Enroll today and get beauty services worth Rupees 1500 free!

The clinic has five centers in Bangalore and one in Kolkata, and employs 400 people. Annual sales are under Rupees 10 million ($ 225,000) "We plan to open more branches and also upgrade much of our equipment," says Dr. Sameera Anand, the Managing Partner. The company's medical expert, Dr. Savita Deshpande, explained how exactly they enroll a client. "We check the client's present condition, medical history and the usual things like height, age, weight and fat composition. Then we customize a package of machine therapy, diet, massage, and exercise. We also do psychological counseling where necessary. We don't take on pregnant women and people who have serious heart problems, pacemakers, artificial valves or major metal implants."

A compact machine with a digital display stood in one corner of Dr. Savita's room. "That's the body fat composition analyzer," she said. "You have to stand on it barefoot. A tiny electric current is passed from one foot to the other." As fat retards the flow of electricity, that attribute is used to calculate the fat component in the body mass. In men it should be between 8 and 20% of the body weight, in women between 21 and 30%.

In scientific terms, the body mass index (BMI) is a person's weight divided by his or her height squared. For example, a person with 1.7 meters height and 80 kilos weight will have a BMI of 27.68 (80/1.7x1.7). The National Heart, Lung and Blood Institute of the US considered the BMI range of 18.5-24.9 normal. Those between 25.0 and 29.9 are overweight. A BMI of 30 or more is obese.

But, according to V.K. Bahl, professor of cardiology at All India Institute of Medical Sciences, Indians have a higher fat/weight ratio than people in many other parts of the world. Even the World Health Organization, after a debate in a seminar held in Hong Kong in July 2002, revised the BMI range from 25.0-29.9 to 23.0-26.9 for identifying overweight people in India. So, according to these revised guidelines, an Indian with a BMI of 27 or above is considered obese.

Dr. Savita subscribed to the view that men are generally not bothered about their physical fitness. 80% of Inspiration's 7000 clients in Bangalore are women. Clients range from 18 to 50 years, most of them using a package between six and ten thousand Rupees ($ 135 - $ 225). "Very few of my clients are over 50. Perhaps they become philosophical at that age."

Simply put, obesity is a result of low metabolism, where the calories ingested are higher than the calories used up--the unused calories tend to accumulate as fat. Obesity can also result from hereditary, physiological, psychological, and endocrinal factors. For instance, in hypothyroidism (inadequate production of the thyroxin hormone), a person puts on weight even if he eats less. Increase in stress levels can also reduce metabolism. But the biggest factor for obesity in India is erratic eating habits and fat rich foods. "The obese belong to the upper middle class and above because they are assured of the basic requisites of living--food, shelter, and job," said Dr. Savita. "They tend to splurge on foods outside the home. In cities like Bangalore, even if there are ten restaurants located on one road, one more new restaurant is assured of steady business right away."

As far back as 1998 a study done by the Nutrition Foundation of India in association with the Indian Council of Medical Research, the Heart Foundation of India, and the National Institute of Nutrition found that nearly a third of males and more than half the females from upper middle class had a BMI of more than 25.

"There's no need to stick to the traditional three meals a day," advises Dr. Savita. "Have them four or even five times a day. But make those meals smaller and healthier. That combined with regular exercise can help you maintain a good metabolic rate."

Shameer, a tall and handsome physiotherapist from Calicut, has been with Inspirations for nearly a year. He has been involved in treating more than 500 obese clients. "Losing weight is tough in the beginning," he says. "It's like removing several bricks from a pile that has accumulated for years But once you lose a good portion of those excess bricks, it's easy to maintain the reduced weight. Only you have to be disciplined about your diet and exercise."

At both VLCC and Inspirations I fond it difficult to talk to clients; almost all shied away when I approached them. But 25-year-old Shilpa Murali, a customer support executive in a software company, agreed to share her experience. She had just finished her third session in a 10 kg reduction program. "I have lost 900 grams so far," she said. "I feel lighter and stronger."

Shilpa is married and has a 4-year-old son but was motivated to reduce her weight because 'looks are important in today's society.' Also, she was conscious that overweight could lead to heart problems. Her diet now consists of chapattis (Indian bread), vegetables, rice in the afternoons only, and chicken once a week. "No sweets. I loved them when I was young." She took out a picture from her wallet and showed it to me. A pretty and slim girl, about half the size of the woman sitting before me, smiled in the photograph. "That was before marriage. I want to look like that."

Weight loss through Homeopathy

Homeopathy--from the Greek words homoios (similar) and pathos (suffering) -is an alternative system of medicine that attempts to treat 'like with like.' The system involves treating the sick with extremely diluted agents that in undiluted doses produce similar symptoms of the illness in the healthy. Propounded by the German physician Christian Friedrich Samuel Hahnemann (1755-1843), the system is popular in Europe and India, but hasn't found much acceptance in America.

Dr. Batra's Positive Health Clinic Pvt. Ltd. claims in a TV commercial to be the largest chain of homeopathy clinics in the world. Started in 1996 by Dr. Mukesh Batra, the company has 51 clinics all over India with over 275 doctors and has treated more than a quarter million patients so far. The company plans to open branches in Dubai and UAE.

Uday Davda, Business Manager, said that about 12% of their patients have enrolled for weight loss. "We offer an annual medical plan for just Rupees 6900 ($ 155) for any ailment--be it diabetes, hair loss or obesity." About obesity, he claims that Dr. Batra's system emphasizes the underlying medical condition rather than the cosmetic.

"We go to the root of the problem. When a patient approaches us, we ask all kinds of questions to determine what kind of constitution he has because every individual is different. Then we customize a package of medicine, diet and exercise." The medicines prescribed are Calcare Carb (for the laid back individual), Graphites (for the shy and the timid), and Natrumual 6x (for the active). Each of these medicines has a different principal ingredient -minerals in Calcare Carb, carbon in Grahphites, and common salt in Natrumual 6x "The greatest advantage of our medicines is that there are absolutely no side effects."

Ramesh Avadhani is a freelance writer based in Bangalore, India. He has a background in marketing and journalism, and has had over fifty articles published in India, the United States, Europe, the United Arab Emirates and Australia. Some of the diverse publications that have featured his work include Living Now, Dragonfire, Citizen Culture, Reptiles magazine, Gastronomica and Woman this Month.
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Title Annotation:CULTURE
Author:Avadhani, Ramesh
Publication:World and I
Geographic Code:9INDI
Date:Jun 1, 2010
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