news details |
|
|
| Transition from Malnutrition to Obesity: The changing nutrition scenario in India! | | | Dr. Pragya Khanna | 4/12/2018 10:30:48 PM |
| Today, India is ranked as the third most obese nation in the world after the US and China and also the diabetes capital of the world, with about 69.2 million people living with it as per the 2015 data by World Health Organisation. According to the World Health Organization (WHO), obesity is one of the most common, yet among the most neglected, public health problems in both developed and developing countries. Globally one in six adults is obese and nearly 2.8 million individuals die each year due to overweight or obesity. Due to the increased risk of morbidity and mortality, obesity is now being recognized as a disease in its own right. Additionally, obesity is strongly associated with other metabolic disorders including diabetes, hypertension, dyslipidaemia, cardiovascular disease and even some cancers.
During the past six to seven decades there has been a remarkable change in the pattern of nutrition-related problems in India. Looking back, we can see how far we have come. But, looking forward, we see that the road ahead is long and challenging.
The past seven decades have seen notable shifts in the dietary scenario in India. Even up to the 1950s severe forms of malnutrition such as kwashiorkar and pellagra were widespread. As nutritionists were finding home-grown and rational solutions for these pervasive problems, the population was escalating and food was limited. However, India was able to mitigate these problems and these "incredible changes" did not come about through distribution of synthetic vitamins, drugs or special formulations, but through a better understanding of the diseases themselves, and through local-level health and diet-based interventions. Although there was a strong move to introduce a protein supplementation programme with fish concentrates and wheat fortification with lysine to tackle kwashiorkor, the Indian nutrition scientists argued against these moves, and were ultimately proved to be right.
At that time, the threat of widespread household food insecurity and unremitting malnutrition was very real. Then with the coming of Green Revolution the shortages of food grains disappeared within less than a decade and India became self-sufficient in food grain production. But, not surprisingly, the Green Revolution had some deleterious side-effects and there were some menacing problems arising from this revolution that were more intimidating, like cropping patterns giving low priority to coarse grains and pulses, and monocropping that lead to depletion of soil nutrients and 'Green Revolution fatigue'. The heavy use of chemical fertilizers and intensive cultivation practices depleted soil fertility in many areas, robbing it of valuable and essential micronutrients and thereby compromising the nutritional quality of the foods grown in these soils.
While the food scarcity problem was largely solved by the 1970s, the malnutrition problem was not. The Green Revolution had concentrated almost entirely on rice and wheat. The result was a relative neglect of pulses and horticultural products. Pulses are an important source of protein in Indian diets, predominantly for vegetarians. There has been a progressive increase in the price of all the pulses; these are generally not being distributed under the subsidized Public Distribution System, and are, therefore, not within the purchasing power of the poor. Again, while India is among the largest milk producers in the world, the milk intake of the people who need it the most (young children and pregnant women in the poor socio-economic groups) is low. Vegetables and fruits are perishables, and in the absence of effective storage, preservation and transportation, the prices are unstable and the availability uncertain. With all these factors coming into play, the diets of the average Indian household did not show any significant improvement over the last few decades of the century.
On the cusp of the new century, an additional factor appeared on the nutritional landscape in India and a new nutritional problem began to emerge in India, the problem of over-nutrition and obesity. With steady urban migration, upward mobility out of poverty, and an increasingly sedentary lifestyle because of improvements in technology and transport and fast food culture obesity rates began to increase, resulting in a dual burden. All these factors inevitably made their way into India, particularly in the urban areas, with predictable results. Measured in terms of its performance in meeting its Millennium Development Goals, India appears diminutive. Despite its continuing high levels of poverty and illiteracy, India has a huge demographic potential in the form of a young population. This advantage must be leveraged by investing in nutritional education, household access to nutritious diets, hygienic environment and a health-promoting lifestyle. This requires co-operation from all the stakeholders, including governments, non-government organizations, scientists and the people at large.
The twist to the tale as far as India and other countries in the region are concerned is that this sharp rise in obesity is a manifestation of "nutritional transition". Children who experienced intrauterine growth retardation, resulting in low birth weight, appear to be programmed to develop along a lower growth trajectory. Paradoxically, however, many overweight and obese adults are those who had experienced calorie deprivation and faltering growth in early childhood due to poverty and deprivation. Subsequently, with better access to food and low physical activity, they fall prey to the opposite problem of obesity.
Today, sixty-four hundred million Indians, 64% of the population of India are chronically malnourished. At the same time, 11% of the Indian population is over-nourished. While malnourishment is prevalent throughout India, over-nutrition is most prevalent in the cities. In fact, in some cities inhabitants are both malnourished and overnourished. This is possible because over-nutrition results from an excess of calories consumed whereas malnutrition is caused by a lack of quality in the food consumed. This typical scenario is commonly seen nowadays resulting from poor nutrition. Whereas malnutrition results due to the lack of food intake or consumption of inferior quality of foods, over-nutrition results due to intake of the cheapest food available, usually food high in "filler" calories and low in micronutrients essential for health. The lack of micronutrients not only causes the family to buy more food, leading to obesity for some, it can also lead to malnutrition. Thus, solutions for these families need to focus on improving the quality of food imported into the cities from the countryside, and on increasing the income of the urban poor.
Ironically, the children of well-heeled and affluent class of India's cities face the similar problems but with a different perspective, that is often labelled as lifestyle problems. These include a sedentary lifestyle and complete lack of exercise as many city children no longer have to even walk to school. Also, a shift in diet towards more processed foods affects all urban Indians. As the fast food industry is expanding, India is threatened with an increasing incidence of obesity. In order to curb this rising threat to its health care system, India should look into banning the advertising of fast food to children.
India's economy is, by all accounts, better poised to withstand the recessionary trends seen across the major nations of the globe, making it less poor and more "wealthy." Yet, it is this very wealth which brings with it an unwanted epidemic of obesity, diabetes and cardiovascular disease. Development brings with itself urbanization and reduction in physical activity. It also fuels inflation, which reduces access to increasingly expensive fruits and vegetables. And, while the rural poor may continue to accrue the benefits of physical activities, the urban poor will be at a relative disadvantage - how will they be able to afford going to the fitness centers that continue to offer health and succor to the urban elite?
Indian studies, however, indicate that the living conditions in rural areas have improved considerably. Transport facilities, medical care and food habits, educational status, and family income have dramatically improved, which along with easy access to city and television watching, result in unwanted changes in lifestyle. These have eventually led to significant increase in body mass index (BMI) as well as abdominal obesity in both sexes as compared to a similar study conducted in the year 1989. The prevalence of overweight rose from 2 to 17.1%. The changing lifestyle of the rural dwellers was found to be a contributory factor for the rising rates of obesity and associated metabolic diseases such as diabetes.
On one hand, India remains the developing nation of my childhood still struggling to end poverty, illiteracy and disease, on the other hand, India today is a fast-rising global power that's home to vast amounts of new wealth.
Childhood obesity is mainly a problem of modern India, teeming with American-style malls, fast food outlets and newfound luxuries like cars and air conditioning that have dramatically changed the lifestyles of families with money to spare. Kids are far more sedentary than they used to be, the pressure to study and do well in school is more intense than ever, and whatever little spare time they have is spent these days on video games, mobile phones or Facebook.
The problem is so prevalent that there is even an Obesity Foundation of India which also blames the prevalence of television commercials promoting unhealthy foods and poor eating habits. It estimates children's consumption of sugary sodas has increased by 300% in the last two decades.
But obesity is not just affecting the urban well-to-do. Indian researchers have found it is also an issue in India's villages, where 3 out of 4 Indians still live.
The points to ponder are therefore while the number of undernourished people has gone down by one-third in the last 10 years, India still has more underweight and stunted children that any other country. One reason for India being ahead of all the poorer African nations, is its high population. On the other hand obesity is on the rise because of sedentary lifestyle, unhealthy diet and eating habits that are becoming increasingly common amongst rural and urban youngsters. |
|
|
|
|
|
|
|
|
|
|
|
|
| |
| |
|
|
|
|
 |
|
|
|
|
STOCK UPDATE |
|
|
 |
| BSE
Sensex |
 |
| NSE
Nifty |
|
|
| |
CRICKET UPDATE |
|
|
|
|
| |
| |
|
|
| |
|
|
|
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
