Perception, environmental determinants, and health complications of excess weight in India: a mixed methods approach

In light of the high and rising prevalence of obesity, we studied females and males aged 25–54 years with excess weight in the Kolkata metropolitan region, one of India's main cities, to understand the perception, environmental determinants and health complications of obesity. We resorted to primary fieldwork. The close-ended quantitative survey questionnaire was designed to capture the perception and health complications of the sampled population, while a semi-structured interview guide comprising open-ended questions was prepared to capture the target population’s in-depth views. Following the WHO guidelines on BMI and WC cut-off for Asian adults, the sampled population comprised females and males aged 25–54 with a waist circumference of 80 cm and 90 cm or higher, respectively, and a BMI of 25 or higher in the Kolkata metropolitan area. Using a concurrent mixed methods approach, we collected and analysed quantitative and qualitative data separately using descriptive statistics and inductive coding before combining them. In the study area, we completed 120 surveys and 18 in-depth interviews. Some environmental factors promoting obesity were the lack of access to healthy, fresh foods, lack of health awareness programmes, advertisements, and weather conditions in Kolkata. Interview participants also extended their concerns about food adulteration and the food industry. Participants confirmed that obesity could increase the risk of developing diabetes, hypertension, cholesterol and heart disease. Further, participants felt squatting was challenging for them. Hypertension was the most common existing health complication found among the study participants. Participants suggested raising awareness, promoting and making access to healthy food and wellness programs more accessible, and regulating fast foods and sugary beverages at institutional, community and social/public policy levels to prevent obesity. Health education and better policies are required to combat obesity and related complications.