Dr VK Sahgal has a flourishing medical practice in two posh colonies of New Delhi. Patients often insist on visiting him at home if he is unable to see them during consultation hours. His speciality is what he refers to as lifestyle diseases prevalent among women.
“I don’t believe in prescribing medicine,” he says. “Most of my consultations are monotonous lectures on a balanced diet, the importance of exercise and the harmful effects of smoking and alcohol.”
After some reluctance, he lets me sit through one of his consultation sessions.
A young woman enters the room dressed in western clothes — blouse, trousers, blazer and high heels. She had scheduled an appointment at his home.
Even without looking at her, Dr Sahgal asks her to remove her jacket and heels and step on the weighing machine before she sits down. He notes the weight: 68 kg. The second and third questions, while scribbling notes, are her age and height. The answers are 26 and 5 feet 4 inches, respectively.
Later, she crouches in the bucket chair and talks about hair growth on her chest and back, irregular periods and acne. The immediate diagnosis is polycystic ovary syndrome (PCOS). Dr Sahgal starts counselling her in what he had told me is usual in almost every case.
“I can give you medicines to control hair growth, treat the acne and regularise periods, but you can cure yourself only with a modification in your lifestyle,” he says.
“What do you mean?” the patient asks.
The next 25 minutes are spent in advising the patient to exercise every day, lose weight, eat the right kind of food — more protein and less carbs — and watch her diet to control PCOS. The patient tells him that she is an editor with a publishing house, grew up reading fiction, loves her job and is not fond of exercising.
When she leaves, Dr Sahgal reveals that in the past decade he has seen a surge in the number of patients whose diseases are linked to lifestyle, particularly obesity.
“Increasing incomes in urban India has resulted in the intake of calorie-intense food, more alcohol consumption, smoking and no physical exercise,” he says. “What is dangerous is that all educated professionals seem to have limited knowledge on health and nutrition. Girls ask me, ‘How can I have diabetes when I don’t eat sugar?’ There are too many myths. That all food breaks down to sugar needs to be explained.
“I have to tell them that breakfast is an important meal, explain what a balanced diet is and how much protein and carbs the body needs every day and that 45 minutes of daily exercise is crucial.”
Dr Ritesh Gupta, additional director of Fortis C-DOC Hospital, explains that PCOS is caused due to obesity in girls as young as 13. Obesity can lead to resistance to insulin, which affects the ovaries. Apart from obesity, the other risk factors are lack of exercise and balanced diet.
According to Dr Gupta, the number of PCOS patients has seen a phenomenal increase in urban India over the past decade and the associated dangers are too many.
“A decade ago, I saw one patient of PCOS a month; now I see five every day,” he says. “A majority of them are obese adolescent girls, who are at an increased risk of getting diabetes and hypertension, which are also a growing occurrence among women.”
The last National Family Health Survey, conducted in 2005-06, reported that overweight/obesity affected almost 15 percent of women and 12 percent of men, mostly in urban areas.
The National Sample Survey conducted in 2014 has recorded an alarming increase in the consumption of fat in every state, indicating that the extent of obesity has increased. The average daily fat intake in urban India has risen from 42 g to 52.5 g — an increase of more than 10 g in about two decades.
According to the World Health Organisation (WHO), India is the third most obese country in the world after China and the US, with more obese women than men.
A combined study by Fortis C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology; National Diabetes, Obesity and Cholesterol Foundation; Diabetes Foundation (India), and the Centre for Nutrition and Metabolic Research titled ‘Obesity and the Metabolic Syndrome in Developing Countries: Focus on South Asians’ noted that “as the economic situation improves, an increasing prevalence of obesity and metabolic syndrome is seen in developing countries in South Asia”, with women and children being particularly vulnerable.
It is not just the urban rich who are suffering from lifestyle diseases. Dr Gupta says that he is seeing more and more cases of hypertension, diabetes and obesity among poor women from urban India as well.
“A nutritious diet includes fruits and vegetables, which the slum-dwellers are struggling to buy,” he says. “Women are particularly vulnerable to obesity and obesity-related diseases, including hypertension and diabetes because their lives are sedentary.”
The private health sector is catching up in urban areas to treat the wealthy, but the public health system is still blind to increasing prevalence of lifestyle diseases.
“India is going through an epidemiological transition,” says Anjali Bhardwaj, a medical anthropologist and maternal health consultant with Oxfam. “People in low- or middle-income countries initially suffer from communicable diseases such as malaria, hunger and maternal mortality and then transition to lifestyle diseases as their incomes rise.
“India is currently facing both — urban areas have transitioned to lifestyle diseases even when hunger, maternal mortality and communicable diseases are prevalent in rural regions. However, the public health system is geared towards communicable diseases, under-nutrition and preventing maternal deaths. Lifestyle diseases are almost entirely ignored in policymaking.”
In a report on non-communicable diseases in 2014, the who said that one out of four Indians above the age of 30 faces the risk of dying from lifestyle diseases. The report stated that India did not have a policy plan to reduce non-communicable diseases in relation with risk factors or a proper monitoring and surveillance system.
The study on obesity in South Asian notes that programmes focussing on increased physical activity and healthier food options for schoolchildren could play a major role in tackling obesity-related diseases.
However, India’s health policy is silent on creating such awareness. Neither the National Urban Health Mission nor the preliminary report of the high-level committee on the status of women, formed by the Ministry of Women and Child Development, pays any heed to obese women vulnerable to lifestyle diseases.
An official with the Ministry of Women and Child Development told Tehelka on the condition of anonymity that the National Nutrition Mission — the brainchild of Union minister Maneka Gandhi — also remains mum on obesity and related diseases among women..