Q&A WITH DR. C. GOPALAN, LEADING INDIAN AUTHORITY ON GLOBAL NUTRITION AND HEALTH

Following is a Q&A with Dr. C. Gopalan, M.D., FRS, President, Nutrition Foundation of India, New Delhi, India


1. What are the main nutrition and health challenges facing India today?

Stunting and under-nutrition in children from poorer segments of the population and the rising incidence of obesity and Type II diabetes mellitus among the relatively affluent are major health-related issues in the country today.


2. Very early on, you recognized and publicized the growing problem of chronic diseases in the developing world. How is India faring today on the chronic-disease front, specifically with regard to: (1) diabetes; (2) heart disease; and (3) cancer?

There has been a progressive increase in the prevalence of diabetes and cardiovascular disease in the country, both in urban and in rural areas. Prevalence of cancers in India has not increased, although there has been a change in the type of cancers we are seeing. For instance, there has been a reduction in cancer of the cervix in women, but an increase in breast cancer; in men, we have seen a reduction in oral cancer, but an increase in lung cancer. The data on the time trends in these diseases is in the NFI publication, "Dual Nutrition Burden in India," which can be found on the Web at nutritionfoundationofindia.res.in


3. In a 1998 report, you estimated the prevalence of abdominal obesity in India to be between 20 and 30 percent, projecting that it will double between 2002 and 2010. Where does India stand with less than three years to go? Have your projections changed, and if so, how and why?

In urban areas, there is an increase in the prevalence of abdominal obesity even among relatively younger individuals from middle-income groups.

Bhargava and co-workers have shown that in urban Delhi in the 1990s even low middle-income adults who were undernourished in infancy, childhood and adolescence develop obesity -- both general and abdominal -- hypertension and diabetes by the time they are 30.

Time Trends in Nutritional Status of Delhi Cohort

 

Male

Female

Age

No.

Weight

(Kg)

No.

Weight

(Kg)

At birth

803

2.89±0.44

561

2.79±0.38

2 yrs

834

10.3±1.3

609

9.8±1.2

12 yrs

867

30.9±5.9

625

32.2±6.7

30 yrs

886

71.8±14.0

640

59.2±13.4

Source: SK Bhargava, et al 2004

 

Current Status of Delhi Cohort:
Prevalence of Abdominal Obesity In Middle-Class Males & Females in India

Characteristic

Men

Women

No.

Value

No.

Value

Weight (Kg.)

886

71.8±14.0

640

59.2±13.4

Height (m)

886

1.70±0.06

638

1.55±0.06

BMI

886

24.9±4.3

638

24.6±5.1

Waist:Hip ratio

886

0.92±0.06

639

0.82±0.07

BMI>_25

BMI>_23

886

886

47.4

66.0

638

638

45.5

61.8

Central Obesity (%)

886

65.5

639

31

Impaired GTT

849

16

539

14

Source: SK Bhargava, et al 2004


4. What has been and is being done through government programs to address Indiaís nutrition and health issues on a national level?

There have been several initiatives to improve the nutritional status of the population between 1950-1990, including the following:

- Increasing food production - building buffer stocks
- Improving food distribution - building up the Public Distribution System
- Improving household food security through

  • Improving purchasing power
  • Food for Work programme
  • Direct or indirect food subsidy

- Food supplementation to address special needs of the vulnerable groups - Integrated Child Development Services (ICDS), Mid-Day Meals
- Nutrition education, especially through the Food and Nutrition Board and ICDS
- Efforts of the health sector to tackle

  • Adverse health consequences of under-nutrition
  • Adverse effects of infection and unwanted fertility on the nutritional status
  • Micronutrient deficiencies and their health consequences

Review of the situation in 2000-2001, prior to the formulation of India's Tenth Five-Year Plan (Planning Commission, 2002), showed that, while under-nutrition and micronutrient deficiencies continued to be major public health problems, over-nutrition and obesity were also emerging as major problems in many states. With this in mind, the Tenth Plan envisaged a paradigm shift from:

  • Household food security and freedom from hunger to nutrition security for the family and the individual
  • Untargeted food supplementation to the screening of all persons from vulnerable groups, identification of those with various grades of under-nutrition, and appropriate management
  • Lack of focused interventions on the prevention of over-nutrition to the promotion of appropriate lifestyles and dietary intakes for the prevention and management of over-nutrition and obesity.

Effective implementation of focused and comprehensive interventions aimed at improving the nutritional and health status of the population was given the highest priority. It was emphasized that the increased outlays to combat the dual nutrition burden should result in improved outcomes and outputs in terms of reduction in both under- and over-nutrition.

The rationale for the paradigm shift is now understood, and efforts are underway to implement interventions to combat the dual nutrition burden. But in a vast and varied country like India with large interstate and inter-district variations in the magnitude of the nutritional problems, access to services and ability of the population to utilize available services, it is not possible to expect substantial improvement in nutritional status within a short period of five years.


5. What are nongovernmental organizations (NGOs) doing to combat these problems? Whatís been the impact of these national and nonprofit initiatives to date?

NGOs like the Nutrition Foundation of India carry out field studies, which help to identify problems and solutions related to health and nutrition. The results of these studies are passed on to governmental agencies that support the implementation and evaluation of specific projects related to health and nutrition. NFI field studies and their data have contributed to the improvement of India's Goitre control and ICDS programmes, among others. Independent NGOs continue to experience difficulties in raising adequate financial support for carrying out meaningful programmes that could help identify alternative strategies.


6. What is the toll of Indiaís nutrition and health issues on the countryís children and other vulnerable populations, and how is this being addressed?

Due to the multi-pronged strategies to address under-nutrition, there has been a progressive decline in under-nutrition rates in preschool children in India. Data from surveys conducted by the National Nutrition Monitoring Bureau and from National Family Health surveys have shown that there has been substantial reduction in severe under-nutrition and some reduction in moderate under-nutrition in preschool children in India; however, the pace of this decline has been slow. The graphs below depict the reduction in underweight, stunting and wasting over time.


7. What, in your opinion, are the two best approaches to improve Indianís health conditions from childhood, considering school and home intervention, as well as national programs targeting different age groups?

The two best approaches are:

  1. Improvement of the school system and the institution of a comprehensive school health service, which will address the practical health needs of children and their parents. Also, institution of a National Health Scout Movement in schools would sensitize students and parents to health and nutrition problems, and equip them for better citizenship.
  2. An intensive programme of focused nutrition education to rural adolescent girls (school dropouts) and mothers of tomorrow to help improve childrearing and household diets, and health and nutrition education beamed to the work places of the urban middle-class to encourage them to improve their lifestyles.
 



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