Why India has so much diabetes
Visceral fat at low BMI, dietary shift, urbanisation, and genetic predisposition: the multi-layered story of why diabetes prevalence in India is the highest per capita in the world.
Per capita, India has more diabetes than the United States. The answer has three layers: genetics, lifestyle, and a fast-changing country.
South Asian genetics
We accumulate visceral fat at lower BMIs than other populations. That fat drives insulin resistance. Indian guidelines use BMI 23 (not 25) as "overweight." Waist circumference matters more than weight: 90cm for men, 80cm for women.
The dietary shift
Traditional Indian diets were heavy in millets, lentils, and seasonal vegetables. In 50 years: white rice and wheat replaced millets, sugar consumption tripled, refined oils replaced ghee in vast amounts, processed snacks became everyday food. Carb load went up. Fibre went down.
Rapid urbanisation
1980: under 25% urban. Today: 35%+ urban and climbing. More sitting, more screens, less walking, more stress, less sleep, more eating out.