The midweek buffet lunch at a fashionable vegetarian restaurant in Bengaluru was delicious but unexceptional until the dessert arrived one table over. It levitated on a cloud of cardamom smoke, hissing loudly: the sizzling chocolate cake, drowning in chocolate syrup, the size of a dinner plate. Actually two. One for each twentysomething computer techie. Both finished the whole thing.

Much of the Indian professional class may be at risk from these muted metabolic timebombs. A traditional Indian fondness for sweets and snacks has combined with rapidly rising incomes for employees in technology, banking and related sectors to enable the buffet stage of gastronomic evolution.

Barry Popkin, a nutrition and population expert at the University of North Carolina, has suggested that after economies improve and famine recedes, patterns of food consumption and physical activity shift in ways that promote the emergence of obesity and its cardiovascular and diabetes complications. Perhaps just as significantly, Indian memories of famines real or threatened during the past century may persist in ways that promote the buffet dining model. Unconscious fear of deprivation prompts the second helping.

In South Asia, type 2 diabetes is developing into an epidemic. Early cardiovascular death and cancer, particularly breast cancer, strongly associates with such metabolic abnormalities. Already about a third of urban South Asians show evidence of metabolic syndrome, a worrisome precursor of type 2 diabetes. In some Indian states, the age-specific prevalence of metabolic syndrome among elderly women is as high as 90%.

Unlike in European-origin or African-origin adults, fat deposition in South Asians, Koreans, Chinese and other Pacific groups of people is not necessarily into the reservoirs we recognise: the big thighs, the rolling gut, the flabby butt, the waggling underarms, but internally and “ectopically” into visceral organs such as the liver, kidneys and heart, where it wreaks tremendous metabolic damage to the whole person. South Asian adults need not reach high body weights to experience the dangerously elevated risks for cardiovascular disease, stroke and diabetes of a much heavier caucasian person. For the wrong individual, a chocolate kiss could literally provide a pre-taste of early death.

Diabetes and premature demise is becoming a hidden cost of development. Broad and obvious measures of increased economic output, disposable income, quality housing, indoor plumbing and reduced infant mortality are laudable but may conceal hidden metabolic dangers.

A newly sedentary lifestyle is a much more serious health issue for the well-fed Bengaluru call centre employee than for their American counterpart. Increased disposable rupees and consumption of calories in India, and parallel changes in other Asia-Pacific countries, take place against evolutionary pressures that have selected for human populations with high-insulin sensitivity and superb ability to store or metabolise glucose rapidly and efficiently after a meal.

This picture of human metabolism in India evolved against a background of starvation combined with rigorous physical activity outdoors. It makes sense that the sudden metabolic imbalance that emerged in South Asia over the past 15 years as economies improved has upset the calorie-activity equilibrium of centuries.

Furthermore, traditional South Indian foods are often cooked in coconut oil or sweetened with palm sugar, which have high concentrations of palmitic acid, an entirely natural substance that has an unfortunate ability to induce insulin resistance in fat cells directly. But because South Indian obesity and diabetes is a relatively new phenomenon, traditional diets must be interacting with recent economic and lifestyle changes. These relationships must be better studied and understood before specific policy recommendations can be formulated.

What can be done now? Fortunately, many Indian cities are investing in development of public parks, more paved sidewalks and green areas for outdoor physical activity, and promoting individual and team-based sports activities.

Schools are taking the initiative to emphasise energy balance and calorie control, while many traditional Indian physical activities such as yoga and dance are enjoying increased popularity. It should be clear by now that as development in the Indian context takes non-western forms, so too should remedies to “diseases of development” innovate along non-western lines.

Given the predisposition of South Asian adults to diabetes at low body weights, these preventive measures are even more urgent to implement in India than in western countries, to avoid the coming trap of westernised disease patterns.

Without serious public health and NGO consideration of these unintended consequences of economic success, children in the newly enriched professional families of South Asia may find themselves coping without parents much earlier than they imagined, and facing a deepening shadow of diabetes and briefer lifespan themselves.

Gerald V Denis is associate professor of pharmacology and medicine at Boston University. Follow @GdenisBoston on Twitter.

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