1 00:00:01,040 --> 00:00:04,680 From Indias largest newsroom, I'm Arun George and this is the 2 00:00:04,680 --> 00:00:16,120 Times of India podcast. A new Lancet report says that 3 00:00:16,120 --> 00:00:19,080 roughly 80 million Indians, including one million in the 5 4 00:00:19,080 --> 00:00:22,600 to 19 age group, may be obese. The report had some good news 5 00:00:22,600 --> 00:00:25,240 for India, though, showing that while obesity may have risen 6 00:00:25,240 --> 00:00:28,880 between 1990 and 2022, there has also been a reduction in 7 00:00:28,880 --> 00:00:31,680 malnutrition in India. The report says that while India 8 00:00:31,680 --> 00:00:34,080 is among the leading countries as far as malnutrition, 9 00:00:34,080 --> 00:00:37,000 characterized by thinness and undernutrition is concerned, 10 00:00:37,240 --> 00:00:40,040 now, the rate of obesity has grown at an alarming rate 11 00:00:40,040 --> 00:00:43,680 between 1990 and 2022. In today's episode, my colleague 12 00:00:43,680 --> 00:00:45,800 Alka Dukar and I are in conversation with. 13 00:00:45,800 --> 00:00:48,640 Doctor Guha Pradeepa. From the Madras Diabetes 14 00:00:48,640 --> 00:00:51,320 Research Foundation in Chennai, Doctor Guha is one of the 15 00:00:51,320 --> 00:00:54,440 co-authors of The Lancet report. She talks about what the report 16 00:00:54,440 --> 00:00:57,240 reveals and what Indians need to do given the number of people 17 00:00:57,240 --> 00:01:00,640 with obesity is still far less than other developed economies. 18 00:01:00,920 --> 00:01:02,760 Alka started. By asking her why, the report 19 00:01:02,760 --> 00:01:04,599 presents an alarming trend for India. 20 00:01:06,000 --> 00:01:09,480 Let's start with understanding the latest Lancet report from 21 00:01:09,480 --> 00:01:13,160 the Indian perspective. Why do you think it reveals an 22 00:01:13,160 --> 00:01:17,520 alarming trend? Yes, this study is very, very 23 00:01:17,520 --> 00:01:22,040 important for the nation currently because you can see 24 00:01:22,040 --> 00:01:28,240 the dual burden of obesity as well as under nutrition among 25 00:01:28,240 --> 00:01:30,560 children and adults. Doctor. 26 00:01:30,560 --> 00:01:32,680 Guha says it's. Important for us to know obesity 27 00:01:32,680 --> 00:01:35,720 estimates because it's a factor behind things like heart disease 28 00:01:35,720 --> 00:01:39,680 and diabetes which are called NCDS or non communicable 29 00:01:39,680 --> 00:01:42,720 diseases. It's a common risk factor for 30 00:01:42,720 --> 00:01:46,320 the other NCDS like cardiovascular disease and 31 00:01:46,320 --> 00:01:49,320 diabetes. So it is very important that we 32 00:01:49,320 --> 00:01:55,040 know the burden of obesity so that we can plan how this can be 33 00:01:55,040 --> 00:02:01,400 curbed so that we can reduce the risk of developing NCDS among 34 00:02:01,400 --> 00:02:05,760 children as well as adults. So as per this study, the 35 00:02:05,760 --> 00:02:12,520 obesity rate has increased from OH point 1% in 1990 to 3.1% in 36 00:02:12,520 --> 00:02:18,040 2022 for girls and from OH point 2% to 3.9 for boys. 37 00:02:18,440 --> 00:02:22,000 This is really alarming. And also you can see that 38 00:02:22,000 --> 00:02:27,200 obesity among women has increased from 1.2% in 1990 to 39 00:02:27,200 --> 00:02:32,800 9.8% in 2022 and from OH point 5 to 5.4 among men. 40 00:02:33,560 --> 00:02:36,120 But while there has been a rise in the number of people who can 41 00:02:36,120 --> 00:02:39,320 be classified as obese, the study also shows that the number 42 00:02:39,320 --> 00:02:42,000 of people classified as underweight has dramatically 43 00:02:42,000 --> 00:02:46,040 reduced in 30 years. At the same time, the study also 44 00:02:46,040 --> 00:02:49,520 found that those who are classified as underweight 45 00:02:49,680 --> 00:02:56,320 declined from four 1.7% in 1990 to one 3.7 in 2022, and from 46 00:02:56,360 --> 00:03:01,920 three 9.8 to 12.5% for men. And among children, there was a 47 00:03:01,920 --> 00:03:06,600 7% decline among girls and two 3.5 among boys. 48 00:03:07,560 --> 00:03:11,280 What, for you, is the most worrying aspect of the findings 49 00:03:11,280 --> 00:03:15,960 from this study? One is children are becoming 50 00:03:15,960 --> 00:03:20,760 more obese at a younger age and this goes through their life 51 00:03:20,760 --> 00:03:23,640 course. And if you consider girls and 52 00:03:23,640 --> 00:03:29,080 women since they have many like puberty, pregnancy then going to 53 00:03:29,080 --> 00:03:33,440 menopause so many stages, there is a reason for them to the 54 00:03:34,640 --> 00:03:38,280 obesity increases gradually from childhood. 55 00:03:38,760 --> 00:03:42,200 So that is alarming where you can see that women, the 56 00:03:42,200 --> 00:03:46,000 percentage, the millions are more among women compared to 57 00:03:46,320 --> 00:03:49,920 men. So all these biological changes 58 00:03:49,920 --> 00:03:54,200 influence women and the obesity rates are high among them. 59 00:03:54,640 --> 00:03:58,440 They have to take care of women, particularly because they they 60 00:03:58,440 --> 00:04:03,440 don't think it is important to look at, take care of their 61 00:04:03,440 --> 00:04:06,920 health, whereas they only want to take care of their family's 62 00:04:06,920 --> 00:04:09,040 health. They are not taking care of 63 00:04:09,040 --> 00:04:11,400 themselves. That's very, very important. 64 00:04:12,600 --> 00:04:16,839 Also, could you talk about the non communicable diseases, the 65 00:04:16,839 --> 00:04:20,040 burden that India has and the findings of the study? 66 00:04:20,040 --> 00:04:23,160 What does it reveal about how vulnerable we are to these non 67 00:04:23,160 --> 00:04:27,040 communicable diseases? Non communicable disease include 68 00:04:27,040 --> 00:04:31,880 cardiovascular disease, cancers, respiratory disorders, diabetes. 69 00:04:32,240 --> 00:04:38,560 So what happens is this increase is seen due to various causes 70 00:04:38,840 --> 00:04:41,880 including lifestyle changes, urbanization. 71 00:04:42,280 --> 00:04:46,360 Earlier it was very less. Now it is really a huge burden 72 00:04:46,360 --> 00:04:50,760 in India and you can see that the common risk factors are 73 00:04:50,760 --> 00:04:55,120 there like hypertension, obesity, all these are common 74 00:04:55,120 --> 00:04:59,400 risk factors in cities and you can see that due to the stress 75 00:04:59,400 --> 00:05:05,040 which people are undergoing now work stress, the at home 76 00:05:05,360 --> 00:05:08,440 children have stress at school studying. 77 00:05:08,760 --> 00:05:13,080 So earlier it was all mostly playful and the children used to 78 00:05:13,080 --> 00:05:18,560 play but now schools mostly they do not have place like for doing 79 00:05:18,560 --> 00:05:21,640 their physical activity. When you go to a workplace 80 00:05:21,640 --> 00:05:24,720 mostly they are sitting. So the cerentialism has 81 00:05:24,760 --> 00:05:29,520 increased and the screen time, mobile time that has all 82 00:05:29,520 --> 00:05:33,440 increased which is one of the Causeway as well as the diet 83 00:05:33,440 --> 00:05:36,440 part. When you look at diet pattern, 84 00:05:36,440 --> 00:05:41,880 the traditional diets including whole grains, pulses, fruits and 85 00:05:41,880 --> 00:05:44,280 vegetables, green leafy vegetables, all this has 86 00:05:44,280 --> 00:05:50,040 disappeared and now all refined foods, sugary items like drinks 87 00:05:50,040 --> 00:05:53,040 and everything has come up and also junk foods. 88 00:05:53,520 --> 00:05:57,720 So the intake of fruits and vegetables which WHO recommends 89 00:05:58,040 --> 00:06:03,000 is at least five servings per day of fruits and vegetables. 90 00:06:03,560 --> 00:06:07,480 But in our ICMR India have said the national study which we are 91 00:06:07,480 --> 00:06:10,320 the National Coordinating Centre, Metas Diabetes Research 92 00:06:10,320 --> 00:06:16,920 Foundation, we found that only 2.5 is the servings. 93 00:06:16,920 --> 00:06:22,840 They take maximum 2 to 2.5 S where how will they get that 94 00:06:22,840 --> 00:06:26,080 recommendation? So now even who has increased 95 00:06:26,080 --> 00:06:29,160 the physical activity recommendation to 150 minutes 96 00:06:29,160 --> 00:06:33,640 per week to 300, we are not getting that 150 itself. 97 00:06:34,480 --> 00:06:37,760 How will people manage to get the three 300 per week? 98 00:06:38,840 --> 00:06:45,400 But if they do have an idea and think about how they have to 99 00:06:46,000 --> 00:06:49,960 keep themselves fit, then all these have to be followed. 100 00:06:51,280 --> 00:06:55,080 One of the headlines that I mean a lot of the media organizations 101 00:06:55,080 --> 00:06:58,760 focused on was the fact that 1.25 crore Indian children are 102 00:06:58,760 --> 00:07:02,200 now overweight. How much of A concern is that at 103 00:07:02,200 --> 00:07:06,160 this point given it's still currently restricted to maybe 104 00:07:06,280 --> 00:07:10,480 the richest portion of India in a sense and there is a large 105 00:07:10,480 --> 00:07:13,600 segment that isn't in that category just yet? 106 00:07:14,840 --> 00:07:19,760 Schools have to promote good eating habits and increase 107 00:07:19,760 --> 00:07:23,600 physical activity. Apart from the regular classes, 108 00:07:23,880 --> 00:07:27,840 that is very, very important. That is mainly in the middle and 109 00:07:27,920 --> 00:07:31,880 upper social economic classes where I'm talking about they 110 00:07:31,960 --> 00:07:35,520 This has to be taken up by the schools to promote healthy 111 00:07:35,760 --> 00:07:39,320 living among children. And what happens to those who 112 00:07:39,320 --> 00:07:41,560 are not in that category just yet? 113 00:07:41,560 --> 00:07:45,600 What, for you is the action to be taken in that case, where you 114 00:07:45,600 --> 00:07:48,080 have a lot of children who are perhaps not getting adequate 115 00:07:48,080 --> 00:07:51,840 nutrition? Yes, that also we have to take 116 00:07:51,840 --> 00:07:55,960 care and government has to look into this because this is mostly 117 00:07:56,240 --> 00:08:02,240 the low socio economic group going into this category and in 118 00:08:02,240 --> 00:08:04,560 schools like noon meal that is good. 119 00:08:04,840 --> 00:08:08,880 So maybe they can also give breakfast to them. 120 00:08:09,240 --> 00:08:14,320 What we can say is even awareness to the people in lower 121 00:08:14,320 --> 00:08:17,960 socio economic parents, we have to target parents there. 122 00:08:18,560 --> 00:08:22,360 So we need to see that parents give healthier foods. 123 00:08:22,760 --> 00:08:28,680 They have to increase their proper balanced diet as well as 124 00:08:28,680 --> 00:08:32,240 healthy diet. But wouldn't that be a problem, 125 00:08:32,240 --> 00:08:34,520 especially for somebody who is poorer? 126 00:08:34,520 --> 00:08:37,000 Because like, it's something that even the study notes that 127 00:08:37,440 --> 00:08:41,679 for a poorer person, a healthier meal is costlier and is actually 128 00:08:41,679 --> 00:08:45,600 may be out of reach. As you say even vegetables, 129 00:08:45,600 --> 00:08:50,200 fruits all have become costly. So we cannot ask them to take 5 130 00:08:50,200 --> 00:08:53,640 servings at least one to two servings as whatever they are 131 00:08:53,640 --> 00:08:58,560 taking because they have all forgotten about vegetables and 132 00:08:58,800 --> 00:09:03,440 fruits. One is cost then also like the 133 00:09:03,880 --> 00:09:08,520 unhealthy fat, saturated fat which they are taking fried 134 00:09:08,520 --> 00:09:11,120 items. So we can at least tell them 135 00:09:11,120 --> 00:09:14,720 that these foods are unhealthy. These foods are healthy, give 136 00:09:14,720 --> 00:09:18,280 them the healthy choice and see millets and all are not that 137 00:09:18,280 --> 00:09:21,160 costly. So they have to move to 138 00:09:21,160 --> 00:09:24,760 traditional foods which are low cost. 139 00:09:24,960 --> 00:09:28,360 So we need to give them ideas like which is healthy, which is 140 00:09:28,360 --> 00:09:31,320 non healthy. Those we need to tell them and 141 00:09:31,320 --> 00:09:34,560 educate the parents at least the women who are looking for the 142 00:09:34,560 --> 00:09:36,400 children. That's very, very important. 143 00:09:37,600 --> 00:09:41,240 There are also questions over the body mass Index measure 144 00:09:41,240 --> 00:09:44,920 itself about whether it is the best measure for obesity. 145 00:09:45,200 --> 00:09:48,760 So could you explain why BMI data was then used for this 146 00:09:48,760 --> 00:09:51,200 study? And are there any better metrics 147 00:09:51,200 --> 00:09:54,800 that you'd like to see for measurement of obesity, at least 148 00:09:55,040 --> 00:10:00,040 going ahead? See, obesity can be measured in 149 00:10:00,440 --> 00:10:04,240 two ways. One is BMI which regularly that 150 00:10:04,240 --> 00:10:06,200 is just we need a height and weight. 151 00:10:06,640 --> 00:10:08,520 The other one is waist circumference. 152 00:10:09,080 --> 00:10:13,400 Abdominal obesity is measured by using waist circumference. 153 00:10:13,840 --> 00:10:17,200 Many studies have shown that waist circumference that is 154 00:10:17,240 --> 00:10:23,560 abdominal obesity is more risk than the generalized obesity 155 00:10:23,560 --> 00:10:28,200 which we use BMR. So therefore even just a waist 156 00:10:28,200 --> 00:10:34,640 measurement is just enough. So we do have diabetes risk O 157 00:10:35,280 --> 00:10:39,080 with us where we have just four simple questions which is 158 00:10:39,080 --> 00:10:44,760 developed by MDRF. You need age, you need a waist 159 00:10:44,760 --> 00:10:48,760 circumference, even a pant size or whichever you may not have 160 00:10:48,760 --> 00:10:52,680 measured your waist there. You have a pant size then family 161 00:10:52,680 --> 00:10:56,400 history and how active are you. Just post all questions and we 162 00:10:56,400 --> 00:11:02,600 have diabetes IDRS risk. So this can be used to just 163 00:11:02,600 --> 00:11:06,400 screen whether they are at risk for diabetes. 164 00:11:06,520 --> 00:11:11,560 Even even many studies have validated for other disorders. 165 00:11:11,560 --> 00:11:15,360 Also whether this is useful even for identifying diabetes 166 00:11:15,360 --> 00:11:20,040 complications we can use this. So simple risk tools are very 167 00:11:20,040 --> 00:11:23,960 important. And are these trends, especially 168 00:11:23,960 --> 00:11:27,920 for the obesity numbers that are there, are they reversible in 169 00:11:27,920 --> 00:11:30,160 any way? And how would one even go about 170 00:11:30,160 --> 00:11:33,640 doing that? Yes, now we are also showing 171 00:11:33,640 --> 00:11:39,800 that diabetes is reversible if you have lifestyle changes, just 172 00:11:39,800 --> 00:11:44,080 physical activity and dietary pattern changes and reducing 173 00:11:44,080 --> 00:11:47,120 stress. But what you can do is try to 174 00:11:47,120 --> 00:11:52,000 reduce the burden. So this needs effort from the 175 00:11:52,000 --> 00:11:58,120 government side, NGOs, schools, organisations, family itself, 176 00:11:58,440 --> 00:12:02,480 all of them need to take a few steps towards this. 177 00:12:02,720 --> 00:12:05,560 Then only the whole the burden can be reduced. 178 00:12:06,640 --> 00:12:09,360 Basically, something that you'll point out in the paper also is 179 00:12:09,360 --> 00:12:14,080 that a lot of efforts are pointed at individuals and you 180 00:12:14,080 --> 00:12:16,680 know, individuals are told you need to do something about it, 181 00:12:17,000 --> 00:12:21,080 but there is a larger systemic change also that's needed, 182 00:12:21,080 --> 00:12:23,200 right? And how do we go about changing 183 00:12:23,200 --> 00:12:26,280 that? We need government policies, 184 00:12:26,280 --> 00:12:29,920 community initiators apart from individual actions. 185 00:12:30,240 --> 00:12:34,320 So children's parents as well as educators should be educated 186 00:12:34,320 --> 00:12:38,200 about the importance of balanced diet, regular physical activity 187 00:12:38,520 --> 00:12:40,960 and the risks associated with obesity. 188 00:12:41,400 --> 00:12:44,760 Schools can incorporate a nutrition and physical education 189 00:12:44,760 --> 00:12:48,800 into the curriculum to promote healthy habits right from the 190 00:12:49,000 --> 00:12:53,160 younger age. And also they need to know that 191 00:12:53,480 --> 00:12:57,000 at least for children, at least 60 minutes of physical activity 192 00:12:57,360 --> 00:13:01,400 per day is recommended so that they stay fit and healthy. 193 00:13:01,960 --> 00:13:04,800 And at the government level, policies that regulate the 194 00:13:04,840 --> 00:13:08,760 marketing and sale of unhealthy foods, that's very, very 195 00:13:08,760 --> 00:13:12,480 important, and beverages to children, such as restricting 196 00:13:12,480 --> 00:13:16,680 junk food, advertisements targeted at children, clear 197 00:13:16,680 --> 00:13:20,560 nutritional labeling is needed and promoting healthier options 198 00:13:20,560 --> 00:13:24,640 in school canteens. All these can be implemented at 199 00:13:24,640 --> 00:13:29,480 the school level. Also, there should be increased 200 00:13:29,600 --> 00:13:34,520 accessibility and to affordable and healthy food choices, which 201 00:13:34,520 --> 00:13:37,920 is lacking now. And by bringing up these 202 00:13:37,920 --> 00:13:42,400 changes, it will be possible to reverse the trend of rising 203 00:13:42,560 --> 00:13:46,480 obesity rates among boys and girls as well as adults. 204 00:13:46,800 --> 00:13:49,600 We need a multifaceted approach to this. 205 00:13:50,720 --> 00:13:54,560 So there is a push to label foods better here to improve 206 00:13:54,560 --> 00:13:57,760 nutritional information, particularly on processed foods. 207 00:13:58,240 --> 00:14:02,120 What does India need to do in this regard, given its 208 00:14:02,120 --> 00:14:06,160 consumption is still far lower than many advanced economies? 209 00:14:07,040 --> 00:14:08,960 The. Consumption of processed food is 210 00:14:08,960 --> 00:14:12,920 lesser compared to Western countries, but it is of great 211 00:14:12,920 --> 00:14:18,280 concern here because that is also one problem caused which is 212 00:14:18,280 --> 00:14:22,400 leading to obesity and other health conditions. 213 00:14:22,840 --> 00:14:28,640 Now there are some laws coming up saying that all processed 214 00:14:28,880 --> 00:14:33,880 foods should have labelling so that people are aware of what it 215 00:14:33,880 --> 00:14:38,560 contains and this is coming up and many of them are aware of 216 00:14:38,560 --> 00:14:41,640 that. Now this is very useful because 217 00:14:41,640 --> 00:14:45,240 the labelling is very, very important and also like even 218 00:14:45,600 --> 00:14:49,880 what even other processed foods like even in canned drinks and 219 00:14:49,880 --> 00:14:55,240 everything, how many calories it has, what artificial flavours 220 00:14:55,240 --> 00:14:58,480 have been added, everything. The government is working on it 221 00:14:58,520 --> 00:15:04,440 and it is very actually it is a good move to reduce this intake 222 00:15:04,440 --> 00:15:07,920 of processed foods so once they are aware of what the contents 223 00:15:07,920 --> 00:15:12,000 are then they will restrain from taking those items. 224 00:15:15,760 --> 00:15:19,680 Today's episode was produced by Jayaraj Singh and Sahil Gupta. 225 00:15:20,240 --> 00:15:22,520 For a daily spotlight on. People, ideas and. 226 00:15:22,520 --> 00:15:24,720 Stories that matter subscribe to us. 227 00:15:25,080 --> 00:15:29,520 We are available on TOI, Spotify, Apple, Google Podcasts 228 00:15:29,720 --> 00:15:31,520 and all other platforms of your choice. 229 00:15:31,960 --> 00:15:36,960 For any news tips, e-mail us at TOI Podcast at Timesinternet in.