India's Supersize Kids This World

This programme contains scenes which some viewers may find upsetting.

Think of India as a skinny nation?

Think again.

-Oh, my God.

-This is an 80 waist shorts.

Millions of Indians are now morbidly obese.

I think India is, right now, facing a major health crisis.

In a country experiencing a fast food invasion,

I follow the lives of two boys with the same problem...

I love food. I can't bear not to have food.

..facing very different futures.

This is not a cosmetic surgery from any angle,

this is a life-saving surgery.

The world's got an obesity crisis.

India's got that, plus diabetes and it's on its doorstep now.

CAR HORNS BEEP

I arrived in Mumbai in time for Diwali,

the annual five-day festival of lights.

FIREWORKS BOOM AND CRACKLE

My parents are Indian, and I visit regularly,

but this was a first for me.

Mumbai traffic is bad at the best of times,

but tonight is New Year's Eve, tomorrow is Diwali

and everyone is out doing their last-minute shopping for food,

cos that's what Diwali,

in fact, any Indian festival, is all about - what you're going to eat.

India has many traditions, but the pace of change here is amazing,

especially when it comes to food.

Look at that. That is brand-new,

I've never seen anything like that,

a street food stall in India selling hot dogs and burgers.

The Bulani family became notorious recently

for their eating habits and I've been invited

to join them for their Diwali celebrations.

FIREWORKS BOOM AND CRACKLE

Look how beautiful this is.

Every house has one outside their flat for Diwali.

Hello.

Thank you.

Indian hospitality.

If you go to someone's house, any Indian household,

you will always be offered something to drink

and something to sweeten your mouth as well.

Right. What's this?

Indian burger.

Right, here we go.

Oh, my God.

Oh, that's so tasty. Ooh, it's got a kick.

As they say in India, "It's too good."

A few years ago,

the Bulanis' love of food made international headlines.

This is Sagar Bulani, the family's only son.

When he was seven and weighing 14 stone,

he became one of the youngest kids in the world

to undergo weight-loss surgery.

How old is he here?

Wow. How much does he weigh?

90kgs?

So, where is Sagar now?

-Here.

-Me.

-No.

Yeah.

You are not the same kid! Come.

Oh, my God.

Where are you? Is it really you?

Turn around.

Same eyes. Can you remember that person?

No.

I don't. I forgot him.

You forgot it.

In India, chubby kids are traditionally

viewed as a sign of a family's wealth and they're often

referred to as "healthy", meaning they're not underfed.

-What do you think?

-LAUGHTER

-They're all having a good laugh. Are you embarrassed?

-No.

THEY LAUGH

I've just said, "What did you feed your child?"

She said, "I don't know. I didn't feed him that much."

So I said, "How did he get so fat?"

The god-like surgeon who operated on Sagar is Dr Shashank Shah.

His clinic is in the city of Pune,

three hours' drive from Mumbai.

Much of rural India is desperately poor,

with a third of its population living below the poverty line.

But it's a different story in India's booming cities.

It's incredible how much building work's going on and all

these new office blocks, apartments, hotels - it's coming up so quickly.

Weight-loss surgery is big business here,

and Dr Shah's one of the key players.

One out of every three Indians in urban area would have some grade

of being overweight or obese.

-A third?

-One out of three.

It's a pandemic of obesity, secondary type 2 diabetes,

so it's a pandemic of diabesity.

-And this is a problem with affluent middle-class India, right?

-Yes.

This is not a problem of the poorer...?

No, the rural India is still protected

because India has a diverse problem of under-nutrition in some regions

-and over-nutrition in some.

-Yeah.

Dr Shah's first patient of the day is a 40-year-old woman,

weighing more than 22 stone.

How many times a day do you do this sort of surgery?

Oh, my God, I do it ten times a day.

A day?

Ten times a day, minimum.

Dr Shah is going to perform a gastric sleeve operation.

He's going to, essentially, take away a piece of the stomach,

the curvature of the stomach, to make it smaller.

And by doing that, he's going

to remove the part that produces the hormone that makes her feel hungry.

Now, this is the needle.

So now, this is the thickness of the wall.

-And she's only 40?

-Yes, she's only 40.

She's very young.

Very young.

I'm going into various layers of fat.

-This is all fat?

-Yes.

-And now, I'm inside.

-Wow.

Oh, my God.

What does a high calorie, fatty diet do to us?

It can induce an array of diseases, like diabetes,

high blood pressure, heart disease, kidney disease,

joint destruction, sleep apnoea, infertility.

Almost every organ in the body can be affected by this.

All these problems that you're seeing, the amount of fat,

the fatty liver, the fatty stomach, this is all caused by diet?

All caused by diet, lifestyle and obesity.

And this is a major operation, isn't it?

The risks of any major operations are there,

and more so because all these patients are high risk.

And now, this is a stapling device...

..which is going to suture and cut the stomach at the same time.

And that's the stomach coming away?

Yes.

You just don't think of India as having an obesity problem.

You don't think of it as a fat nation.

India is now a global hub of diabetes and it's purely because of obesity.

'Now that the woman's stomach has been cut in two,

'the surplus half is removed.'

And that is the stomach that you have removed?

That is the stomach which came out.

That's it.

It's...

Out it comes.

'Half of the population in India is under 25 years old,

'and Dr Shah is operating on an increasing number of young people.'

16-year-old girl, who was 140 kilograms.

And this is just one of them, and there are hundreds of them.

These are only a few volunteers.

How have you seen it increase in the last five years?

When I started ten years back, we hardly had one adolescent coming,

but in the last five years, probably 25% of the clinic is becoming

a clinic for adolescent obesity.

Mumbai is the centre of the country's economic revolution.

In the course of a generation,

more than 100 million Indians have been raised out of poverty.

Giant shopping malls have sprung up all over the city.

I visited a shop that caters for the growing middle class.

Look at the size of this shirt. Oh, my God.

That is massive.

How big is that?

The Mukherjee family opened their extra-sized clothing store,

Largely Yours, after being inspired by trips to America.

Obesity is one of the leading problems in the country today,

so I thought it was very important to have a genuine big-sized

garment store in India.

This is the only tape in the country which goes up to 90 inches.

90 in...!

-Yes.

-Nobody can be this big and be alive.

Trust me, we have customers with 80 waists,

so I had to keep ten inches spare.

And you get somebody who's bigger than that.

This platform is thanks to one of our customers who was, like, a 68 waist.

He tried to stand by the platform and, ta-loom, the whole floor went.

There was a big hole inside.

-Look at that shirt.

-SHE LAUGHS

I mean, obviously, nobody's that big?

Oh, yes.

We've sold these. I don't keep anything for show.

Nobody is this big.

Yes. Trust me.

You are... Seriously, you're having me on.

-You have not sold this shirt to somebody.

-We have.

Trust me, we had ten of these.

I thought that was a display thing.

I thought that was, like, part of the promotion.

This is more of a service industry for me,

because I like to serve people who are genuinely in need.

You know, it's more of a profession like a doctor,

where people come and thank you for what you're giving them

because this is just not available outside.

There are young kids nowadays who come to us who are,

like, 60 waist, 68 waist.

So, Indians are getting as fat as Americans?

Absolutely. Absolutely. Trust me.

Americans, the only thing is, they have weight all over the body.

They have big thighs, big shoulders.

Indians, the biggest problem is the tummy.

Are you going to try and lose weight, Mr Mukherjee?

I need to maintain myself! Come on, I'm a brand ambassador! THEY LAUGH

'As well as adopting American-style waistlines,

'Indians are also embracing Western-style consumerism.

'In two years, sales of luxury goods have rocketed by nearly a third

'and the country's new rich spend in one day

'what their grandparents would earn in a month.'

'India is also getting a taste for Western-style fast food.

'Up on the food courts, I met up with 20-year-old Adit Chetty

'and his fellow students.'

Hey, Adit. How are you?

-I'm fine.

-Good to meet you. Anita. Nice to meet you.

-And these are your buddies?

-Yeah, these are my friends.

Hey, how are you?

-So, this is your hang-out, is it?

-ALL:

-Yeah.

The mall?

Why do you come here?

Because this is one place where we get everything - cinema, eat.

This is the place where you can chat along,

so this is our second home for us.

So, how much do you weigh?

126.

126 kilos? Wow!

Wow!

-Your weight, for you is not an issue?

-No, not at all.

-Not at all?

-Not at all.

-Why is that?

-Because I like the way I am.

We don't have any issues. We love him like that.

You love him...just as he is.

He's a teddy bear.

'All things that other kids, I also can do. So I don't think 126...

'It's just a number, for me.'

Right. Of all these places you want to eat, where are we going?

-McDonald's.

-McDonald's?

Why wouldn't you go for Indian food?

Basically, Indian food we regularly eat at our homes and we love

eating McDonald's burger, especially that fish one - Filet-O-Fish.

-It's yummy.

-How many can you eat at once?

I can go up to six.

-Six?

-Yeah.

-In one sitting?

-Yeah.

-Right. You know what you want.

The average cost of a fast-food meal is around £3.50.

This, in a country where two-thirds of the population

lives on less than £2 a day.

What have you ordered? Two Filet-O-Fish.

Yeah, two Filet-O-Fish.

-Yeah?

-And medium fries for all of us.

How old were you when you first started eating McDonald's?

Somewhere around ten.

-Ten years old?

-Yeah.

So, you've been eating McDonald's for ten years?

That tag line, "I'm Lovin' It."

That's perfectly suiting me, I'm loving it.

So, you have no desire to lose any weight, then?

-No.

-Are you not concerned about your health?

I'm concerned about my health, but I don't think my health,

right now, is at something... adverse effect or as such.

I think I'm good at the moment.

Is this a snack, or is this lunch, or is this...?

-What would it be?

-It's a munch.

-It's a munch?

-A munch.

'Adit's family is part of the new middle class,

'who moved to Mumbai from rural India.'

Hello. How are you?

'His dad's an accountant and his mum, Sujata, is a teacher.'

-Adit's mum?

-Yeah.

-Pleased to meet you.

Join us, have a seat. Have a seat.

-I know that Adit is your only son.

-Yeah, he is my only son.

And you dote on him? You love him very much?

Yes, yes.

Does he get whatever he wants?

Yeah, almost.

-Almost he gets.

-Yeah?

Do you think he should lose weight?

Yes, yes, yes.

Now once, at least one-and-a-half year more,

for him to finish his education.

After that, I'm going to be very strict in that.

But because he doesn't get time, you see, by the time he gets home...

Even if gets back 7:00, 7:15,

7:30, then he has to have his bath

and all his work by nine o'clock, he has to go to college.

Do you think he wants to lose weight?

I don't think so. Do you feel so? He is so happy with his weight.

After a year, maybe I start reducing weight.

-After a year?

-Yeah.

-You're not going to start right now?

-No.

What if I did this?

And said, "That's it, Adit,

"those two Filet-O-Fishes were your last ever McDonald's?"

Yeah. You'd up and walk, would you?

Then I'd go to Pizza Hut.

McDonald's is over, pizza still remains.

And there you have a 20-year-old who weighs 126 kilograms.

He needs to see a doctor, that's what he needs to do.

I think he needs a wake-up call.

These kids are experiencing a lifestyle revolution.

The previous generation dined out sparingly and children walked

or cycled to school with a packed lunch made by their mothers.

Being rich in a poor country today

means kids are driven everywhere and games are more likely to be

played on a computer than in the street or playground.

The huge pressure on academic achievement,

which is prized above all else, has led to more sedentary lifestyles.

It's no wonder a third of pupils in some private schools are obese

and all of those kids are likely to stay obese into adulthood.

I love food. I just love food. I can't bear not to have food.

Everything to me is tasty, if it tastes good.

I love Lebanese. I like everything.

All the vendors around the school know him, and they ask him,

"Is it the usual?"

Everyone knows what harm it has, but for the taste they say,

"OK. Forget it.

"We can just enjoy and we'll forget about the gain and the inch gain."

'13-year-old Kaleb weighs 109 kilos, around 17 stone,

'and his weight is a serious concern for his mother Dimple.'

Problem with him is he can't control the weight gain

and it's an average of five kilos a month.

-That's a lot.

-That's a lot.

We've tried everything. He's gone to a couple of very well-known dieticians who have

helped Hollywood stars. But he's just a child.

How much can you curb a child on his food habits?

He has to have an active lifestyle,

but because of his weight he can't play a sport.

What's the largest you've been? What the heaviest you've been?

-Right now.

-Right now?

And it's been going up five kilos every month?

-Yes.

-You don't have to lift a finger.

People get into their air-conditioned cars,

their driver takes them to their air-conditioned office,

someone will bring them their lunch. It takes sedentary lifestyle to a whole new lifestyle, doesn't it?

It does. I mean, even if you're a normal middle-class family,

you can afford your cook,

you can afford driver and you can afford servants.

Everything else is done for you.

I have friends that make jokes like,

"I can live without my husband, but I can't live without my maid!"

THEY LAUGH

Hello, Kaleb.

Ah, very nice. Very nice.

There are many underlying reasons why people have eating issues,

and Kaleb experienced tragedy when he was very young.

At the age of four, his father died of a heart attack.

Do you think the death of your husband might have affected him

psychologically, in terms of his eating and his habits?

Definitely, cos when he sees his friends going out on annual trips

with family, he knows the father, mother, sister, sibling setup.

And then he comes home he's like, "Where are we going?"

And the first question is, "It's just the two of us, right?"

So, both of us resorted to eating, taking our food as our best friend.

One day I woke up and said, "No, I have to give him

"a very good life and I need to lead a healthy lifestyle myself."

So, I started shedding off the kilos

and I realised that I had stopped but he hadn't -

he was still taking comfort in what he was eating.

-Are these your buddies?

-No, they tease me lot.

-What do they say?

-You know...

Call me "fat-ass" and all that.

-Fat-ass?

-Yeah.

They see me walking, they laugh and then they call me stuff

and I just ignore them.

They keep on doing it all the time.

How bad did the teasing get?

Well, really bad, like, you know - terms like, "You have manboobs."

And he was very depressed about it.

How does that make you feel?

-Can't be nice?

-I feel really hollow inside, like...

Makes you feel hollow inside?

Yeah.

I don't want to live with such a thing so I want to lose weight,

but then I love food so much.

Yeah.

It could probably drive someone to suicide or, you know,

hurt themselves.

And do you think that's where Kaleb was heading?

I think that's where Kaleb was heading, yes.

Um, he had tried it once...

-To kill himself?

-To kill himself.

Um, we lived on the 13th floor and, um, and...

the window was wide open and he just climbed on it

and he wanted to jump out.

I just held on to him with all my might and pulled him back.

And that's when I realised...

And I went to school in my pyjamas.

I didn't even bother getting ready

because I needed to talk to the principle of who had driven

Kaleb to a point where his life was not important to him.

Keeping Kaleb away from the food he loves is not going to be easy.

The face of India's high street is changing dramatically.

Since KFC arrived in the mid-90s,

all of the major fast-food chains have followed.

As Western markets slow, emerging economies, like India,

offer the best hope for massive expansion.

Chandra Bhushan from the Centre for Science and Environment

is campaigning for tighter controls of the fast-food industry.

Ten years back, you would have not seen this McDonald's

and the KFC here.

How reflective is this of a major city in India, then?

I think it reflects the change that is happening in the culture of the country.

And would you see this Calcutta, in Delhi...?

-Absolutely. You see it everywhere.

-Bangalore?

Even in small towns.

You go to a street in a small town, you will have a McDonald's there.

-The Golden Arches will be there to greet you.

-Absolutely, yeah.

'In the new India, traditional street vendors

'are being crowded out by the fast-food giants.'

The traditional food in this country is very healthy.

This is steamed rice cake.

Then he will give you a nice chutney.

-Mm, it smells amazing.

-And a little bit of vegetables.

-Yep.

-Vegetables and lentils.

Very healthy.

So that is a plate of, what I would describe as,

Indian fast food - we got it pretty quickly.

Ten rupees for something that looks incredibly tasty and it is healthy.

Mm.

Oh. It's got a kick to it.

-It's spicy.

-It's spicy.

-Oh, my God.

-Thank you.

-Thank you very much.

So why, Chandra, would people choose to buy

McDonald's, KFC, Domino's, Subway, and not eat this?

I think the reason is, when these fast-food joints come,

they're massively advertised.

So, from television to newspaper to billboards,

you have glamorous advertisement about these foods.

But there is no-one who is going to advertise about this healthy food.

Yeah.

'Unlike the UK, where fast-food ads are banned from kids' TV,

'in India companies are allowed to market to children.'

Is there no advertising standards agency here?

There is, but it's a voluntary agency.

They do put out guidelines,

but obviously their power to enforce is very poor.

'Chandra's organisation produced India's first ever

'report about fast food.'

'It raised concerns that companies were providing less

'information about their products to Indian consumers

'than to those in the West.'

The industry has grown at a much faster pace than regulation,

and that's why these companies are getting away with this.

'For his report, Chandra analysed a range of fast foods

'bought on the high street.

'He found that the fast food sold in India contained, for example,

'more harmful trans fats than

'similar products for sale in the West.'

The point is very clear.

These companies are not telling Indians what they're eating, OK?

But why do Indians need to be told? It's junk food.

It's junk food is fine, but at least they have to make an informed choice.

Right now, they absolutely don't know that, for example,

this might have a lot of trans fats. They shouldn't be eating it.

So, why are Indians aspiring to this?

Why do they want to want to eat it?

That's what the dream is all about, to have a Western lifestyle,

to...to...

When you pick up a burger, and when a kid is given this burger

it's about living the life of a Western kid.

OK, so this is really popular...

'But some of the products designed

'for the Indian market are even more unhealthy.

'For example, McDonald's Spicy Paneer Wrap,

'at a whopping 800 calories,

'contains far more fat than any product they sell in the UK.'

The health cost of this food, as it is being eaten now, is enormous.

We should not be doing the wrong thing that West has already done.

For example, first becoming fat,

then spending a huge amount of money of healthcare.

That's what West has done, that's what UK has done.

That's what America is doing right now.

We have to learn from their mistakes

and devise policies which will work for us.

So, we need to tell people what to eat, we need to put

regulations in place so that these companies are reined in.

Then there has to be a massive education.

A school education is very important.

Kids must be told how bad these foods are.

It's a long battle, it's a hard fight, but we are able to fight it.

Health education in India is limited

and a lack of access to information

means there's very little awareness.

Most young people, like Adit, know that fast food is fattening,

but they seem unaware of the long-term problems of obesity.

I was hoping he might come round to the idea of finding out more.

Adit?

It's Anita.

How are you?

Listen, Adit, if you're up for it, I've made a few phone calls

and there is a doctor in Bombay - a very good doctor -

who is prepared to see you for a check-up.

Are you up for it?

Good. OK.

That's...

Yeah? Brilliant.

Wow. He said yes straight away.

Um, I think that's quite a big step for him.

I don't even think he realises how big it is.

While Adit thinks about his medical,

Kaleb and his mum have a life-changing decision to make.

Over the past 12 months, he's tried dieting and exercise,

but hasn't lost weight.

Dimple is so worried about her son's physical

and psychological condition,

she's gone to see Dr Muffazal Lakdawala,

who's one of Mumbai's top weight-loss surgeons.

Kaleb, basically when we're looking at options,

because you've tried the diet and exercise route,

you do know that you've got a whole load of crap going into your system.

Because you're eating the kind of things, absolutely,

that any dietician would not want you to eat.

-All right?

-That's mostly on weekends.

If we can't do something to reverse this trend

and make you lose weight, and manage to get you

to maintain weight loss, there are surgical options.

'Dr Lakdawala is recommending a gastric band operation,

'which will make Kaleb's stomach smaller.

'Not only will this reduce his weight,

'but it should avoid the onset of diabetes,

'which his family has a history of.'

How are you feeling about it, Kaleb?

-A bit too excited.

-Are you excited?

-Why are you excited?

-I'm nervous.

-I know, how are you feeling, Mum?

-I'm nervous.

-Why are you excited?

-So, I get to become thin, and who wouldn't?

There are advantages to it - I get better friends and, you know...?

-Better friends?

-More friends.

-Yeah, yeah.

Better-looking friends. THEY LAUGH

Add a girl in front of that!

This is life-changing, right now.

This is absolutely, at 13, now your life is about to change.

That's the best part.

Wow.

13 years old, he's going to have a life-changing operation,

and we're going to get to see him go through it.

Diabetes is a disease caused by high blood-sugar levels,

and it can lead to heart disease and strokes.

India has the largest diabetes population in the world,

with more than 50 million sufferers,

and Indians are believed to be more prone to the condition.

Why has India got such a major problem with diabetes and obesity?

Why India in particular?

Er, genetically as Asians

and as Indians we are predisposed to developing type 2 diabetes.

There is something called the thrifty gene theory.

What the thrifty gene basically means is that in years gone back,

when out forefathers didn't have so much to eat, whatever they got,

they used to conserve.

Today, when we have too much more,

we are still conserving what little we do have.

And when you have too much, you conserve more.

And that is leading to a host of diseases

and they're becoming more and more obese.

It's genetics that loads the gun and environment which pulls the trigger.

For India's kids it's an environment that's changing dramatically.

Multinationals are not the only ones cashing in.

Local entrepreneurs are chasing the youth market by repackaging

traditional street food as fast food.

Jumbo King is the city's first domestic chain

and sells a deep-fried potato burger called vada pav.

The franchise has more than 40 outlets already,

and it's millionaire owner Dheeraj Gupta

has plans to open another 250 across the country.

Hello.

-Hi, how are you? Hello.

-Anita.

-Hi, Anita.

-How are you?

-Good, I'm very good.

-Mr Jumbo King.

-Ah, yes.

-What do you sell?

We have this traditional snack, it's the vada pav,

this sells about two millions units in Mumbai everyday.

Not us, the whole, that's how many people.

Two million of these potato burgers.

Those are the combinations, the combos that we have with Pepsi.

-There's the Schezwan Jumbo King right at the end.

-The Chinese one.

-So this is Indian street food?

-Absolutely.

Tell me about this idea then,

why did you decide to open a shop like this

and market it like this and call it Jumbo King?

Jumbo King is entirely inspired by McDonalds.

We realised that Indian food needs to be branded similarly.

So you've basically taken the Western model,

-the western fast food model.

-Yes.

Why would the man on the street come to Jumbo King

and not go to the vada pav guy over the road?

50% of India's population is below 25.

These are the guys who are coming to us...

because there is a feeling of cool to come

and eat at a Jumbo King rather than at one of those.

It's cooler to be here, it's about where you're seen eating vada pav.

Yes.

The Indian fast food market is estimated to be worth £7 billion.

By 2016 it's expected to double

as domestic chains like Jumbo King adopt Western-style marketing.

And you sell fries as well. Oh, it says, "Introducing French Fries."

-Yes.

-So this is a new thing. More carb.

-Oh, yes.

-We're just trying it out.

-Potato with your potato.

Yes.

What made you come up with the name Jumbo King?

My five-year-old daughter, that time she was five years old,

she could remember Jumbo King.

We are like, we have a name that

if a five-year-old child can remember it,

you have a simple name.

-Are we going to see more fast food outlets in India?

-Oh, yes.

Indian or Western?

-Both.

-And what happens when India gets health conscious?

We have a brown bread Jumbo King,

and we're going to come out with a non-fried baked version.

As soon as the customer starts demanding healthier stuff.

We'll be the first to move along with the market.

-So the demand has to be there first?

-Yes.

Hello, Adit.

How are you?

'Adit's agreed to come for a checkup.'

'It will be the first time he's seen a doctor in five years.'

He doesn't think there's a problem, you know.

He doesn't think there's a problem.

-He's very happy.

-I don't think there's any problem.

-You don't think there's a problem?

-No.

I think if I can cut down on my food, it should be good enough.

That's 1.70 centimetres.

That's 56 inches.

Put your feet on the tile.

That's fine. OK. That's 142.2.

-You told me you were 126.

-Yeah.

You've got quite a shocked expression on your face.

Previously I was around 126.

When was that?

When I last weighed.

-A year.

-A year ago.

-Yeah.

So, now you're...

-Almost 20-odd kilos up from last year.

-Yeah, in a year.

Adit weighs more than 22 stone

and Doctor Lakdawala's team will be advising him

on what this means for his health.

...if you've consciously done anything

in the past few years to lose weight?

-Two years back I had joined the gym.

-Right.

-But that was only for three, four months.

-OK.

Anything else that you might have tried?

No, nothing.

The fat percentage that he has is around 44%.

Now for a boy of his age it should be around the 20 mark.

Your ideal body weight should be around 70 to 75 kilos.

He's almost twice this wait.

Medically that fits into a super obese category, OK?

When he was small, younger in his age,

when we met the doctor the doctor said that was just baby fat.

He's in the morbidly obese category.

He's in the fattest group of people on the planet.

The only thing I notice, just walking,

he's got a few marks on the neck.

This is not dirt.

You might keep scrubbing it as much as you want and it will not go away.

This is a precursor for type two diabetes.

I'll tell you right now, we've not done his blood test,

but if you were to do his blood test,

I can better understand on paper that he'll have insulin resistance,

just from seeing these signs.

The doctor believes Adit's so heavy he's beyond dieting or exercise.

His only option now is a costly weight loss operation.

This is not a cosmetic surgery from any angle,

this is life-saving surgery.

This surgery basically gives that ray of hope to people

who are looking at only darkness at the end of the tunnel,

and for morbidly obese people that's what we do.

Doctor, that child there, after doing the surgery,

has not lost so much weight.

He's lost loads. Sujata, are you looking at the same picture as me?

This kid is humongous,

this kid is half his size.

Right now this kind of new culture

that has kicked into India of junk food and everything,

we all know as parents, as doctors, as professionals,

we all know that junk food is bad for your health,

but somehow it's tasty, and that's the biggest problem.

But I had read once in a newspaper,

somewhere abroad in a Western country,

a man used to just have burgers,

he always used to have fast food and he died at the age of 105.

There are freak cases, like that man would probably be a freak case.

But it is not always correct.

If you have this fast food and all, the person will not survive for long.

It's nothing like that. I don't... It's just a misconception.

What do you think, Adit?

I don't know. At the moment I don't know anything. I think...

-Don't look at mum.

-Yeah, don't look at mum. What are you saying.

We will ask mum something else. What would you like?

I don't know what to think.

I wasn't expecting so much weight.

-What were you expecting?

-130, maybe, 120.

-But even 130 is really big.

Yeah.

So even if you were 130, what would you have thought?

"That's OK. That's fine."

No, actually I didn't know that it had

so many problems associated with it.

And so they will arrange another appointment now

-to get his blood test done and everything?

-Yes.

We'll reschedule his blood test and stuff like that,

so at least they're aware of where he stands.

My gut feeling is this kid will come for surgery, not now,

but maybe next three months,

but maybe by the next six months to a year.

If this kid doesn't have surgery he'll come back to me at 180 kilos

five years from now. Diabetic, hypertensive, sleep apnoea,

really unwell.

But he will definitely come.

The chances of him going on to lose this weight, when he's 50 BMI,

is extremely, extremely remote.

Around the world weight loss surgery is controversial,

especially for young people.

It's often seen as treating the symptoms, not the cause,

and doctors can be accused of jumping too quickly to operate,

especially when they charge thousands of pounds.

But shedding weight by conventional means can be hard work.

I joined 16 year old Simarin for a work out.

Her parents are opposed to the idea of surgery.

For me, to come down every week thrice to do this

means I'm very, very, very committed.

-Yes, good.

-Waking up at 5:30 in the morning and coming down here.

-5:30?

Yeah, cos you've to get up, get ready, come down,

warm up a little bit and then we start at 6:30.

What's driving you to want to lose all the weight?

Just the fact that every... I take my weight everyday.

And I'm genuinely a very focused person, so for me, if I am not losing

even a little bit everyday, I get very frazzled and I don't like it.

So just the fact that every time I stand on the weighing scale

I'm losing a little bit everyday, that's what keeps me...

-Keeps you going.

-That's what keeps me going.

Six months ago Simarin weighed over 16 stone.

Since then she's lost more than 15 pounds

after her mum, Poonam, joined her on a diet.

And she's still got about 20, 25 kgs to lose. So, it's a lot to go.

It's a lot to go.

Would you ever consider any alternatives methods

-of losing the weight?

-No way.

I do not, as a lifestyle,

want to teach my children the easy ways to succeed.

That is the kind of thing I want my children to learn -

there is no shortcut to success in life.

You can do it for one thing, what about the rest of your life?

So, I am absolutely anti that.

She has cried and told me, "Mom, do that.

"Don't make me go through all this."

So at times when I used to get very irritated

because I'm not getting enough food or whatever,

I would just be like, "Just finish it off, let's be done with it."

But then she's always been very anti.

At that point it was very hard to understand but now I know.

I've lost so much weight I know I'm much happier doing it this way.

I would never allow her to do...

I'm happy then, she's like this.

But no easy way.

MUSIC: "Gangnam Style" by Psy

Simiran's parents can afford a fitness coach,

a dietician

and a personal Zumba teacher

who visits once a week to give the whole family a work out.

Most kids in India don't have this option,

so they don't have this choice.

But if they do, they certainly don't have parents

who are prepared to go through it with them.

Cos that's what it takes in order to lose weight

in a culture like the Indian food culture.

You need the entire family to change their attitude towards food

and not just the kid.

She has the support of a couple of very wealthy parents

who are able to provide her with the best weight loss treatment

that you can buy.

Including a Zumba teacher come to your house.

-Yes.

-Woo. APPLAUSE

But Simarin is the exception, not the rule.

Medical professionals are bracing themselves

for a massive diabetes surge in the next 20 years,

and estimate the number of sufferers will reach the 100 million mark.

I wanted to know what the food industry thought about

the country's obesity pandemic.

So I visited the National Restaurant Association of India,

a trade body for domestic

and international companies, to meet Riyaaz Amlani.

You're on the verge of an obesity crisis in this country.

One in five kids are overweight.

What I'm trying to get from you is at what point do you accept

that you have a part to play in it

and that you need to be responsible for what's going on.

We're definitely not a bunch of, you know,

people who sit in boardrooms going, "How can we take over the world?"

We are conscientious,

we do feel about our customers and we do feel that

we contribute positively to society in many ways,

and we take a lot of pride in that.

Sure, but do you accept your responsibility

and your part to play in it?

-Absolutely.

-If you say yes, what are you doing about it in that case?

Look, we do have, in all the restaurants,

we make it a point to have healthy options.

-Like what?

-We have salads, we have grilled stuff.

We have low carb stuff, stuff with low salt.

But when we actually go out there we provide these healthy options,

we find that when people are ordering at restaurants,

it's not what they want.

When customers start demanding...

healthy food,

restaurants will have no choice but to give them healthy food.

If customers demand unhealthy food,

restaurateurs will have no choice but to give them what they want.

-It's just the way it is.

-Yeah.

And that's something we need to understand.

We are one revolution behind the Western world.

You're comparing it to the West,

and I would describe India, in terms of its fast food, as the Wild West.

In the UK you get access to nutritional information.

It's transparent,

you're not allowed to advertise aggressively towards children.

You cannot open a restaurant,

a fast food joint within 400 metres of a school.

-Let me ask you a question.

-Yeah.

Now, let's just say that I take all this information

and I put it up on a website.

You think that's going to stop people from eating the product?

But I just want to know what responsibility you will take.

You are a powerful body, a lot of people have signed up to you,

including all the big international brands,

you could implement change at least within your own group.

Honestly, this has not been an issue which has been top of my,

you know, the Indian restaurateurs consciousness, really,

to be honest with you.

It's not been something which is top of my...

But, yeah, there is merit in what you're saying.

There should be more transparency on what we put out there.

There should be more responsibility and we'll start looking into that.

I'm quite shocked that you said it's not been an issue.

Are you saying there's no discussions being taken place

about nutrition and health generally amongst your body?

It is not a burning issue, let's just put it that way.

It's not something that we talk about all the time.

If there's not going to be a demand for a product,

what is the point of selling it if nobody is going to buy it?

It's quarter past five in the morning.

It's the morning of the surgery

for Kaleb.

And...

I'm feeling a little nervous for him,

so goodness knows how he's feeling.

I'm going to get ready and go round to his house

and go down to the hospital with both of them.

-Morning, Dimple.

-Morning.

-How are you?

-Good, how are you?

-Yeah, very well, thank you.

I told my mum.

She was absolutely shocked that I'm going through with the surgery.

But I mean, she's like, "You're the mum, you decide.

"You take that call."

It's a big decision to put your child through.

I thought for something else that I've not tried yet

and that probably might work.

He's my entire world, and he's in your hands.

So how busy is it today? Have you got lots of surgeries lined up?

We do about five or six a day, and that's when we're exhausted.

At one point we have 200 kgs coming in and 190 kgs coming in,

and you have four of five of those, it's exhausting.

India is a developing nation,

and they are all the multinationals coming into India at the moment.

It's a growing economy.

But the side effects to it,

all these fast foods are going to be this.

So the government needs to take a stand and say, "No more in schools.

"No more below this age group."

It will come when they realise the magnitude of the whole problem.

Kaleb's having a gastric band fitted

which will reduce the size of his stomach.

It's a serious operation

but less drastic than the gastric sleeve operation I saw before.

Why would you not give him the sleeve?

Because he has to still grow.

I don't want to remove a part of the stomach

-which contains the ghrelin hormone.

-Right.

And how many 13-year-olds have you done?

This is the first.

I'm very, very reluctant when I have to operate on kids.

I try not to.

You've got more 13-year-olds having these kind of problems

than the adults.

And just imagine that you have a whole population of people

becoming diabetic by that time.

We should prevent this kind of growing menace somewhere

and nip it in the bud.

That's your gall bladder.

-And that's where your heart is. Can you see it?

-Oh, wow, yeah.

We're getting a good look inside Kaleb here, aren't we?

This is the fat.

So where is India heading?

If we teach the kids, maybe you'll save the next generation

if not this.

What's that?

I'm just touching that area of fat where it's stuck

and getting rid of that.

Now he's cut away the fat the doctor's ready to fit the band.

-So it's going in now?

-Yeah.

-That's it.

And that's its new home.

Now my endeavour is to pull all this fat down

-and then to put the band around this area.

-Mm-hm.

I'm going to now pass the band across.

So could this be sending out a message that says,

"If you don't want to exercise and diet, this is a quick fix."

No, no, no, no.

It's not a quick fix. It's the only fix that you might need.

And so my advice to most youngsters is, "Don't go down that path."

Just explain where will his food go now then,

which part of the stomach will it go into.

This is the food pipe.

The food will come here, this is a pouch

which will then hold the food back.

So basically you will only be able to consume

-a tiny amount of food at a time.

-Yep.

And because he's having this surgery now at such a young age,

-is this going to help prevent him from getting diabetes?

-Yeah.

Hypertension, all the other bits and pieces

that come with being overweight?

As we had heard from him is that his entire family is mostly diabetic.

So with this kid we at least prevent him

from ever going beyond this point.

Hopefully he should lose around 30-odd kilos with this surgery,

and then grab that opportunity with both hands.

Every time I operate on a kid this young

I just wonder, why couldn't he have done something better?

So, perfect. It's gone perfect.

Wow.

-I'm a little bit...

-Of course.

-He's fine?

-He's absolutely fine.

All of a sudden it's just dawned on me that he's a 13-year-old kid.

He's having major gastric surgery

that should only be done on adults really who have had...

a life of living really badly. He's 13.

Wake up, wake up, wake up.

Wake up, wake up, wake up.

Come on.

Give me your bright smile, baby.

Open up your eyes, Kaleb.

I'm sure this is going to be a very positive thing.

From now on he's...

He's going to be...

It's going to be a life-changing thing, so...

No regrets.

I hadn't seen Adit since his checkup

and I wanted to know about his test results.

But it seems he hadn't even turned up for his follow-up appointment.

But it's only a blood test, Adit, like, it would take...

like ten minutes to do and then you get the results within a day.

But, Adit, what is more important than your health?

What about all the things that the doctor was saying?

You don't think there's any urgency?

I'll speak to you later.

You can rest now. OK. OK. Bye.

Wow.

OK, that is a kid who's just gone home and put his head in the sand.

He says he doesn't want the blood test

because it's going to disrupt his studies

and he's got exams going on at the moment.

I just think it's nonsense.

I just think he doesn't want to have to deal with it.

PHONE RINGS

Oh, it's Adit.

Just calling back.

Hey, Adit.

Hey. Hello. Hello, Sujata.

MOUTHS: His mum.

So you're not interested in what the doctor has to say?

You're not interested.

What about all the stuff he was saying about his diabetes,

the marks on his neck, hypertension, high blood pressure, cholesterol?

You think he said all that to make money.

I'm not hassling you, Sujata, and I don't, lis...

MOUTHS: Wow.

OK. Thank you. Bye-bye.

Wow.

Right, she was absolutely fuming and irate, and she ended

the phone call by saying that,

"I will tell the world that I'm happy with my son's fatness

"and I know what's best for him and I'll do what I want."

And they have no intention of having a blood test or going

back to see the doctor.

We can't argue with that, it's his mum.

I was on my way round to see Kaleb the day after his surgery.

He was already back home, less than ten hours after the operation.

Hey, Dimple.

Hi, come on in.

-How are you?

-Good.

-There we go. Some flowers.

-Thank you.

-This is my dad.

-Pleased to meet you, how are you?

Hey, Kaleb.

How are you feeling, Kaleb?

Fine. A little bit sore?

You want to show Anita how it looks.

Shall we see.

And how are you feeling?

When I walk it hurts.

-You've got a little bell there.

-What's the bell for?

-To call me.

-That's brilliant.

Are you feeling hungry?

No.

Stomach's hurting.

-But you're not feeling hungry?

-No.

It takes me half an hour to finish this much of food.

-Half an hour?

-Yeah.

But you're not thinking about food though, are you?

It's the last thing on my mind.

So your bronchitis will improve.

Your sugar levels with improve.

It also means that you won't have more problems further down the line.

-Yeah.

-And he's not looking at diabetes for ever.

That's gone, ever.

So that's wow, that's amazing.

Dimple had kept Kaleb's operation a secret from her father.

Dimple actually hasn't told her dad that Kaleb's had the surgery

and she's going to tell him right now.

I don't know how he's going to react.

Where they come from, this is not a typical thing to do.

This is not something that you would want to consider.

Don't cry.

Kaleb is...

the apple of their eyes.

This is the reason I didn't tell him.

You want to see me thin?

Thin. Yeah.

Papa, this is going to be very, very good for Kaleb.

This will work. This will work.

It's an exciting time for those of use who know and love India.

Many of the country's deep-seated problems

shows signs of finally being tackled.

But there is a downsize to the rapid economic development.

India's obesity crisis means that

the same generation that's benefiting from the new wealth

is also facing an increased risk of diabetes and heart disease.

I hope that the operation will mean a better future for Kaleb at least.

Has there been any weight loss?

-I only know it's been a few days.

-Yeah, six kgs.

Six kilos!

-That's incredible.

-I know.

If in five days I lose six kgs then I'm on my highway.

-Express way.

-You are on the express way.

-I mean, this is about lifestyle now, isn't it?

-Yeah.

I think I am getting to the lifestyle already.

-Already?

-Yeah.

Well, Dimple's dealt with her son's issue

and the only way she knew how by going to the doctors,

and yes, she's probably prevented him from having

cardiovascular problems, diabetes,

but India has a huge crisis on its hands with obesity

and diabetes and they need to wake up to it.

The authorities in India have been slow to recognise

the health risks of a fast food revolution.

At the moment, economic growth and tax revenues from the food industry

are more important than regulation.

Change will probably only come as it has become to in the West

when the problem becomes so widespread in India

that it can no longer be ignored.

Subtitles by Red Bee Media Ltd