Diet and Physical Activity-II

Nutrition requires not just diet, it also requires physical activity. Regular, moderate to vigorous physical activity, which can make use of the nutrition in an appropriate manner without excess calorie or fat accumulation in the body. Physical activity has been clearly shown to be beneficial for reducing all-cause mortality, increasing life expectancy and certainly most of it is through the cardiovascular benefits.

It protects the heart and blood vessels. But it also protects against cancer. Some of the cancers, especially bowel cancer are much less likely to occur in people who are regularly physically active. Mental health improves in people who are physically active. Bone and joint disease is much less in people who are physically active. So physical activity has multiple health benefits. And we are really looking at particular benefits for heart disease and where we find that in terms of the risk of coronary heart disease or heart attacks, 31% of the current disability adjusted life year lost due to heart attacks is because of physical inactivity. And therefore you can derive a huge benefit of averted disease and disability if we are actually physically active on a regular basis. But the social conditions in terms of current modernity are now militating against regular physical activity. As development occurs in low and middle income countries we see people becoming more sedentary. In China for example, we have seen that occupational physical activity, domestic physical activity and travel related physical activity have declined markedly over the last 20 years, whereas there has been a slight increase in active leisure time physical activity, but that does not compensate for lack of physical activity in the other major domains. Indeed, it is a paradox of modernity that previously people used to be paid for doing physical work, now we are to pay for doing physical work by registering for a gym membership.

And now we see that we are spending most of our time sitting at a desk or watching television and that has a price to pay. Even independent of physical activity we see that sitting or being sedentary for several hours a day has independent risk of increasing heart attacks and lowering life. So if people sit for a long time, then you’re likely to have increased risk of heart attacks. But we ought to limit that as well and start moving around. Even fidgeting in the chair is fine. This of course means that we need societal responses, not just individual behavior change. And we are seeing several factors that are actually acting as negative influences. We are seeing a shift from pre-industrial agrarian economy to industrialization, changing dietary habits and physical activity habits, profound changes in households technology with labor-saving devices and dramatic shift in leisure activities for adults and children. We ought to do some social reconditioning to counter these effects. And most of what we do will also be good for sustainable development.

So if we look at the kind of interventions that we need, first of all we must understand the role of the market. Market is aggressively sometimes promoting unhealthy foods as well as devices which reduce leisure time activity and also the kind of avocations that actually make you a couch potato. So we ought to be able to mold the market much more effectively by increasing consumer consciousness, by providing financial incentives and disincentives, better incentives for healthy foods, disincentives for unhealthy foods and so on and alter the industry practices towards producing healthier products. In terms of policy, there has been a tremendous amount of evidence showing how policy can be remarkably effective in bringing about change. And Finland has been the poster child of prevention. It had the highest ischemic heart disease and cardiovascular mortality rates in the ’60s, but by deliberately bringing about policy change to reduce the amount of unhealthy fat intake in food products as well as altering the individual behaviors by health education, in 20 years they brought down the heart attack rates to much lower levels than elsewhere in Europe. Now we are also seeing other interventions like food labeling, reduced salt in processed food. We’re seeing ban on Trans fats and advertising restrictions, all of them being implemented in Europe and elsewhere, in United States. So there are market interventions which are sometimes needed in order to ensure that consumers are provided with healthier options. In Mauritius for example, a mere shifting of the ration oil in the public distribution system from palm oil to soy oil the healthier oil became the cheaper option and which in five years the mean plasma cholesterol concentrations in the population came down by 15%, just by changing the pricing structure.

And similarly, in Poland, after the fall of the Soviet Union, there was a greater import of vegetable oils and withdrawal of subsidies on animal fats, along with an opportunity to import more fruit and vegetables into the country. And this within a few years brought down cardiovascular mortality rates quite dramatically in comparison with the neighboring central and eastern European countries. So this is what policy can do sometimes. And of course we have both the individual approach as well as the public health approach when it comes to behavior change.

There are of course individual behavior change prompts that are required for people to adopt healthier practices. But we must also create a conducive environment through policies for enabling people to make and maintain healthy living choices across the lifespan. And there, urban design and planning for example becomes very important for physical activity and even for diet. Protected pedestrian paths, designated cycling lanes, community recreational spaces, integrated transport systems, reducing vehicular density and emissions, insuring traffic flow and regulation are quite smooth and also permit good physical activity, Land use and housing, Accessible food markets. Having fruit and vegetable availability closer home for example. All of these are measures which can improve not only the quality of life but certainly can improve people’s health. Quite often it is said that you know all these are matters of individual choice, why does the state have to intervene? We don’t want a nanny state telling people what to do. Whether to smoke or to, what kind of food to eat or how much to work, should be entirely a matter of individual choice. Yes, individual choices do matter. But choice can be conscious condition or compelled. A conscious choice can be on the basis of correct information or incorrect information. But choice is often conditioned by aggressive marketing and promotion by the industry for example of unhealthy foods and also the cultural factors in the community. It can also be compelled by lack of availability and affordability. If fruit and vegetables are extraordinarily expensive, if salmon is very expensive compared to beef or red meat, then clearly poor people can’t make that choice. So we ought to create conditions in which choice becomes easy for people. And that is where we need to really look at how best we can actually bring about a social environment which is conducive to healthy individual choices as well as sustainable development which enables people to lead healthy lives free from non-communicable diseases but also protect the environment at the same time. Because the determinants of non-communicable diseases and environmental degradation are very similar. The foods we eat and produce, the kind of cities we live in or pollute all of these are linked both to non-communicable diseases and the environment. So we ought to be looking at diet and physical activity, not merely as individual preoccupations, but as societal concerns. And then only we’ll be able to provide a holistic response to this major cause and contributor to non-communicable diseases.

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