What is keeping India unfit? Don't lose your sleep figuring it out!
Now that Fitness India has been kicked off, urgent action is needed at both government and private sector levels to make citizens healthy and productive.
Indians are unfit. Full stop. They are unfit in the workplace, in public and at home. The 2018 Indian Council of Medical Research (ICMR) State-Level Disease Burden Initiative, India: Health of the Nation’s States, reports that the estimated proportion of all deaths due to non-communicable diseases (NCDs) is up from over 37 per cent in 1990 to 61 per cent in 2016. About 60.4 per cent of respondents have never ever had their blood pressure checked.
Almost 1.73 million Indians will get cancer next year. Breast cancer has gone up by 39.1 per cent between 1990 and 2016. The report also says cardiovascular diseases increased by 34.3 per cent in the same period.
Says Dr Upendra Kaul, chairman of cardiology unit, Batra Hospital, Delhi, “It’s shocking that the maximum number of patients aged 25-45 admitted to the Emergency Ward have sedentary lifestyles.” Take 20-year-old Rohan who came to the hospital for bariatric surgery; his weight was 165 kg. He had severe sleep apnea along with a pre-diabetic condition and hypertension.
Doctors blamed his odd sleeping hours, poor eating habits, and not working out. “Rohan was operated and gradually his weight came down from 165 to 90 kg. His sugar level and BP were also controlled,” says Dr Pradeep Chowbey, Chairman, Minimal and Bariatric Surgery, Max Hospital, Delhi. Dr Kaul is worried that the number of young candidates for bariatric surgery has gone up exponentially.
In the last five years, 65 per cent of obese patients were between 18 and 40 years old. Last week, Prime Minister Narendra Modi launched the ‘Fit India Movement’ to take the country towards a healthier future. He faces a challenge that is easier said than done.
Do the math.
WHO study: 34 per cent of Indians are too lazy to stay healthy.
Fitness discovery platform Gympik study: 52 per cent people between 20-35 of age in five major metropolitan cities have no time to exercise.
A market intelligence survey: Approximately 64 per cent of Indians do not exercise.
ICMR study: 33 per cent of urban men and 44 per cent of urban women are either overweight or obese.
World Obesity Federation: India will have 48.3 million obese people by 2025.
Paediatric Obesity report: By 2025 there will be 17 million obese children in the country.
WHO: India is the most depressed country in the world followed by China and America. Scary.
India badly needs a magical ‘Fitness Mantra’.
“India is such a huge country and a mixed bucket of fit and unfit people. Without an adequate health policy and programme, more deaths are occurring in India from NCDs than communicable ones,” adds Dr Kaul.
NCD IS THE BAD BOY: The WHO has criticised unhealthy diet and poor physical activity as the main reasons for the staggering increase in BP, blood sugar, elevated blood lipids and obesity in Indians. The Global Burden of Disease Study reveals that non-communicable diseases (NCD) is responsible for 60 per cent of total deaths in India. Of these, 26 per cent deaths are cardiovascular-related.
Dr A Sreenivas Kumar, Director, Cardiology and Research, Apollo Hospital, Hyderabad, says that most lifestyle-related diseases are preventable or can be delayed by consuming nutritional food, avoiding junk food and fatty-preservative eatables, adopting regular workout routines such as yoga, aerobics and even a good walk. “But unfortunately these have disappeared from our daily routine,” he laments. The consequences are visible. Forty-nine per cent of Indians are diabetic.
Diabetics are recommended regular exercise to keep the disease in check. According to a 2017 ICMR report, 64 per cent of diabetics in India were diagnosed only in the past 25 years. Their number will double by 2025. Experts feel the Fit India Movement will face many hurdles, the main among which are a policy crisis and lack of awareness behind rising lifestyle disorders and NCDs.
NO KIDDING: Rising child obesity is endangering the country’s future. As per the National Health Portal of India (NHP), children are not going out of the house to play. Instead, they have become couch potatoes or play computer games. Few walk or cycle to school, which are ill-equipped to provide proper physical education. “Sparse awareness programmes and strategies, low vaccination rates and unavailability of basic amenities and a hygiene crisis, communicable diseases such as malaria, pneumonia, dengue fever, hepatitis, tuberculosis have become a menace in India,” says Dr KK Agarwal, Senior Medicine Consultant and President of Heart Care Foundation of India. He warns of rising antibiotic resistance that must be checked “if we have to meet the ‘Fit India’ goal”.
STEP UP, PLEASE: Experts say that most health agencies have failed to improve or enhance health facilities in India. The government is also behind in achieving its healthcare goals in terms of accessibility and quality. The Global Burden of Disease Study records that Sri Lanka and Bangladesh have bettered India in meeting health goals, “It is high time we realise that Indians are unfit,” says Dr Anoop Misra, chairman, Fortis-C-DOC, Centre for Diabetes, Metabolic Diseases and Endocrinology, Delhi. Health infrastructure in the country cannot cope with the countless patients filling up hospitals. There is no official fitness policy. Poverty and illiteracy are further deterrents to prevention programmes. The ICMR study on obesity further reveals that in rural areas, 12 per cent men and 15 per cent of women are overweight or obese. Almost 20 per cent of Indians are undernourished. “Obesity leads to many chronic conditions. Combating the escalating epidemic of coronary heart disease (CHD), stroke, diabetes and other diseases needs action through various channels of fitness,” says Dr Hemalatha, Director, National Institute of Nutrition, Hyderabad.
NUTRITION MATTERS: Apart from Fit India Movement, the government has put in place a few public fitness initiatives. The Food Safety and Standards Authority of India (FSSAI) has urged industries and restaurants to voluntarily pledge to reduce the percentage of salt, sugar and fat content in their products.
Edible oil industries have promised to reduce trans-fat by 2 per cent by 2022. Experts are in favour of making ‘Eat Right’ a regulation instead of voluntary activity. ‘Harm Reduction Strategy’ patients include foods of different colours such as vegetables, nuts, pulses, fish, and dairy in their daily diet.
Quality of workout is another fitness parameter but the shrinking open and secure spaces such as parks, playgrounds, walking routes and cycling tracks are forcing people to stay indoors. A study by a market intelligence agency among 3,000 adults above 18 reveals that approximately 64 per cent of Indians do not exercise in gyms though almost 46 per cent believe in a healthy lifestyle.
Indians are into simple exercises; 67 per cent take brisk walks, 26 per cent practice yoga and 11 per cent have taken up cardio and team sports such as football and cricket. Only 10 per cent of Indians do body-lifting exercises.
Experts state that urban Indians do not find the time to exercise because of hectic work hours or long commuting time. The Department of Health and Human Services advises at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity a week or a combination of both.
URBAN EXERCISE: However, all is not gloom and doom in the fitness world. The downside is that it is an urban phenomenon, while the percolation rate into smaller cities and towns is very slow.
According to a Deloitte report, India’s USD 13 billion wellness market in 2015 is expected to grow at a CAGR of nearly 12 per cent by 2020. McKinsey predicts that fitness is the next trillion-dollar industry. Indian fit-tech startups are attracting investors.
The State of the Indian Startup Ecosystem 2018 Report estimated 4,892 tech-health startups in India and a hike of over 45 per cent in total investments in the space — USD 504 million was raised between 2014-2018.
The Redseer study, Indian Habit of Being Healthy, has found that there are 90 million health-conscious people in India; again predominantly urban, stating that the “young, economically empowered population” are looking for “a more value-conscious demand”. Fitness technology is finding a huge number of urban-takers.
The better gyms and personal trainers are expensive: a gym membership could set you back by between Rs 75,000 and over Rs 1 lakh annually in metros. They offer one-stop solutions for user convenience. Expert coaches are available to monitor food intake and nutrition choices.
Apps such as ‘Gamification’ keep track of personal fitness with data on steps walked, calories burnt and cardiac rate. Fitness provider ‘Bioprint’ is tech-driven and custom-oriented, like maintaining records of a user’s BMI. To stop monotony from killing fitness aspirations, gyms are constantly evolving new workout regimens. ‘Masala Bhangra’ depends on pop-psy to motivate health club members to do bhangra to uninhibitedly work up a sweat and dance away their fat.
The rigorous ‘RIP 60’ routine uses body weight for resistance through hundreds of movements. ‘Battle Rope’ involves army-like rope training which has many takers in showbiz. These are, however, mainly urban phenomena. Fitness experts have realised the value of group fitness classes with customised workouts such as concentrated step aerobics, HIIT and cardio kick-boxing.
Specially designed boot camps by established fitness chains promote bonding with the trainer, class, club and group. It also makes people more competitive. But as of 2014, there were only 21,000 fitness centres in India: assuming that all Indians are healthy, this was just one gym for 59,000 people. Creating a fit India requires multi-level action.
“Nutritional food is a key parameter for fitness,” says Dr Priyanka Rohatgi, chief clinical dietician, Apollo Group of Hospitals, Bengaluru.
- The government must ensure that all Indians must get access to affordable and healthy foods such as fruits, vegetables and nuts.
- Provide subsidised healthy meals, quality check on the manufacture of junk food and aerated drinks.
- Make it mandatory for schools and office canteens to serve healthy food.
- Lay down rules for all national and international food chains to also provide healthy options such as fruits, nuts and fibre-based products.
- Label food products outlining the calories, fat content and nutritional value.
- India can learn from Japan and constitute nutrition support teams to counsel patients in various hospitals about good and bad eating habits.
- Hold PPP drives to create health awareness.
- “Fit India movement is a long-awaited movement and has the potential to bring awareness and encourage people to think in the right direction,” says Dr Hemalatha, Director, National Institute of Nutrition, Hyderabad.
- Set up parks and open gyms in every residential area to encourage community for walking and workouts.
- Workplaces and educational institutions must take initiatives to encourage physical exercise.
- “Regular physical exercise in any form not only makes children physically fit but also improves their learning and judgment skills,” says Dr Anoop Misra, chairman, Fortis-C-DOC, Centre for Diabetes, Metabolic Diseases and Endocrinology, Delhi
- NCDs are self-invited through unhealthy lifestyles. Lay emphasis on prevention.
- Create well-designed, scientific health policies to educate, heal and cure.
- Set up well-equipped check-up camps run by capable professionals for early diagnosis, affordable pathlabs and timely reporting and analysis of predicted epidemics.
“Bad sleeping patterns are the most vital yet underestimated cause of poor fitness,” says Dr Pradeep Chowbey, Chairman, Minimal and Bariatric Surgery, Max Hospital, Delhi
Prescription: Health awareness programmes must target the most important yet underestimated cause for poor fitness: poor sleeping patterns resulting in unhealthy and untimely consumption at night. Sleep deprivation increases the ghrelin (hunger-stimulating hormone) levels and brings down leptin (hunger-suppressing hormone) which generates a constant feeling of hunger.
“More deaths occur from NCDs than communicable ones,” says Dr Upendra Kaul, Chairman of cardiology unit in Batra Hospital, Delhi
- Promulgate government action by setting fitness criteria in job selection and government health schemes.
- Introduce incentive schemes for good health at the school, college and professional levels.
“Drug misuse must be rectified properly to achieve ‘Fit India’ goal,” says Dr KK Agarwal, Senior Medicine Consultant and President of Heart Care Foundation of India
Prescription: The PM could address Mann ki Baat-style health-related awareness messages to the people to maintain their fitness levels.
“Genetically we are more prone to heart diseases,” says Dr A Sreenivas Kumar, Director Cardiology and Research, Apollo Hospital, Hyderabad.
- The PM has rightly encouraged citizens to come out of their homes for long walks. But there are very few walking tracks in the country, whose number must be increased.
- Government must launch programmes on engaging citizens in workouts.
- Fit India Movement has given health experts, industries and consumers food for thought. The goal is to get the right recipes.
A study by Gympik, a fitness discovery platform based out of Bengaluru, says most Indians do not find time to exercise. The fitness survey based on the responses of 1.06 million people, mainly in the age group of 20-35 years, in Delhi, Bengaluru, Mumbai and Hyderabad, reveals that 52 percent do not find time to exercise, while 36 percent lack the motivation to join a fitness centre. In fact, 14 percent claim to be absolutely clueless about where to begin their fitness journey from. The WHO guidelines suggests children aged 5-17 should workout at least 60 minutes every day to improve metabolic health biomarkers, muscular fitness, cardio-respiratory bone strength and cardiovascular parameters.
For complete fitness, men and women should maintain a BMI of 18.5 to 23 (body weight in kg/ht in m2) and a waistline of less than 85 and 80 cm for men and women respectively. As for diet, rich sources of minerals, vitamins and polyphenols are essential, for which intake of 500 gm of fresh vegetables and fruits and regular intake of few grams of nuts and seeds are required to keep oneself fit and healthy.