It's a public health disaster on our hands

Among the hundreds of Diwali greetings on WhatsApp, one stood out because of its uniqueness. It wished the recipient good health -- defined by an ideal waist-hip ratio, body mass index, good and bad cholesterol level, and normal blood sugar and blood pressure. Its popularity on social media is an indication of increased health awareness among at least urban Indians.

Unfortunately, awareness alone is not enough. There is little matching action among urban Indians to ensure for themselves a healthy diet. Worse, rural India is fast catching up.

Medical research illustrates overweight and obesity, insulin resistance, diabetes, hypertension, heart diseases and cancers are not only on the rise but have already assumed epidemic proportions among city dwellers. Nutrition transition, coupled with sedentary and unhealthy lifestyles, are to blame.

Maternal and childhood undernutrition are also among the causes triggering a rise in non-communicable diseases. About 2.6 million Indians are forecast to die of coronary heart disease, which constitutes some 54% of all cardiovascular deaths in India by 2020.

A recent survey by the National Institute of Nutrition in 16 states waves the red flag. Among urban population, between a third to half the men and women suffer from overweight and obesity-related problems. One in three urban men and women have hypertension, and one in four men and women have diabetes. Hyperlipidemia afflicts one in three men and women.

In summary, it’s a public health disaster on our hands. “Lack of time, coupled with easy availability of convenience foods and misleading advertisements, drive the nutrition imbalance in the cities,” said Neelanjana Singh, nutrition consultant at Heinz Nutrilife Clinic in Delhi and a member of the Indian Dietectic Association.

India’s growing prosperity therefore comes at the cost of the health of its citizens. Take diabetes, for example. The NIN survey showed overall prevalence of diabetes among urban men and women was 28.1% and 23.3% respectively. Among men, prevalence of diabetes was the highest in Puducherry, followed by New Delhi, Karnataka and Kerala. Among women, the trend was almost similar – Puducherry, followed by New Delhi.

A separate study commissioned by the Indian Council of Medical Research on India’s diabetes trend came up with the disturbing finding on how the lifestyle disorder is affecting more urban poor. The diabetic epidemic shifts towards the poorer section of the society living in affluent states including Karnataka.

Chandigarh, Tamil Nadu, Punjab, Andhra Pradesh, Maharashtra, Karnataka and Gujarat are among the states and union territories with the highest prevalence of diabetes, according to the ICMR survey. Tripura is an exception as the north eastern state has one of India’s highest diabetes prevalence despite not being a rich state.

“Cities in more affluent states have transitioned further along the diabetes epidemic. As the overall prosperity of individual states and the country increases, the diabetes epidemic is likely to disproportionately affect the poorer sections of society, a transition that has already been seen in high income countries,” said Viswanathan Mohan, president, Madras Diabetes Research Foundation, Chennai.

But the nutrition imbalance in the cities is only half the story as overnutrition and undernutrition coexist in India. The NIN survey also points out how the prevalence of low body weight, stunting (low height for age) and wasting (low weight for height) remains high among children from the Scheduled Castes and Scheduled Tribes. It found 39% stunting among boys below five years from Dalit households and 34% among those from tribal families. For the backward classes and the rest of the population, the corresponding figures are just under 28% and 27% respectively.

Poor nutrition was higher in kids from households with low per capita income, illiterate fathers and lack of access to sanitary latrines.

A comparison between urban and rural children show those from the cities enjoy a better nutrition profile. But pitted against the children of the developed world, the same set of urban boys and girls turn out to be malnourished. “Even in affluent families, there areshortage of micro-nutrients in diet though there is no shortage of food,” said Singh.
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