Obesity is a separate morbidity. 30% of obese Americans are not actually ill. But 40% of non-obese Americans are sick with metabolic syndrome. So, more than are obese and sick, by the raw numbers. Obesity is a big problem in the US, but metabolic syndrome is a bigger problem, and suffering both is worse than either alone.

Pakistan has as much metabolic syndrome as other former UK colonies, but remarkably little obesity.

Metabolic syndrome is a product of excess fructose in the bloodstream, itself a product of sugar consumed without enough accompanying fiber. Beverages are a particularly concentrated source, but other stuff packaged as food can be as bad.