We know packaged food is unhealthy, but according to a new study, packaged food from India is the unhealthiest globally.

On assessing more than 4 lakh food and drink samples from 12 countries, researchers from the Australia-based George Institute for Global Health found that packaged food coming from India scored the highest in contents of saturated fat, total sugars, and energy density. It should be noted that these three factors are responsible for causing obesity, type 2 diabetes, and cardiovascular diseases. Additionally, Indian food and drink samples were also found to be the least nutritious and most energy-dense, that is, they are high in fat and have low water content — for example, biscuits and confectionery, crisps, peanuts, butter, and cheese.

To arrive at these rankings, researchers used the Health Star Rating System, which measures nutrient levels – energy, salt, sugar, saturated fat, protein, calcium, and fiber – in food samples and assigns them stars. Half a star means least healthy and five stars mean that the sample is the healthiest.

Based on this ranking system, India’s packaged samples were at the bottom with, an overall rating of 2.27 stars, below China’s food, which scored 2.43, and Chile’s, which scored 2.44. However, packaged food samples from China had the most harmful levels of saturated fat in packaged food and beverages.

In terms of the healthiest packaged food samples, the U.K.’s were the healthiest (rated 2.83), followed by the U.S.’s (2.82) and then Australia’s (2.81).

“Globally we’re all eating more and more processed foods and that’s a concern because our supermarkets’ shelves are full of products that are high in bad fats, sugar, and salt and are potentially making us sick,” lead author Elizabeth Dunford told LiveMint. “Unfortunately, it’s the poorer nations that are least able to address the adverse health consequences that have the unhealthiest foods,” she added.

Availability and consumption of unhealthy packaged food might also be able to explain the increase in obesity in India. The Swaddle has earlier reported that while the prevalence of obesity in the adult population in 2012 was 3%, by 2016, it had increased to 3.8%.

According to the U.S. Centers for Disease Control and Prevention, being obese can put an individual at a higher risk of type 2 diabetes, coronary heart diseases, strokes, osteoarthritis, cancer and overall poor quality of life.

“White bread, white rice, phulkas … the overall intake of simple carbohydrates is huge. The widespread availability of fast food is also a problem,” Ambrish Mithal, chairman and head of the Department of Endocrinology and Diabetes at Medanta, Gurugram, told LiveMint. The same article had also stated that as people’s social status goes higher, the less likely they are to work by hand. A decrease in physical activity can contribute to an increase in the risk of obesity.

“Whatever little movement we do is paid activity, like going to the gym or yoga,” Tina Sapra, a Gurugram-based nutritionist and founder of the DoctorDiet clinic, told LiveMint. “Taking a 1-hour exercise class lulls us into thinking we’ve done enough when we actually should be turning our entire day into a mini-workout if we want to maintain a healthy weight,” she added.

Therefore, this study “…is a wake-up call for countries like India where the packaged food industry is burgeoning and expanding its reach to small towns and villages,” Vivekanand Jha, executive director of the George Institute for Global Health, India, told Livemint. He added, “Policymakers and the food industry need to work together to reformulate products to reduce the ever-increasing risk of obesity and its consequences.”