MADHUMEHA (DIABETES Mellitus) and obesity, described by our ancient physician Charaka, at about 400 to 500 BC have become global health problems afflicting millions of people worldwide. In his Charaka samhita he observed that madhumeha was prevalent in those who indulged in excess intake of milk, curd, jaggery, sugar, meat of animals from marshland, cereals that are less than a year old and recently distilled alcohol, laziness, excessive sleep and inactivity.

Causes for obesity

Charaka attributed indolenence and gluttony as important causes for obesity. Charaka visualised the link between obesity and diabetes, but modern medicine established the mechanism involved in diabetes causing obesity.Obesity is defined as excess body fat relative to the weight. Genetic susceptibility plays a role both in diabetes and obesity but it is modifiable by environmental circumstances and individual life style choices; described as "genetic loads the gun and environment triggers it off."

Major factors

The profound changes in the eating habits, rapid industrialisation, mechanisation of agriculture, lack of physical activity and stress of modern life have all contributed to the epidemic of diabetes and obesity.The relationship between obesity and diabetes is of such inter-dependence that the term `diabesity' has been coined. When the amount of energy (calories) consumed exceeds the energy spent by way of physical activity and for metabolic processes, it results in positive energy balance and excess calories are stored in the fat tissue (adiposity) and the weight increases. The greatest concern at present is that the unfavourable life style patterns are no longer an issue only for adults but also in children and adolescents. A recent survey of school children of Delhi revealed that nearly 30 per cent of the children are obese due to consumption of fast food/junk food and lack of exercise.

Junk food

It is true that junk food causes obesity but to wean them away from the addiction to junk food may take a long time. While efforts are being taken to drive home the ill effects of fast food by a sustained campaign, the virtues of healthy food habits should also be simultaneously propagated. Low cost physical activity is an underutilised resource. Inclusion of physical activity is particularly important in a weight loss programme compared with diet restriction alone. The nihilistic attitude that it is difficult to persuade children to refrain from unhealthy food habits and adopt a healthy life style modification is not justifiable. Singapore has shown the way that it is possible. In 1992, the education ministry commenced a `trim and fit' programme for school children to reduce obesity and improve physical fitness.

Exercise programmes

Nutrition education was integrated in the curriculum, special enjoyable exercise programmes were introduced and most importantly the food and beverage availability in the school proximity was controlled. By 2002 the prevalence of obesity among children reduced remarkably. Similar programmes are urgently needed in our country also. Having the knowledge is not enough and it is necessary to apply the knowledge.`Catch them young' is the first step in the preventive strategy as the continuously increasing weight and obesity in childhood results in overall risk of type 2 diabetes.

Public awareness

The need of the hour is for a joint effort by the government and NGOs to create public awareness and enlist the co-operation of parents and school authorities in the prevention of diabesity. Making physical training compulsory is the least expensive and most effective in promoting physical fitness. People should aim for the cosmetically contoured constitution and not for the fat flabby figure. DR. V. SESHIAH

Director
Dr. V. Seshiah Diabetes Care and Research Institute
Chennai