due to crunched time and ease of availability and few restrictions on access to or availability of junk food. Though urbanisation has led to supportive policies in almost every sector, such as health, agriculture, transport, urban planning, environment, food processing, distribution, and marketing; built environments lead to less physical activity, fewer open markets and farm stands and less outdoor recreational space. Also, technology advancements lead to lesser outdoor play, an increase in time spent watching television and playing computer games, more advertisements, and mass media marketing of junk food and carbonated beverages resulting in poorer diets and high‐calorie food intake (Bahadoran et al. 2016). Even the job sector has seen a surge in jobs of a more sedentary nature (such as manufacturing and desk jobs) and fewer active jobs (such as farming). The effects of this environment have majorly impacted the health of individuals, not only physical health but also intellect, mental development, as well as on physical and emotional structure which has increased the incidence of chronic comorbidities, and become the leading cause of deaths worldwide.
Another major issue regarding urbanisation is associated with climate change. Urbanisation leads to the migration of people from rural places to the cities, which forces rapid, inadequate, and poorly planned expansion of cities. According to World Economic Forum Reports 2015, developing countries account for around two‐thirds of annual greenhouse gas emissions, caused by their economic growth and rapid urbanisation, poor infrastructure, and activities of people (World Heart Federation 2015). These directly affect climate change and increase the potential of natural catastrophes to cause unprecedented damage. Climate change, increasing ambient temperature, carbon‐extensive construction and large generation of greenhouse gases decreases the quality of life in the cities, reduces the conducive environment for physical activity which lays a huge burden on weight management.
Obesity research has highlighted that physical activity levels are declining, and sedentary behaviours increasing, not only in developed countries, such as the United States, but also in low‐ and middle‐income countries, such as India, China, Bangladesh, and UAE (Radwan et al. 2018). The proportion of overweight individuals has seen a considerable spike between the years 1980 and 2020 from 40% to almost 75% in the United States, Canada, England, Spain, Austria, Italy, France, and Korea. According to the World Factbook‐CIA 2016–2020, United States, Jordan, Saudi Arabia are among the top countries with the highest overweight people as a percentage of the total population. India though has a lower percentage of these people as compared to global ranking yet has an alarmingly high number of overweight people increasing every year.
Along with it, dietary changes and nutritional transition of the growth in fast food consumption have been significant worldwide, and affect both developed and less developed societies (Kallio et al. 2015). Lifestyle influenced excessive and life‐threatening accumulation of BF, and the associated risk of obesity with a huge number of cardiometabolic disorders and cancer results in the notable increase in morbid obesity worldwide. Also, the rate of obesity‐associated diseases is increasing in children at the same rate as the adult. If positive changes are not implemented to keep the ill effects of urbanisation in control, 38% of the world's adult population will be overweight and nearly 20% will be obese, by the year 2030 (Hruby and Hu 2015). In the developed countries, with prevalent increasing trends of established urbanisation and no control measures in check, it is estimated that 85% of adults being overweight or obese by 2030. Therefore, it has now become imperative that in urban planning, an environment should be provided taking public health and the risk of obesity into account. This is an urgent necessity considering that metabolic dysregulations, CVD, and cancer facilitated by obesity are the major contributors of mortality worldwide for the last half a century.
2.5.7 Obesity, a Major Risk Factor for Prevalent Cardiometabolic Syndrome
It has been reported that overweight and obesity are the causes of more number of deaths worldwide than underweight. Studies investigating the cause for the increase in frequency of obesity have identified a strong correlation between obesity and urbanisation and also between obesity and physical activity and chronic diseases (Dey and Senapati 2021a). This is so because obesity facilitates the incidence of cardiometabolic syndromes including insulin resistance, dyslipidaemia, and hypertension which together leads to chronic CVD, stroke, some types of cancer, and type II diabetes (Table 2.1). According to WHO, obesity and life‐threatening excessive accumulation of BF is a major requisite risk factor and largest contributor in the aetiology of cardiometabolic syndrome and disorders.
The association of obesity and cardiometabolic syndrome is known to increase the risk of type 2 diabetes mellitus by fivefold and CVD by threefold. The impact of obesity‐linked cardiometabolic risk is so adverse that various present studies aim to establish more specific and optimal cut‐off values for anthropometric indicators of obesity to prevent the burden of healthcare on the economy (Figure 2.8) (Macek et al. 2020).
Figure 2.8 The most prevalent shared risk factors between obesity, cancer, and cardiometabolic syndrome. CMS, cardiometabolic syndrome.
Major obesity complications relate to the pathology of disrupted metabolic homeostasis regulated primarily by several adipokines and cytokines such as leptin, adiponectin, tumour‐necrosis‐factor (TNF)‐α, and interleukin (IL)‐6. Obesity complications disrupt the normal adipose physiology in both men and women differently. It causes non‐alcoholic fatty liver disease (NAFLD) which is the most common chronic liver disorder and many cardiometabolic disorders including high fasting triglycerides; low ‘good’ HDL cholesterol, high levels of C‐reactive protein in the blood, a marker of chronic inflammation and elevated blood pressure. The coexistence of two or more of the cardiometabolic syndromes facilitated by obesity doubles the risk of CVD and heart attack and stroke and increases the risk of diabetes fivefold in a period of 5–10 years (Virani et al. 2020).
The rise of progressive urbanisation and related globalisation of unhealthy, sedentary, and stressful lifestyles result in overweight, which has potential adverse health consequences such as CVD including CHD, atrial fibrillation, venous thromboembolism, and congestive heart failure. The urban setting and fast‐moving face of life in the cities have led to an increasing trend in fast food consumption and out‐of‐home eating lifestyle. It ultimately culminates in a lower diet quality with lower micronutrient balance, high calorie, and fat intake. These impair the fat metabolism, homeostasis of glucose and insulin, oxidative stress, sleep disorders, and lipid and lipoprotein disorders which are together also termed as cardiometabolic disorders (Bahadoran et al. 2016). The association of obesity and related cardiometabolic disorders was initially highly prevalent in the United States, Europe where the implementation of urbanisation and industrialisation first began. The trend of two‐ to threefold increase in the prevalence of overweight and obesity was reported in developing countries of the Middle East and southwest Asia between the late nineteenth century and continues till date. Incidence studies of CVD highlight that between the age of 20 and 79 years, overweight and obesity correlated with the early development of major cardiometabolic disorder stress followed by CVD and resulted in higher mortality with obesity. Half of the world's population with metabolic healthy obesity develop metabolic syndrome and poses increased threat of CVD compared with those with a healthy normal weight. Therefore, the presence of metabolically healthy obesity is also a high‐risk state rendering greater cardiovascular risk age, BMI, and obesity are also risk factors for stroke, venous thromboembolism risk, and hypertension in patients. Metabolic syndrome related to obesity is also linked to other issues caused by obesity which include sleep issues, obstructive sleep apnea, and breathing troubles including asthma (Drager et al. 2013). In this regard, the latest research is focused on the development of compositions and compounds which are cardio‐protective and anti‐cardiac in nature (Kundu
