I P O A D
Initiative to Prevent Obesity And Diabetes

 

 

Diabetes and obesity are on the rise at a rapid pace. The World Health Organization (WHO) estimates that currently there are 1.6 billion adults (aged 15+) who are overweight and at least 400 million adults who are clinically obese - double the figure of 200 million in 1995. The outlook for the future is even bleaker, with more than 700 million people predicted to be obese by 2015 and a total of 380 million people predicted to be living with diabetes world wide by the year 2025(WHO). Each year a further seven million people develop diabetes – that is one new diabetic every 5 seconds.

Problem in Children: Previously Type 2diabetes was mainly a disease of the middle-aged and the elderly. In recent decades, however, the age at onset of diabetes has now been reported even in children and adolescents in many populations. The obvious consequence of more children with diabetes is more adults in the future suffering from diabetes and its complications. Compared to adults there is relatively little information on type 2diabetes incidence and prevalence in the young. National population data on the exact prevalence of type 2diabetes remain limited and are unavailable for our country. Therefore the precise burden of T2DM in children is still unknown. However, given the rising prevalence of overweight in children, the problem is likely to be quite substantial. About 16% of our population is in their adolescence and around 8% of them are overweight. Findings from epidemiological studies have repeatedly confirmed a strong positive association between excess adiposity and risk of developing type 2 DM. It is estimated that for every kilogram increase in body weight, there is a 7-9% increase in the risk of developing diabetes. Also, there are evidences from epidemiological studies that even moderate, sustained weight loss can decrease the risk of developing T2DM. A study in Japan demonstrated a parallel rise in type 2diabetes incidence in children with the levels of obesity from 1975 to 1999. Significant increase in the intake of fat and animal protein and decrease in physical activity have been the major influences. An estimated 22 million children under the age of 5 are said to be overweight worldwide. An analysis by the International Obesity Task Force (IOTF) revealed that overweight and obesity affects one in 10 children worldwide. The rises in overweight/obesity levels and type 2diabetes are inextricably linked, leading to the rise of a novel vocabulary to describe the combined condition - “Diabesity”. According to the IDF (International Diabetes Federation), a “new generation is entering adulthood with unprecedented levels of obesity. This in addition of the existing burden of adult obesity, reinforces the concern that weight related chronic diseases will be the most significant public health concern throughout the 21st century”.

Causes: Cardiovascular diseases are mostly caused by smoking, obesity, diabetes and hypertension. All these are modifiable risk factors. In the early part of the 20th century until 1960, these factors played a role only in the elderly above the age of 55 yrs, whereas, these factors affect the young and productive citizens of the country now. How has this change come about? Lack of awareness and change in life-style are the main reasons. The rapid increase in obesity reflects the intense changes in society and personal attitudes and behaviours over the past half century. While genes do play their part (they determine an individual’s susceptibility to weight gain), it is calorie intake and physical activity that hold the key to a balanced weight. Economic growth, modernization, urbanization and globalization of food markets are just some of the reasons said to underlie the epidemic. The IDF states that an interplay of genetic, social and environmental factors are driving the global explosion in type 2 diabetes. In our younger days, we needed to walk at least 5-6 kms to the school and back. We used to indulge in games. The curriculum was not that demanding. TVs and Computers never used to be the primary time killers. All these have changed. The changed scenario has led to an early onset of life-style diseases.
Situation in Kerala: The prevalence of life style disorders like diabetes and heart attack is on its rise in Kerala when compared to other parts of the country. Recent analyses have shown that the prevalence of diabetes in urban areas like Ernakulam district of Kerala is above a whopping 17%, whereas it is just 1% in Rajasthan, 2.3 % in Tamilnadu, and 3.4% in Delhi in 2005. The prevalence of heart diseases also is on the rise in Kerala when compared to that in other parts of the country. It was 6.4 per cent in Kerala whereas for Punjab it was three per cent recently.
There is a parallel increase in Life style diseases with increasing provisions of modern facilities. During the past one decade, lifestyle indicators like electricity, telephone, computers, television, better roads and vehicles etc., are provided even in the rural areas of Kerala state compared to rest of the country. Because of this there is no gross urban - rural difference regarding the prevalence of these diseases in Kerala, unlike in most other parts. This high prevalence of diabetes and cardiovascular diseases in Kerala calls for urgent interventions on war-footing. Preventive measures starting from very young age like school-going age group, are to be administered for creating any significant reduction in the incidence of life-style diseases among the future generations. It is time for the society at large and the government in particular, to wake up from slumber and to take on this growing threat staring at us like a time bomb!

Impact on Mortality: In modern day, diabetes is the major contributor of cardiovascular mortality and morbidity. Some 3.8 million men and women are expected to have died from diabetes in 2007. Most people with diabetes die as a result of the complications of diabetes such as cardiovascular disease and kidney failure which arise due to poor glycemic control. Cardiovascular disease accounts for the highest number of deaths in the world, second only to cancer. It is the combination of diabetes and obesity which is so lethal. People with diabetes and obesity are three times more likely to become critically ill from acute organ failure and three times more likely to die from any cause than people without diabetes. Obesity is a “silent killer”, a risk factor for many potentially fatal conditions, including heart disease, high blood cholesterol, high blood pressure, stroke and, of course, diabetes. According to the diabetes atlas of IDF 2006, approximately 80% of people living with diabetes are in the developing world. A major chunk of this is born by India where the younger generations are exposed to the risks of obesity, diabetes and their complications due to the fast changing lifestyles.

Economic impact: Like all major health epidemics, diabetes and obesity place a tremendous burden on the global economy. Diabetes, though known to be a life-style disorder for ages, neither the government nor any non-governmental organization has taken an initiative to prevent this largely preventable disease. There are 33 million diabetics in India, more than 15 times the number of AIDS patients. But, the money spent for imparting awareness and preventing this scourge is quite negligible compared to AIDS prevention programs. Regarding control of non-communicable health hazards, combating smoking is at the very top of international health care policy agendas, whereas, the world is only very slowly reacting to the obesity and type 2diabetes time bombs. The rapidly increasing incidence rates for both diabetes and obesity suggest conditions which are spiraling out of control. Suppose there is an afflicted person in a family, a sizeable portion of that family’s income will have to be spent in the treatment of diabetes and its complications. This will erode the basic economic security of the family and the country at large. The IDF estimates that global health expenditures to treat and prevent diabetes and its complications total at least $232 billion in 2007, a figure which is expected to rise to $302.5 billion by 2025. In the United States alone $174 billion is spent annually for the management of diabetes and its complications with which one can buy 580 Air Bus Super Jumpo Jets. One in every 5$ spent on health in the US is spent on diabetes alone. This statistics for India is not correctly available. The WHO estimates that over the next 10 years (2006-2015), China will lose $558 billion in foregone national income due to heart disease, stroke and diabetes alone. This can never be much less for India! So, unless a corrective step in the right direction is taken now, it will consume the society like a Tsunami. Therefore from a public health perspective, it is of great importance to reach children and adolescents through preventive programs addressing issues of physical inactivity and dietary practices.

Need to Intervene: The past 3 decades have seen an explosive increase in the number of overweight and diabetic children in most countries, as the world embraces a westernized life-style. The country with the highest estimated number of adults and children with diabetes is India. Never before has there been a greater need to spread awareness of the risk factors associated with these diseases and to co-ordinate medical progress with cultural modifications. It is observed that only if the interventions are placed well in advance in the life order, that there will be any significant impact on the incidence of lifestyle disorders. In this context, we are making a humble effort to change the grim scenario by intervening at the school going age itself. We strongly believe that, by way of educating the high school level students, we will be able to bring about a dramatic and positive change in the present situation. It is common knowledge that TEACHERS play a very important role in moulding the future citizens. We are making use of their influence on students in imparting valuable health knowledge at an early age, so that, they grow up as enlightened citizens to form a “healthy and lifestyle disease free” tomorrow.

These largely preventable diseases should be reined in at an early age. It is for this specific goal, PVS charitable trust, Calicut, has come up with this novel and commendable project. It is indeed, a step in the right direction and it is the only non-governmental organization in the country to have launched such a project. In this era of information technology, we have rightly named the project as “IPOAD”- meaning “Initiative to Prevent Obesity And Diabetes”, so that this acronym will ring a bell in people who care.

Now as to how we plan to go about it! This is going to be implemented as a three stage project. Stage 1:- Train teachers to impart knowledge to the high school and Plus 2 children regarding life-style diseases like diabetes, obesity etc. Why children in high school? Because, a basic knowledge in science is required to understand the intricacies involved in the pathogenesis of any disease. Why teachers? Because we know that only they can create a lasting impression in the minds of children. Stage 2:- Screen children to find out the high risk group. In children, the development of the disease can be prevented. Remember the old saying- “An ounce of prevention is better than a pound of cure”. Stage 3:- Comprehensive counseling of the high risk group and treatment of the afflicted. An early intervention always improves the outcome. At a later stage, the society at large can be taken up.

The surveillance will be periodically conducted and will continue for generations to come. This will be conducted with the help of district level co-coordinators and counselors, who will be monitored by state level co-coordinators. In conclusion, I firmly believe this project will take to wings shortly and will be applauded by one and all. This will be a role model for the rest of the country to follow.