(Picture Credit: Vivek Tripathy)
Q: Everybody is talking about a nutrition transition. What exactly is that?
A: Nutrition transition is a shift in our dietary pattern and energy expenditure. In India, it is evident that the way we eat now has changed. And this has been happening over the years. People earlier used to depend on healthy foods. It is quite the opposite now. We are switching over to junk foods, rich in fats and sugar. This is a major factor which indicates a nutrition transition. Moreover, we are also leading a more sedentary life these days. Lack of exercise is a major factor contributing to the rise of major health problems these days.
Q: Both obesity and malnutrition are plaguing India. How tough is it for you to handle such a situation?
A: In India, we have both the problems: malnutrition as well as obesity. Food is still not available to people in many parts of the country. That is a major cause of malnutrition. When we talk about obesity, it is all about making wrong food choices. In this context, I would say that our traditional Indian diet contains complex fibres, which are really good for health. These days, we are switching over to refined foods that are very harmful. Therefore, it is the choice of the food that has a huge role to play in ensuring our overall health.
There is also a shift in food and built environment. We now live and work in an obesogenic environment, or an environment that promotes gaining weight. Earlier, when we had to call someone, we had landline phones, and we made the effort to walk and receive the calls. But now we have mobile phones, right in the palm of our hands. Even if are in the house, we sometimes call up another family member in another room. We had the habit of climbing up the stairs, but now we have lifts and escalators. Even children earlier used to go out to play footballs. Not they are focused on the computer.
There are many reasons which are responsible for our sedentary life. Air pollution is a major reason why there is less of physical activity among children. Morning walks have become hazardous, due to high pollution levels. Safety issues are a concern: women don’t go out for a walk after dark in many parts of the country. There is too much vehicular traffic on the roads, no proper tracks for walking or cycling. All that make our lives more sedentary.
Q: What sort of patients do you mostly see at AIIMS?
A: We mostly get referred patients, those who are at a critical stage. We get all sorts of patients, in our out patient department (OPD) where general medical consultations, and other allied services are done. And we also get critically-ill patients for the super-specialties. Their dietary needs and demands are diverse and we have to deal with that, depending upon the state of their diseases and disorders.
Q: How do you think that our relationship with foods has gone wrong? Please tell us from your experience with the patients.
A: India is the diabetic capital of the world. Looking at the recent statistics, there are about 68.2 million diabetics in the country. It has been said that by 2030 there will be around
98 million. So within 15 years, you will observe how there will be a significant rise in diabetes in our country. I remember that I joined AIIMS in 1990, at the Cardio-Neuro centre. Since then, patients with heart disease and stroke have gone up by 50 per cent. This implies that all the lifestyle-related diseases are on the rise.
Lifestyle-related diseases are a direct fall out of nutrition transition. The diabetic patients that come to us don’t just have diabetes. Along with that they also have a host of other problems: diabetic retinopathy, or diabetes complication that affects eyes; diabetes nephropathy affecting kidneys, neuropathy affecting nerves and so on.
We also see patients suffering from polycystic ovarian disease. Young women, as well as adolescent girls, suffer from this. Life has become so competitive, they study at home for long hours and in the process eat a lot and get obese. This causes hormonal changes, as a result of which, they experience irregular menstruation, hair growth, acne issues and so on.
Students come from far-flung places to study in Delhi. They often do not get nutritious, home-cooked food. They depend on ready-to-eat foods, the dabba system, dhabas and, of course, everybody now has food-delivery services at the tip of their fingers. They consume a whole range of foods in excess, often about 5,000 kilocalories a day. Big food brands that promote breakfast cereals and muesli, are high in sugar. Several beverage companies also have high quantities of sugar in their juices. Then there is social media which promotes new weight-loss challenges, which are highly unhealthy. This is also a part of nutrition-transition. All these are contributing to our deteriorating health conditions.