Indians love their chai and snacks. It is something we indulge in both in the morning and in the evening. We have it when we are bored and when we are working. It is a part of our everyday life. How many of you realise that a typical cup of chai can contain as many as 90 calories. If you add the biscuits and snacks, each of these can turn out to be a 200-calorie session. Many of you would be attending small office parties. Each office party you attend amounts to 1,000 calories, besides the food that you have consumed through the day, writes Dr Kamal Mahawar, Consultant General & Bariatric Surgeon, Sunderland Royal Hospital, in his new book ‘Battling India’s Obesity Crisis: Fight With Fat’.
Snacks is a big problem for most of us, as we eat on the go – sometimes due to alleviate hunger, but more often to deal with boredom. Moreover, things like biscuits, chocolates, sweets, fried snacks etc are all around us, and difficult to escape. Each of these items can easily contain 20-30 calories, and before you know it, you’ve consumed 100 calories, says Dr Mahawar, in his book published by Fingerprint.
In an ideal world we’d all be snacking on fruits and low-calorie snacks made up from vegetarian sources. For example, snacks based on recipes of sprouts, vegetables, corn, onion, tomato, etc can taste good, be very filling, and at the same time are not full of calories. The only problem here is availability. Our food industry has not invested enough in making them available everywhere at reasonable prices. So even if you want to eat healthier snacks, the options are pretty much non-existent.
The only problem here is availability. Our food industry has not invested enough in making them available everywhere at reasonable prices. So even if you want to eat healthier snacks, the options are pretty much non-existent, he writes.
Commenting on the obesity problem in the world and in India, he says: “Obesity has turned into a pandemic problem. Just consider the numbers: As of 2014, it is estimated that over 640 million people -- 266 million men and 375 million women --- were obese worldwide. While the figure may not sound that alarming, it takes on a whole new meaning if compared to the number 40 years ago. In 1975, 105 million (34 million men and 71 million women) were obese."
The 2014 figures would seem more alarming if we include the overweight (BMI 25.0-29.99) and not just those who are obese (BMI 30.0 or more). The current number then stands at more than 2 billion – more than a quarter of humanity! Add to this another disturbing figure – in the last four decades, an average individual has gained weight at the rate of 1.5 kg every decade.
Doctors consider both the undernourished as well as the overnourished (obese) as malnourished as both these groups are suffering from an aberration of Nutrition, though they represent the opposite ends of the spectrum.
In percentage terms, approximately 11% of men and 15% women in the world are obese, and by 2015 the number is projected to rise to 18% for men and 21% for women.
Though India is behind in terms of percentage, in terms of absolute numbers we are at the front. With 3.8% of men and 4.2% of women as obese, India is the third most obese country in the world!
Alongside the obesity epidemic, there is another epidemic that is growing – of Vitamin D deficiency. A large number of obese individuals are also deficient in Vitamin D.
What would one consider a balanced diet?
“A balanced diet is one that contains all the macronutrients – carbohydrates, fat and proteins in the right amount, as well as the necessary vitamins and minerals. A balanced diet derives 60% of total calories from carbohydrates, 25% from fat and 15% from proteins.”
Is it wise to cut out carbohydrates from one’s diet?
“Carbohydrates are the commonest source of energy and we cannot live without them. Not eating enough carbohydrates is not good for your health and will make you ill. So, whoever has told you that you can live without carbohydrates is wrong, just like those who think we should avoid all fats or those who profess we should only eat proteins.
“There is actually data to suggest that excess of proteins is also not good for the heart and kidneys. Since you cannot consume fibre without natural carbohydrates, a high protein diet may also adversely affect your bowels. At the same time, it is also a fact that the Indian diet tends to be deficient in proteins and we could all do with a bit more protein in our food.
“It is useful to know some basic principles of dietetics. For example, sugary or sweet food is bad. Now sugar is a type of carbohydrate, as is roti or bread, but there is a difference between the two. Food like roti, bread, rice, lentils etc are carbohydrate-rich staple foods and are perfectly fine when consumed as part of a balanced diet. The same is true of fruits like apple and banana and vegetables like potatoes, which also come under this category of good carbohydrates. Here we need to differentiate between good carbs, such as the ones mentioned, from bad carbs such as sweets, chocolates, sugary drinks, anything else that contains sugar and even fruit juices."
The book is replete with interesting and useful information on how to fight fat and eat healthy.
Dr Mahawar told Outlook on email: “Obesity is now a pandemic and in terms of percentages, the problem is actually not that bad in India compared to Western countries. But the way we are we going, it is set to get much worse unless we urgently do something about this.”
The reasons for Obesity: “Though scientifically speaking, we don’t fully understand the causes of obesity, I suspect there are a number of drivers of obesity epidemic in India - fast food culture, sedentary lifestyle, easy access to food and celebration food, processed food, lack of physical activity, lack of time to cook healthy meals at home, loss of work-life balance, stressful life, etc.”
What could be done to fight the fat? “Families could do a number of things. Keep an eye on their weights. Know what is healthy and what is not. Avoid sugary, sweet food and fried food. Be aware of liquid calories. Avoid eating out too often. Eat more vegetables and fruits and undertake 30-60 minutes of physical activity every evening.”
What about the mushrooming fast food outlets? “Fast food culture is a major driver of the obesity epidemic. Fast food outlets should be asked to provide the calorie content and breakdown with vitamin/mineral content of each food item. They should be encouraged to also have healthier options like fruits and vegetables on the menu. Food labelling could help, and we could develop a colour-coded system where healthier options are labelled green and high fat-high sugar food is labelled red etc.”
Are anti-obesity pills good; what about bariatric surgery? “One should never take any obesity pill unless advised by a qualified doctor. The currently available options have limited efficacy and only work for patients suffering from milder forms of the disease. The side effects of bariatric surgery can vary depending on the nature of surgery. Both medications and surgery can be very effective in appropriately selected patients, but there is no medical treatment or intervention that does not have any side effects. Prevention is definitely better than treatment when it comes to obesity.”
“Our life style is becoming more and more sedentary with improving access to modern amenities. Physical activity is no longer a necessity for very many of us in white collar jobs. It means we have to pay special attention to being physically active and indulging in some sort of physical activity or exercise on a daily basis.”
After each chapter, the author has very thoughtfully summarized the contents in point form.
(Dr Kamal Mahawar is Consultant General & Bariatric Surgeon, Sunderland Royal Hospital; Visiting Professor, University of Sunderland; Associate Editor, “Obesity Surgery” and "Clinical Obesity”; Associate Director of Scientific Programme and Member of the Council, ASGBI: Author “The Ethical Doctor” and “Fight with Fat". Twitter: @kmahawar)