This is the VOA Special English Health Report.

Malnutrition remains a serious problem for India. But a new study shows that India's leading causes of death now also include obesity-related diseases such as heart disease. The Registrar General of India released the report last month.

India's current National Family Health Survey shows that more than twenty percent of Indians living in cities are overweight or obese. And in the northwestern state of Punjab, that is true for almost forty percent of women.

Aradhna Tripathi is a business professional in New Delhi.

ARADHNA TRIPATHI : "Eating is the most important thing in any Indian household and how you show your love and gratitude for a person is through the kind of food you serve him. And the kind of sedentary lifestyle that we lead, are one of the reasons why we have every day the number of obese people in India increasing."

But Aradhna Tripathi says she decided to lose weight after she got pregnancy-related diabetes. Her mother and grandmother are also diabetic. In fact, the International Diabetes Federation says India is now the diabetes capital of the world. It says one out of six diabetics is Indian.

Genetics may play a part. Researchers say Indians store more body fat per kilogram than Europeans. That means obese Indians are even more at risk for diabetes than other people.

Doctor Anoop Misra is director of diabetes and metabolic disease at Fortis Hospital in New Delhi. He says the risk of diabetes is crossing social and economic lines. Five years ago, he says, obesity and diabetes were limited to India's wealthiest people. But now the poorest are also getting heavier.

ANOOP MISRA: "We thought we'd find all malnutrition, but what we found was the paradox. Many people were thin. They're malnourished, undernourished. The other side of the picture was that many people were fat and some of these belonged to the poorest section of that slum."

But Doctor Misra is hopeful that the spread of obesity can be slowed. And he says it must start in the schools by giving all Indian children the same instruction on physical activity and diet.

The World Health Organization says China is also moving up in obesity rates. The estimate has reached about five percent countrywide and as high as twenty percent in some cities.

And that's the VOA Special English Health Report, written by Caty Weaver with Linda Blake in New Delhi. You can find transcripts, MP3s and archives of our reports and share your comments at voaspecialenglish.com. You can also find us on Facebook, Twitter, YouTube and iTunes at VOA Learning English. I'm Steve Ember.