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Doctors often refer to obesity, diabetes, and heart disease as a ‘cardiometabolic triangle’. Each condition increases the risk of the others
Obesity plays a central role in heart attacks in India because it triggers a cluster of metabolic problems, including diabetes, high blood pressure, and abnormal cholesterol levels. (Getty Images)
Nearly one in four adults in India is obese, while the number of overweight children has reached 41 million, second only to China, according to the latest 2026 data. These startling numbers not only signal a looming health crisis but also point to a dangerous chain reaction that often leads to diabetes and heart disease.
Not only does the obesity-diabetes-heart disease trio pose a dangerous health risk, but the relationship between them is also complex, shaped by lifestyle changes, diet patterns, and urban living in India.
How Obesity Is Becoming A Growing Health Crisis In India
India is witnessing a sharp rise in obesity across age groups, particularly among children and adolescents. According to the World Obesity Atlas 2026, India now ranks second globally in the number of children living with overweight and obesity, with around 41 million children aged 5-19 affected.
Experts warn that this trend is alarming because obesity in childhood increases the risk of chronic diseases much earlier in life. Conditions that were once associated with middle age, such as diabetes, high blood pressure, and heart disease, are now appearing in young adults and even teenagers.
Globally, too, the trend is worrying. Millions of children are already living with obesity, raising the risk of metabolic and cardiovascular diseases later in life.
“There is a lot of concern regarding the increasing incidence of obesity in children and young adults. Major drivers for obesity in these people are high consumption of calorie-dense and processed food, sedentary lifestyle, increased screen time, and reduced outdoor activities. All these, along with irregular sleeping and eating patterns, stress, and food-seeking behaviour to overcome that stress, drive hormonal imbalance and lead to increased fat storage at a young age. Age matters because puberty and adolescence are ‘metabolic amplifiers’: hormonal changes make the body more insulin resistant and promote fat storage if lifestyle is poor. Weight gain in young age tracks strongly into cardiometabolic disease later in life. Conversely, children who stay in a healthy weight range through school years have a much lower lifetime risk of diabetes, hypertension, and heart disease,” said Dr. Hetashvi Gondaliya, Diabetes & Endocrinology, CK Birla Hospitals, Jaipur.
Where Does Heart Disease Actually Begin?
Heart disease rarely begins in the heart alone. Instead, it often starts years earlier with metabolic changes in the body.
Excess body fat, especially fat around the abdomen, triggers a series of harmful processes. These include insulin resistance, inflammation, high cholesterol, and increased blood pressure. Over time, these changes damage blood vessels and lead to the build-up of fatty deposits in arteries.
“Heart disease typically starts silently in childhood or early adulthood as tiny fatty streaks in the artery wall. Over the years, excess calorie intake in the form of simple sugars and fats, obesity, high blood pressure, and smoking turn these streaks into cholesterol-laden plaques called atherosclerosis. This atherosclerosis progresses faster and becomes more unstable in patients with obesity. The heart attack we see in the 30s and 40s is actually the final event of a process that has been evolving quietly for decades, often since school or college days,” explained Gondaliya.
Medical studies show that obesity significantly increases cardiovascular risk. Being overweight can increase the likelihood of heart disease several times due to high blood pressure, abnormal cholesterol levels, and metabolic stress on the heart.
The Deadly Obesity-Diabetes-Heart Disease Triangle
Doctors often refer to obesity, diabetes, and heart disease as a “cardiometabolic triangle.” Each condition increases the risk of the others.
The process usually unfolds like this:
- Excess body fat leads to insulin resistance, a condition where the body cannot effectively use insulin to regulate blood sugar. This eventually results in Type 2 diabetes.
- Once diabetes develops, the risk to the heart increases dramatically. People with diabetes are two to four times more likely to develop coronary artery disease or heart failure than those without diabetes.
- This is why many doctors say obesity is the starting point of the cycle, diabetes is the accelerator, and heart disease is often the outcome.
“Obesity, especially around the waist, which is called visceral obesity, causes insulin resistance. The body needs more insulin to control the same amount of glucose, and, over time, this leads to prediabetes and type 2 diabetes. The same insulin‑resistant state raises blood pressure, worsens cholesterol, and triggers low‑grade inflammation in blood vessels. Diabetes accelerates blockages in the heart, brain, and kidneys. So, obesity is the upstream driver, diabetes is a metabolic complication, and heart disease is the outcome,” pointed out Dr Gondaliya.
Why Is Obesity A Major Driver Of Heart Attacks In India?
India has a unique vulnerability when it comes to metabolic diseases. Research shows that South Asians tend to accumulate higher body fat and abdominal fat even at lower body weights, increasing their risk of diabetes and heart disease.
Urbanisation and lifestyle changes have further worsened the situation. Sedentary work, reduced physical activity, and easy access to calorie-dense foods have created what experts call a “metabolic storm.”
“Obesity plays a central role in heart attacks in India because it triggers a cluster of metabolic problems, including diabetes, high blood pressure, and abnormal cholesterol levels. These conditions together accelerate the process of atherosclerosis, where fatty deposits build up in the arteries supplying the heart. Indians also tend to develop higher abdominal or visceral fat even at lower body weight, which is particularly harmful for heart health. This metabolic vulnerability means obesity often becomes the starting point of a cascade that eventually leads to coronary artery disease and premature heart attacks,” said Dr Anjan Siotia, Director of Cardiology, BM Birla Heart Hospital, Jaipur.
Heart disease has already become one of the leading causes of death in India, with it contributing 20% of global heart attack deaths among more than 190 countries.
A recent report by Beat by Beat 2025, released by BM Birla Heart Hospital, reveals that eastern India contributes 30% of the country’s Cardiovascular Disease deaths. One in 10 adults suffers from heart disease. West Bengal, in particular, has a higher prevalence of ischemic heart disease than the national average.
What Is Driving Obesity Among Young People?
Roughly one-fourth of young women and over one-fifth of young men (18-49) in India are overweight or obese. Urban areas see triple the rates of rural regions, driven by sedentary lifestyles, poor diet, and high-stress work. This trend is causing a surge in non-communicable diseases.
Studies show that a large proportion of adolescents do not meet recommended daily exercise levels.
Diet patterns are also changing rapidly. Ultra-processed foods, sugary drinks, and high-calorie snacks are replacing traditional meals. Globally, experts warn that the widespread availability of inexpensive, calorie-dense foods has been a major driver of the obesity epidemic.
Another contributor is screen time. Long hours spent on smartphones, gaming, and streaming have reduced active play among children. Indians, on average, spend 7.4 hours daily on screens, up from 6.9 hours during the Covid-19 pandemic.
Can The Indian Diet Be Blamed For Obesity?
The traditional Indian diet, rich in lentils, vegetables, whole grains, and spices, is not inherently unhealthy. In fact, many nutrition experts consider it balanced and heart-friendly. The problem lies in modern adaptations of the diet.
“The traditional Indian diet by itself is not the main cause of obesity. In fact, many traditional meals are balanced and rich in whole grains, pulses, vegetables, and healthy spices. The problem arises from modern dietary patterns that include refined carbohydrates, fried foods, sugary beverages, and large portion sizes. Combined with a sedentary lifestyle, these changes increase calorie intake while reducing energy expenditure. Urban lifestyles have also reduced home-cooked meals and increased dependence on processed foods. Therefore, it is not the Indian diet itself but the shift away from traditional, balanced eating habits that contributes to obesity,” explained Dr Siotia.
In short, it is not the traditional diet but the modern lifestyle surrounding food that is contributing to obesity.
Does Age Matter?
Age certainly plays a role, but not in the way people might think. Earlier, obesity-related diseases appeared mostly after the age of 40. Today, doctors are seeing Type 2 diabetes and heart disease in people in their 20s and 30s.
Childhood obesity is especially concerning because it exposes the body to metabolic stress for a longer period. Children who are obese are more likely to remain obese as adults, increasing their lifetime risk of diabetes and heart disease.
The encouraging news is that childhood obesity is largely preventable.
“Preventing obesity in children requires early lifestyle habits shaped at home. Parents should encourage regular physical activity, ideally, at least one hour of outdoor play every day. Limiting screen time and ensuring adequate sleep are equally important. Balanced meals with adequate protein, fruits, vegetables, and whole grains should replace frequent consumption of processed snacks, sugary drinks, and fast food. Schools also play an important role by promoting sports and nutrition awareness. When healthy habits are introduced early, children are far more likely to maintain a healthy weight and lower their future risk of diabetes and heart disease,” stressed Dr Siotia.
Three Key Ways To Prevent The Chain Reaction
Doctors say preventing obesity early is the most effective way to stop the domino effect that leads to diabetes and heart disease.
Dr Gondaliya says prioritise healthy foods such as green vegetables, fruits, pulses, nuts and whole grains while cutting back on processed and packaged items, sugary drinks and fried foods. “Aim for at least 45-60 minutes of moderate physical activity daily with a few days of strength training every week. Protect your sleep and stress: 7-9 hours of quality sleep and regular stress‑management activities like garden walks, yoga, and hobbies. These help to stabilize appetite hormones and reduce emotional eating. Doing these consistently in a sustainable way from childhood is far more powerful than any short‑term diet plan.”
Obesity, diabetes, and heart disease are not isolated illnesses. They are deeply connected conditions that form a dangerous chain reaction in the body. The sooner the chain is broken, the healthier the future generation will be.
March 06, 2026, 08:30 IST
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