Negate, deny, justify, change, dismay: the kilos on the belly of men and women are met with many reactions. Often we believe that the issue of weight gain is a miniscule problem that only we are faced with. However, globally, the plumping bodies and unhealthy fat especially around the middle of the belly is a major health issue.
Recently, the Government of India published the National Family Health Survey – 5. The survey, while depicting the improving picture of women's health on many aspects, had a startling revelation: in J&K 88 percent of females aged between 15-49 years had a waist to hip ratio of more than 0.85. In other words, nearly nine out of every 10 adolescent or adult females in the UT had or were on the path of abdominal obesity. This is the highest in India, no other state or UT has such a high percentage of women putting on unhealthy kilos around their waist.
Abdominal obesity is associated with a number of health issues, the commonest being type 2 diabetes, hypertension, cardiovascular diseases and is a risk factor for premature death according to accepted medical literature. Although the NFHS – does not have a reference point to compare the current Waist to Hip ratio as this is the first time such data was collected anywhere in the exercise, many feel that obesity was a new world disorder in both men and women, and J&K is no exception. It is just that the numbers are spiking up more than elsewhere.
One is definitely prompted to ask why are women in J&K on the wrong track in terms of their body weight?
Greater Kashmir spoke to a number of doctors on the issue.
In December 2000, a paper was published in Journal of Physicians of India wherein the prevalence of obesity in Kashmiri adults was measured. It was found that 15 percent of adults aged 40 and above had obesity in Kashmir. The surprising part was that only seven percent of males were obese and 25 percent of females were obese in the studied population.
In 2010, a paper published in Diabetes Research and Clinical Practice showed obesity in Kashmiri youngsters aged 20 – 40 years. The figures were double than what the paper published 10 years ago had shown. The disparity between males and females had become more prominent. Dr Abdul Hameed Zargar, well known researcher in endocrinology and ex-Director SKIMS Soura who led this research says that in this decade, the obesity in India was growing more than ever before. He says that obesity was being measured across countries from time to time and India for a long time stood around number 19 position.
“However, in 2014, India had jumped from its number 19 position to number 5, beating a number of European countries. This is about men. And women of India occupied number 3 position on the obesity index, higher than the most prosperous of countries,” he said.
While obesity has been connected to prosperity over the past, it is fast becoming a problem of the less privileged. In the USA and in many other European countries, obesity is now a problem of poor, colored skin populations, the rich and white population having a healthier weight and health parameters.
A study published in the most reputed journal Nature showed that obesity was rushing into rural areas. “In order to have good health, you need good education and good money,” Dr Zargar says. He said he sees a number of patients with obesity hailing from semi-urban and rural areas.
The myths around nutrition, the lack of spaces for exercise, the lack of education and awareness, he feels are contributing factors. “While women in rural areas used to live a labor intensive life-style, the growing prosperity has changed that. It has made us, men and women, more sedentary and the phenomenon is a new one in rural areas,” he said. He said it is important to raise awareness about the issues that abdominal obesity can bring about. “We need to tell women, in cities and in villages, to look and relook at their weight. It will decide a lot of things in their lives,” he said.
Prof Shahnaz Taing, known fertility specialist who retired as Head department of Gynecology at GMC Srinagar says that PCOS was a contributing factor to women’s obesity in J&K. The region, she said, has a disproportionate percentage of females, adults and adolescents, who are diagnosed with PCOS. “Most of the patients are diagnosed at stages where they have already put on much of the extra weight. Many are diagnosed after marriage, when they face fertility issues,” she said.
Dr Taing said that awareness about PCOS among doctors and among the population was not up to the mark and needed attention. What she feels is also important is that women are “pushed” to pay attention to their health. “Her health is paramount as she has to bear the weight of family on her shoulders. But I have seen that she is hardly encouraged to prioritise her own heath,” she says.
While talking about pregnancy related weight gain, Dr Taing said it was incumbent upon the woman that she strives to lose the extra pounds months or a year after delivery. “However, this weight just piles on as she hardly gets time out for herself and exercise,” she says.
Talking about Kashmir and Jammu women, he says that there are many factors that are responsible for the fattening up of bellies.
Healthy Food is Costly Food
The cost of healthy food is a factor that makes it more accessible for the richer. Many doctors have rued about the comparative costs of calorie-rich and nutrient-poor fods being more accessible. “A fruit snack costs more than the packet of chips and a glass of fresh juice costs 10 times more than a can of soft drink,” says Dr Samiullah Mir, a consultant who often visits schools for health camps. He says that school canteens are filled with unhealthy snack options while children are faced with issue of obesity unlike their elders were at their age.
“Our girls are eating more, spending less, much like boys. But what also matters is that they are not encouraged to play games that would help them be active and attain a healthy weight,” he said.
Dr Mir said that women tend to eat less protein, “especially the elder ones” and rely on calorie rich diet to satiate their hunger. “It is cultural too, men must have that piece of meat in the family and woman can fill herself with more rice,” he said. Dr Mir feels that schools need to play a proactive role in making children active and keep them away from unhealthy food choices at school, where they spend most part of their day. “A good start is what they need, the girls too. A healthy and active school life can change their lives,” he said.