After a ban on alcohol, Kerala will now impose a fat tax to keep its people healthy. Kerala’s Finance Minister Thomas Isaac, while presenting the state budget on Friday, announced a 14.5% tax on branded restaurants selling fast foods like pizzas, burgers and doughnuts.

Kerala has a big obesity problem. The state has the second-highest rate of childhood obesity in the country after Punjab, according to the fourth round of the National Health Survey. Previous surveys conferred the dubious distinction on Kerala even for obesity rates of adult men and women.

But the obesity problem goes beyond Kerala. Many more people in India are tending towards obesity, according to a global study published earlier this year in the medical journal The Lancet. A person is considered obese when he or she has a body mass index of more than 25 kilograms per squared meter. By these standards, at least 20 million women and almost 10 million men in India are now obese. This means India stands fifth when ranked for the most number of obese men in the world and third for the most number of obese women.

The numbers are a far cry from statistics of 1975, which the study has used as a contrast, when India was ranked 19th for obesity among 186 countries of the world.

Ironically, India along with China also has the largest number of malnourished men and women. The percentage of underweight people in India has only risen between 1975 and 2014.

Obesity in itself is not lethal but is linked to several non-communicable diseases like diabetes. India has the highest mortality rate due to diabetes among men and the women are not far behind. Close to 8% of India’s population suffers from diabetes, the third highest prevalence among countries after China and the US.

The fourth round of the National Health Survey conducted in 2015-2016 also shows how, in most states, the percentage of overweight or obese people has doubled from the previous round of the survey conducted a decade ago. Obesity is also much more of a problem in urban centres than in rural areas.

While the jury is out on the efficacy of the fat tax to address obesity, there is no doubt about the need across India for nutritional, social and economic adjustments to ensure better diets and lifestyles.