Diabetes is a major health challenge, particularly in a developing country like India. Yet, we seem to be closing our eyes to this silent killer. Increasingly, younger people, including children, are developing diabetes, with the potential to cause serious complications that can derail lives and overwhelm health care budgets.
With India being at the threshold of an outbreak of obesity, insulin resistance syndrome and type-2 diabetes in children and adolescents, it is of immediate importance that we focus on the primary prevention of obesity and inculcation of healthy diet/ life style practices be started from infancy. Children/adolescents (especially those residing in urban areas) are at an increased risk for development of early onset of type-2 diabetes and coronary heart disease, more so due to nutritional westernization and sedentary life styles.
Similar sentiments were expressed by Dr Martin Silink, president of the International Diabetes Federation (IDF). He lamented that schools were not encouraging sports and that computers were overtaking the play fields. He wished that people would go back to the sensible living of yesteryears and make the children rubbish the junk food and their sedentary life style. They need to walk/ cycle/ run/ play, rather sit for long hours before the television/ computers. Otherwise diabetes and other non communicable diseases will subvert the gains of economic development in India. He also advocated the concept of ‘health screening’ of children at the school level. Singapore is already doing this and so is Japan, which is witnessing an unprecedented increase of type-2 diabetes in children.
The aim of the International Diabetes Federation (IDF) is to alleviate human suffering related to diabetes by focusing on prevention and care right from womb to adulthood. The ultimate aim is to encourage governments, policy makers and funding bodies worldwide to prioritize prevention and care. If appropriate public health action is not taken, disability and premature deaths from heart disease, cancer, diabetes and chronic heart disease will grow by more than 21% in Southeast Asia over the next 10 years.
The theme of the World Diabetes Day (WDD) for 2009-2013 is "Diabetes education and prevention." The World Diabetes Day (WDD) campaign is led by the International Diabetes Federation (IDF) and its member associations. The WDD campaign calls on all those responsible for diabetes care to understand diabetes and take control. For people with diabetes, this is a message about empowerment through education. For governments, it is a call to implement effective strategies and policies for the prevention and management of diabetes to safeguard the health of their citizens with and at risk of diabetes. For healthcare professionals, it is a call to improve knowledge so that evidence-based recommendations are put into practice. For the general public, it is a call to understand the serious impact of diabetes and know, where possible, how to avoid or delay diabetes and its complications.
The World Diabetes Day (WDD) campaign slogan for 2009 is "Understand Diabetes and Take Control". Diabetes is difficult. The disease imposes life-long demands on the 250 million people now living with diabetes and their families. People with diabetes must deliver 95% of their own care, so it is of paramount importance that they receive ongoing, high-quality diabetes education that is tailored to their needs and delivered by skilled health professionals. In addition, IDF estimates that over 300 million people worldwide are at risk for type 2 diabetes.Type 2 diabetes can be prevented in the many cases by helping and encouraging those at risk to maintain a healthy weight and take regular exercise.
India’s former union health minister, Dr Anbumani Ramadoss, voiced similar concerns. He was emphatic that the aim of policies on health promotion should be to stimulate health awareness and to promote conditions which favored positive health. He was of the opinion that food labeling should become mandatory in India, wherein all packaged food have to contain information about weight, and the nutritive/caloric value of the ingredients used. He emphasized that the threat from junk food should be taken seriously and that schools should ensure that no junk food—from pizzas to ‘samosas’ - is sold in school canteens, to create a facilitating environment for the students. He also underlined the importance of teaching Yoga compulsorily to school children, as it had proven beneficial effects on one’s physical and mental health.
Health initiatives taken at the family and community level will have the potential to snowball into a major health movement, which is indeed the need of the hour.
The role of parents, community, schools and teachers in contributing to the health of a nation is of paramount importance.
The World Health Organization (WHO) Director-General’s Awardee (2005) Professor (Dr) Rama Kant who heads the Diabetic-Foot Care clinic in Department of Surgery, CSM Medical University, Lucknow, is of the opinion that the role of family and community will determine which way we want to proceed: the sweet path leading to bitter results or a healthy lifestyle. According to him, glucose monitoring in type-1 diabetes (a metabolic disorder in which the body produces insufficient insulin), requires constant family support. Type-2 diabetes is linked to obesity which in turn is linked to modern lifestyle changes. Parents are overworked and find it convenient to let their children feed on fast foods from an early age. High burden of school work, craze for the internet and lack of appropriate play areas in schools and around homes makes it difficult for them to remain active. Keeping this in mind, Prof Rama Kant is currently running the diabetes education project called ‘MARG’ (path), in many schools of Lucknow, with a view to prevent obesity and diabetes through healthy eating and active living.
According to Dr Samlee Plianbangchang, the regional director of WHO’s South East Asian Regional Office (SEARO), one should not live to eat but eat to live. His simple mantra to avoid diabetes is to eat a proper diet (‘no gulabjamuns, please’ he said jokingly) and do regular exercise. He quoted himself as an example of bringing down his blood sugar levels simply by leading a disciplined life. He wanted the media to play a major role in advocating awareness about the benefits of a balanced diet and wished that the ‘anti cola drive’ should not lose its fizz and should be carried forward.
So the message is loud and clear. The prevention programme for diabetes and other non communicable diseases should start from the time of conception of the child in the womb. The pregnant mother should take all precautions to avoid gestational diabetes by managing her diet and physical activity. Once the child is born, proper food habits and tastes need to be developed in her/him right from infancy. Parents have to realize that feeding the toddler on coca colas and burgers is not a fashion statement. Rather, it is a diseased statement.
Television viewing and playing games on the internet should be drastically controlled, as this not only curtails the much needed physical activity, but also exposes young minds to the negative impact of junk food advertisements.
The proverbial seven to eight hours of sleep everyday are also very important. Recent studies have shown that insufficient sleep may trigger insulin resistance and reduced glucose tolerance.
So, when the unhealthy aspects of modern life styles are combined with reduced sleep duration, this might contribute to the increased risk of many overweight and sedentary individuals developing diabetes.
Only when we are healthy in mind and body, can we truly be called progressive as a nation.
Shobha Shukla
(The author is the Editor of Citizen News Service (CNS), has worked earlier with State Planning Institute, UP, and teaches Physics at India's prestigious Loreto Convent. Email: shobha@citizen-news.org, website: www.citizen-news.org)
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