Lead a healthy lifestyle to combat obesity
The world is in the midst of an obesity epidemic and India is contributing sizeably to it. The worldwide prevalence of obesity has nearly tripled between 1975 and 2016. Current Indian statistics from the National Family Health Survey (NFHS) suggest that obesity has increased from 19 per cent to 23 per cent in males aged between 15 and 49 years and from 21 per cent to 24 per cent in females in the same age group between NFHS-4 and NFHS-5.
Obesity is a condition of excessive fat accumulation that may impair health. Body mass index (BMI) is used to define obesity. It is calculated as a person’s weight in kilograms divided by the square of his height in metres (kg/m2). A BMI of equal to or more than 25 kg/m2 defines an individual as overweight and more than 30 kg/m2 as obese. However, for Indians, the corresponding values are 23 kg/m2 and 25 kg/m2. Waist-to-hip circumference ratio is another indicator of truncal obesity which is more closely linked to the risk of cardiovascular diseases.
Obesity results from an imbalance between calories consumed and calories expended. Thus, an increase in the intake of calorie-rich food and/or a decrease in physical activity would lead to weight gain. Energy-rich foods are fats (9 calories per gm) and sugars (4 calories per gm). A positive balance of 500 calories per day would lead to gain of approximately 1 kg in a fortnight.
To put things in perspective, a samosa has 250 calories, laddoo 200, chaat 250, 100-gm biscuits 450, a parantha 180, a chicken burger 400, Maggi noodles 400 and a cola drink 150 calories. Alcohol is another calorie-rich item; a can of beer has around 150 calories. And, it takes a walk of an hour to burn 250 calories.
What is spurring obesity? Increase in family income, easy availability and marketing of high-calorie food and lack of physical activity are the main reasons for it. Unhealthy, processed food is widely available across the country. Our craze for all things foreign is reflected in the mushrooming of McDonald’s, KFC chains and the like on the GT Road in north India, perhaps, with the largest number of such outlets per km anywhere in the world.
There are many myths surrounding obesity. ‘It runs in families’ or ‘my bones are heavy’ is a common refrain. Patients often equate calorie intake with the number of chapatis they eat in a day, not calculating the sugar they consume in tea, milk or sweets and the fats they consume in fried food, savouries and fast food. North Indian food is notorious for its ghee, butter or oil content. Barring rare genetic disorders or hormonal disturbances, obesity is a lifestyle disease. It increases with per capita income, affects more women than men and is more common in urban areas than in rural ones. Punjab, Haryana, Chandigarh, Delhi, Tamil Nadu and Kerala are among the states/UTs with the highest prevalence of obesity.
High BMI is a risk factor for heart disease, hypertension, diabetes, stroke, Alzheimer’s disease, osteoarthritis and many cancers (uterus, breast, ovary, prostate, liver, colon, etc). The World Health Organisation (WHO) estimates that obesity is responsible for 44 per cent of diabetic cases, 23 per cent of ischemic heart disease cases and 10-20 per cent of certain cancers. It has been linked to fatty liver, which is fast emerging as a leading cause of liver damage and cirrhosis across the world. Additionally, obese individuals are more prone to developing gall bladder stones, gastroesophageal reflux disease and sleep apnoea and in young women, obesity is also linked to polycystic ovary syndrome.
Obesity being a global phenomenon, the WHO had called upon member nations to set the target to halt the rise in obesity by 2025, but most countries are off track to meet it. Now, the ‘2030 Agenda for Sustainable Development’ aims to reduce premature mortality from non-communicable diseases by one-third by 2030. The WHO also adopted the ‘Global Strategy on Diet, Physical Activity and Health’, a declaration which describes the actions needed to support a healthy diet and physical activity. But it is for the countries to adopt measures to fight the menace.
At an individual level, we should restrict high-calorie food, especially sugary and fried food, and increase physical activity. All junk or fast food is unhealthy. The food industry should be asked to put a health warning on packaged foods about the salt content, sugar content and calories; it should also ensure that healthy food choices are readily available and are affordable. Restaurants should mention the calorie and fat content of the food served.
The fact that there are many apps that can track our calorie intake and expenditure, and many food items such as chips, biscuits and fruit juices have their calorie values marked on their packaging, yet most people ignore them, suggests that a lot more needs to be done. Individual responsibility will have an effect when people have information about the benefits of a healthy lifestyle. Therefore, it is imperative that campaigns to promote regular physical activity and healthy dietary choices are carried out.
Childhood obesity is even more worrisome since it is a harbinger of hypertension, insulin resistance and early cardiovascular diseases. Today, the number of overweight children in any urban private school exceeds that of underweight kids. A concerted effort is needed to fight the scourge. Advertisements on TV aimed at children should be regulated and schools should consider permitting the sale of only healthy food. It has been seen that children below 14 years of age are most receptive to healthy dietary advice. Both parents and teachers need to be cognisant of the harms of the lack of physical activity.
Obesity remains a lifestyle disease and should not necessitate such drastic measures as bariatric surgery. What is required is awareness about the harmful effects of obesity and knowledge about a healthy diet and physical activity. Policymakers can help by regulating marketing and advertising of junk food apart from nutrition labelling on food products. Civic bodies, state governments, media, the Indian Medical Association and other stakeholders must act in unison. It is time we got serious about the matter.
