India has the world's largest vegetarian population, with 40% of the country adhering to vegetarian diets. While many believe a vegetarian diet is generally healthier than a non-vegetarian diet, the reverse has been observed when it comes to morbid obesity.
The main reason for this is a 'nutrition transition', which involves whole plant foods being replaced by processed and fried foods, as well as refined carbohydrates.
Eating your greens…and a whole lot more
Based on this, bariatric surgeon Sanjay Borude conducted a retrospective cohort study — the first to evaluate morbid obesity culminating in bariatric surgery — to assess the association between a vegetarian diet and the incidence of morbid obesity that would necessitate bariatric surgery in Indians.
He analysed the records of 235 Indian patients who had undergone bariatric surgery at his centre for morbid obesity from 2015 to 2017, noting the annual difference between the number of vegetarians and non-vegetarians who had been scheduled for surgery within that period.
While the difference between the number of vegetarians and non-vegetarians who underwent bariatric surgery in 2015 and 2017 was insignificant, there tended to be more vegetarians in both cases.
In 2016, however, there was a significantly higher number of vegetarians than non-vegetarians who underwent bariatric surgery at the centre.
The study also analysed gender-based differences between the vegetarian and non-vegetarian patients, and found that in 2015 and 2016, there were significantly more female vegetarian patients than female non-vegetarian patients who underwent the surgery.
When it came to the male patients, no significant difference was found in the number of vegetarian and non-vegetarian patients throughout the entire study period.
Population paradox
In an earlier study, the phenomenon of a disproportionate rise in metabolic morbidities in South Asia compared to other regions, despite the prevalence of vegetarianism, was termed the 'South Asian Paradox'.
The author cited previous studies conducted in Western countries, which recommended vegetarian diets for weight management and reported that vegetarians had a "lower propensity of comorbidities like heart disease, high blood pressure, diabetes and obesity", in order to juxtapose Western vegetarianism against South Asian / Indian vegetarianism.
He stated: "Vegetarianism in India is unique in many ways. It is usually practised lifelong and spans across multiple generations. Hence, (the) author believes that the analysis of a vegetarian diet with metabolic morbidity in India may yield different findings than similar studies conducted in the West.
"(The) findings show that vegetarian status did not confer any protective effect on the propensity to be morbidly obese and undergo bariatric surgery…contrary to the expected association between vegetarianism and reduced prevalence of morbid obesity as observed in many Western studies."
He further explained that unlike vegans or even vegetarians in the West, Indian vegetarians consume significant amounts of butter, ghee and honey.
At the same time, since vegetarianism in India is usually not practised for political or health-related reasons — but rather, for religious or cultural reasons — Indian vegetarians may consume more unhealthy snacks, eat more frequently, dine at fast food outlets more often, and consume more fried and processed food than non-vegetarian Indians and Western vegetarians.
Additionally, biological differences between Western and Indian vegetarians may also have a part to play in the vast differences in obesity rates among both demographics.
Lastly, non-vegetarians in India do not usually consume red or processed meat. As such, the potential benefits of reducing or eliminating red and / or processed meat intake could mean that non-vegetarians in India are usually healthier than vegetarians, who tend to consume more refined and processed foods.
However, the author acknowledged that "such divergent findings seem difficult to fully explain in a single-centre retrospective analysis".
Vegetarian variance
The study predicted that with more people adopting vegetarianism and a large number of Indians continuing to subsist on vegetarian diets for religious, economic and cultural reasons, bariatric surgeons would be likely to encounter more obese vegetarian patients.
It further said that the idea of vegetarian diets being inherently healthier than non-vegetarian diets was a myth, and that its findings should be used by bariatric surgeons and healthcare policymakers to discourage the consumption of refined and processed foods while promoting more nutritious vegetarian alternatives.
In conclusion, the author wrote: "(The study) provides an opportunity to address the national epidemic of obesity by restraining the marketing and consumption of unhealthy vegetarian foods, especially to a vulnerable population like adolescents.
"Bariatric surgeons must target customised nutrition intervention across different stages of life, so that healthy eating habits are inculcated at an early age. Further, this needs to be emphasised via public health and nutrition interventions at the government, mass media and food industry levels.
"There is an immense potential to further sub-investigate food choices within a dietary pattern that can make or mar the health benefits associated with the vegetarian practice.
"Plans for future research include enhancing data collection to include the variants of vegetarian diets, and taking a closer look at their macronutrient and micronutrient composition. An understanding of these predictors can help target public health messages."
Source: The Journal of Metabolic Surgery and Allied Care
https://doi.org/10.1007/s11695-018-03658-7
"Which Is a Good Diet — Veg or Non-veg? Faith-Based Vegetarianism for Protection From Obesity — a Myth or Actuality?"
Author: Sanjay Borude