How Did Pakistan Become the Diabetes Capital of the World?

Pakistan didn’t wake up one morning and find itself labeled the “diabetes capital of the world.”
This crisis took decades to build — one meal, one marketing campaign, and one overlooked policy failure at a time.

Today, Pakistan has the highest adult diabetes prevalence on the planet. Roughly one in three adults is now living with the disease, and projections suggest the number could climb beyond 70 million by 2050 if nothing changes. That staggering figure reflects more than just individual choices; it’s the story of how a country’s food systems, urban life, economic pressures and cultural habits collided to create a perfect storm.

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What “Diabetes Capital” Really Means

By current estimates, Pakistan has over 34 million adults with diabetes. That’s more than the entire population of many countries. What’s even more striking is how quickly this happened. At the turn of the millennium, diabetes existed, but it wasn’t the runaway epidemic it is today. Within two decades, the disease jumped from single-digit prevalence to engulf nearly one-third of the adult population.

And while China and India have greater numbers of diabetics in absolute terms, their populations are enormous. When you adjust for population size, Pakistan sits at the very top.

This isn’t media exaggeration. It’s a reflection of how dramatically the country’s lifestyle, diet and health landscape have shifted — and how slowly institutions responded.

How Fast Food Found a Permanent Home in Pakistan

For most of the 20th century, Pakistani meals were relatively simple: lentils, fresh vegetables, seasonal produce, whole wheat flatbreads. Fried foods existed, but they were part of celebrations, not daily life.

That began to change in the late 1990s.

Global fast-food chains — first KFC, then McDonald’s and others — entered Pakistan, setting up gleaming outlets in major urban centers. By the mid-2010s, the fast-food industry had become a major economic player, backed by aggressive marketing budgets and unstoppable expansion.

Several factors helped fast food take root:

Urbanization and time poverty

As families shifted to cities, and more women joined the workforce, time became a scarce commodity. With gas shortages, long commutes and smaller kitchens, quick-service meals were not just tempting — they were convenient. A bucket of fried chicken became the answer to a busy day.

Marketing to the young

Chains targeted youth relentlessly: students, young professionals, and the growing middle class eager to embrace what looked like “modern” lifestyles. Eating at branded fast-food restaurants became an expression of status and aspiration — a Saturday ritual, a birthday treat, a celebration.

Delivery apps and the rise of “snack culture”

Once food delivery apps exploded, the landscape changed again. Fast food shifted from an occasional outing to an everyday habit. Meals blurred into snacks; snacks became meals. Fried foods, sugary drinks and calorie-dense items were just a tap away.

Fast food doesn’t singlehandedly cause diabetes — but its dominance entrenched diets rich in refined carbs, unhealthy fats and excessive calories, layered on top of genetic vulnerabilities common among South Asians.

How “Bad Oil” Entered Every Household

If fast food is the loud culprit, cooking oil is the quiet one.

Vanaspati ghee: the hidden danger

For decades, Pakistan has relied heavily on vanaspati ghee — a cheap, partially hydrogenated fat used in homes, bakeries and street stalls. Many brands contain alarmingly high levels of industrial trans fats, which are linked to heart disease, inflammation and insulin resistance.

Trans fats raise LDL (“bad” cholesterol), lower HDL (“good” cholesterol) and contribute directly to metabolic dysfunction. In simple words: these fats clog arteries and disrupt the body’s ability to process sugar.

The culture of reused oil

Compounding the problem is the practice of reheating and reusing oil — not just in roadside stalls but in many low-income households where budgets are tight. Reused oil produces toxic compounds that damage blood vessels, increase inflammation and can trigger insulin resistance.

Combine cheap vanaspati + reused oil + a national culture of deep-fried snacks, and you get an environment where “bad oil” quietly infiltrates daily life:

• samosas, pakoras, jalebis

• bakery biscuits and puffs

• breakfast parathas and evening fritters

When this becomes a daily habit, the body is constantly battling inflammation and metabolic stress.

Sugar: The Other Pillar of the Crisis

Sugar isn’t just an ingredient in Pakistan — it’s a cultural glue.

Pakistan is one of the world’s major sugar producers, and consumption has soared in parallel with a booming food-processing sector. Several overlapping trends helped push sugar deep into everyday life:

• soft drink consumption has risen steadily

• sweetened tea is consumed multiple times a day

• juices, packaged drinks and desserts are ubiquitous

• adolescents show extremely high weekly intake of sugary beverages

White flour, white rice and sweetened bakery items add to the load. This combination — fast-absorbing carbs and constant sugar exposure — keeps blood sugar spiking and the pancreas under strain, turning insulin resistance into a national norm.

The Lifestyle Trap

Diet isn’t the only factor. Pakistan’s built environment and social norms amplify the risk.

1. Almost no daily movement

Urbanization has reduced physical activity dramatically. Many people spend the day sitting: at work, in cars, at school, and at home. Safe walking paths are limited, parks are scarce or inaccessible, and cultural restrictions often limit outdoor exercise for women.

2. Genetic disadvantage

South Asians are biologically predisposed to develop insulin resistance at lower body weights. Many Pakistanis appear “not obese” by Western standards yet carry dangerous visceral fat that drives metabolic disease.

3. Early-life undernutrition

Generations grew up facing malnutrition. When those same individuals encounter calorie-rich urban diets later in life, their bodies are primed to store fat aggressively — a phenomenon known as the “thrifty phenotype.”

Together, these factors form a metabolic trap few can escape.

A Health System That Arrived Too Late

Even as the crisis grew, Pakistan’s health-care system struggled to respond.

• Screening is limited, so many people discover diabetes only once complications appear.

• Primary care is overstretched, leaving little time for counseling or preventive guidance.

• Policies are fragmented, with no sustained, nationwide mobilization comparable to successful efforts in infectious diseases.

Healthcare has become better at treating consequences than preventing them.

Poverty, Cheap Calories and the Illusion of Choice

For millions, the issue isn’t ignorance — it’s affordability.

Healthier oils cost more. Fresh vegetables can be expensive. Meanwhile, deep-fried snacks, white bread, sweet tea and other calorie-dense foods are cheap, filling and everywhere.

Women, who shoulder most of the household’s food responsibilities, often have limited access to health information and little time to experiment with healthier cooking.

Blaming individuals oversimplifies the truth: when the cheapest option is the unhealthiest one, diabetes becomes a social and economic outcome, not a personal failure.

Other Underestimated Contributors

• Air pollution — exposure to polluted air increases inflammation and raises the risk of metabolic disorders.

• Chronic stress — economic uncertainty, political instability and social pressures contribute to overeating and disrupted hormonal patterns.

• Gestational diabetes — without proper follow-up, mothers and children face long-term risk, perpetuating an intergenerational cycle.

Can Pakistan Reverse the Trend?

The way out is not moral lectures about healthy eating — it’s systemic change.

1. Fixing the oil problem

• enforce strict limits on industrial trans fats

• regulate reuse of frying oil in commercial kitchens

• promote affordable, healthier oil alternatives

2. Reining in sugar

• tax sugary drinks and reinvest revenue into health programs

• mandate warning labels on unhealthy products

• restrict marketing to children

3. Making healthy choices accessible

• improve school meals and workplace cafeterias

• build walkable spaces and community exercise programs

• support women’s access to safe activity spaces

4. Strengthening prevention in health care

• routine screening for adults over 30

• practical nutrition and lifestyle counseling

• better national data systems to identify hotspots

Pakistan didn’t become the diabetes capital of the world because its people suddenly changed. It happened because:

• fast food and ultra-processed snacks infiltrated daily life

• unhealthy oils and vanaspati ghee became household staples

• sugar wove itself into every drink and snack

• cities were built for cars, not people

• and health systems lagged far behind the unfolding crisis

The good news? This trajectory is not irreversible. The same forces that shaped the current food environment — industry, culture, policy and community — can also reshape it.

But it will require leadership, long-term planning and a clear shift in thinking: from blaming individuals to redesigning the environment in which people make their choices.