If you were asked what topped the list of chronic diseases, you might be tempted to answer diabetes, or high blood pressure, or heart disease, or asthma. However, the World Health Organisation has placed obesity on top of the list!
So, does a country like India have to worry? The biggest health epidemic that India will face in the coming decade is not going to be the infections that we are familiar with, such as malaria, tuberculosis or HIV. The epidemic that is going to strain the economy of our country is going to be the disastrous complications directly resulting from obesity: diabetes, high blood pressure, heart diseases and pregnancy complications.
It is estimated that India and China will lose $900 billion of national income between 2005 and 2015 to diabetes and cardiovascular disease. As our economic star is on the ascension, obesity and its consequences threaten to pull us down.
The root cause of obesity
With relative prosperity, Indians now have access to an excess of food. We have moved away from traditional, healthy foods that included large amounts of fibre to highly processed foods full of sugar and empty calories. This change of diet, along with the availability of machines to help with housework, has unleashed the spectre of obesity into our midst.
Women are at risk
The combination of obesity and its associated diseases affects more women than men. The impact that obesity has on women is far-reaching and affects their quality of life and indeed, their mortality itself. Since obesity is a risk factor for diabetes, the mushrooming incidence of obesity in developing countries has caused diabetes to race ahead of other diseases. The shocking fact is that four out of every five women with diabetes are living in a developing country.
The International Federation of Diabetes projects that more women than men will die of diabetes and diabetes-related complications (such as kidney failure and coronary heart disease). In a country where a woman's life is valued less than a man's, even Nature is conspiring against her. One of the major consequences of obesity is its effect on the knees. For every excess kilo that a woman carries, her knees feel a pressure of four kilos. With obesity, the knee joints get worn out and become excruciatingly painful. Unable to walk and exercise, these women pile on more weight and enter a vicious cycle of obesity and pain.
Is it only urban women who are at risk for obesity? While it has been estimated that 50 per cent of urban women in India are obese, the shocker is that 20 per cent of women in rural areas are obese.
Obesity and pregnancy
When I started my practice nearly 30 years ago, the average weight of a pregnant woman at her first check-up was well below 60 kg. Today, the average weight ranges between 65 and 75 kg. BMIs of more than 25 (overweight) and 30 (obese) have become commonplace. Overweight and obese pregnant women face major health risks. They are prone to developing diabetes in pregnancy (gestational diabetes) and high blood pressure (pregnancy-induced hypertension). They also face complications, and even death, if they have to undergo a Caesarean section.
Cultural and economic forces are literally shaping the Indian pregnant woman. In a country, where in recent memory, food shortages were the rule rather than the exception, the economic freedom to eat well is pushing husbands and parents to thrust food at the pregnant woman. In a misguided effort to make the growing foetus ‘healthy', the pregnant woman is coerced into eating calorie-rich food.
Lack of exercise
To the woes of overeating can be added the largely sedentary lifestyle that has become the curse of our society. The software revolution has resulted in thousands of women who hardly get any exercise. Added to this is the foolish notion that being active can harm a pregnancy.
Not a day passes when I am not asked, “Can my pregnant wife climb stairs?” That climbing stairs will harm the baby is a completely erroneous belief. Pregnant women can run up and down the stairs, go to work and be absolutely active without any harm to the foetus.
What is the solution?
The first line of defence against obesity is diet and exercise. This can be a challenge and needs to be approached with determination. Fitness has to be the goal we should all aspire to, to make sure that we continue to be healthy and disease free. The next four columns will give guidelines for dietary and physical fitness.
The author is an obstetrician and gynaecologist practising in Chennai and has written the book 'Passport to a Healthy Pregnancy'.www.passport2health.in
