Weight watch or Waist watch

Overweight Indians may have some cause to cheer as a recent study on one million Asians surprisingly failed to find an increased risk to life of Indians and Bangladeshis who had increased Body-mass Indiex (BMI).

Body Mass Index, a measure of whether a person’s weight is appropriate for his or her height, has become a standard measure across the world, of an individual’s health. You can calculate it by dividing your weight (in Kg) by the square of your height (in metre), or simply by feeding your height and weight and getting it from a calculator available on several websites (try www.gastroindia.net).

Despite the problems of defining what is “normal” in population studies, a BMI range of 20-25 has long been held as the one associated with the least risk of dealth, while progressively higher risk has been observed in overweight ( BMI 25-30)  and obese  (BMI more than 30) individuals, mainly due to  increased frequency of heart disease and cancer.

A recent study published in the prestigious New England Journal of Medicine has challenged this long and widely held view,  and shown that Asians may not be following the same health rules as people of European origin.

While at first sight it may appear as a welcome sanction to go back to our chips, samosas, kheers and colas, and pile up  a few kilos without the accompaniment of  guilt, a closer look at the paper tells a more intricate story.

There are several factors that contribute to our body weight, on which calculation of BMI is based, such as the density of our bones, the water content of our bodies, in addition to  the fat that we have accumulated. What we now realize is that we need not have to get too heavy to get diabetes or heart disease that we are very prone to; a moderate ponch will do.

Another interesting observation to explain the paradox,is  that smoking, still quite rampant in the indian subcontinent, helps keep the weight down, yet substantially increasing risk to life.

Our  approach therefore has to  change from weight-watch to ponch-watch. Fatty tissue, especially when it piles up in the abdominal wall and gives us that familiar ponch that we commonly associate with prosperity, is sinister. It acts as an endocrine organ, secreting cell products called cytokines that clog the arteries of the heart, make our blood pressure  togo up,and predispose us to strokes and cancers.

Weight-to-Hip ratio or even simply our waist size, seems to be the simplest risk-indiactor for Indians, and more accurate than the conventional BMI. It is time we men tried to get comfortably back into slim fit pants with waist size below 34 and ladies below 32 inches.

Good bye then to chips and samosas, and back again to an hour-a-day of aerobics to level our ponch. 

As published in HT City( Hindustan Times) dated 27 June, 2011.

DOCTORS REACH OUT

Of all India’s paradoxes, the weirdest seems to be the way it provides health care to its people. While it offers high-end care to medical tourists as well as Indians who are able to afford the high costs, millions of Indians continue to have limited or no access to basic healthcare.

Responding to this challenge and listening to the calling of their profession, a band of dedicated young Indian doctors have started providing medical help to those who need it most, at the cost of their studies, careers and comfort.  Called “Doctors For You (DFY)”, this group shot into fame recently when they were awarded the “best medical team in a crisis zone” award by the prestigious British Medical Journal group for helping victims of the 2008 Bihar floods.

When millions were rendered homeless during the Kosi floods in Bihar, DFY deployed 110 of its members to treat villagers for diarrhea, chest infections, snake bites, typhoid and malaria. During the 6 months the group treated around 130,000 patients in villages, relief camps and mobile clinics. One of its young members, Dr Chandrakant Patel, lost his life when struck by lighting while sleeping in the open in a medical camp.

DFY was formed in 2007 in Mumbai by a group of young doctors and medical students from government medical colleges to organize blood donations to tide over dengue and malaria epidemics in Mumbai slums when blood and blood products often fell short. Now DFY has clinics in Mumbai and Saharsa (Bihar) and is gearing up to become one of the rapid-response medical teams during natural calamities.

Médecins sans Frontières (MSF) is another such group reaching out to needy communities. It is an independent international medical aid organisation that delivers emergency aid to people affected by armed conflict, epidemics, natural or man-made disasters.

Founded in Paris, in 1971, by a small group of doctors and journalists, it is now an international apolitical movement with branches in 19 countries, conducting 3,800 missions every year with the services of 22,500 volunteers across the globe. 

MSF’s presence in India is substantial. Through small clinics strategically located, it is helping tackle AIDS and tuberculosis in Mumbai and Manipur, Kala azar in Bihar, primary health problems in Naxal-infested Andhra and Chhatisgarh, and mental health issues in strife -torn Kashmir. In addition it responds to medical challenges that natural calamities and conflicts throw up such as the flash floods in Leh and the wreckage of cyclone Aila in Bengal.

Young medicos coming out of medical colleges could benefit immensely by joining these organizations, even for a while, to regain their orientation to medical “service”. Doctors and volunteers who provide these services in remote areas often live the lives of unrecognized heroes and could act as inspiring role models for today’s youth. It is yet another Indian paradox, though, that our media gives them scant attention, and does not bring them adeqautely into the lime light, as they deserve.

As published in HT City( Hindustan Times) dated 19 June, 2011.

Small Hero, Great Heroism

Some heroes do not get to have their pictures splashed in newspapers, but become heroes all the same. As they say, ‘Everyone can become a hero, only the radius may differ’.

Take Ramesh for example. He is a 46 year old male nurse in the nephrology department of SGPGIMS. During his youth he did what many of us did in our teens and twenties: hung around with friends around ‘nukkars’ and in front of cubbyhole cigarette shops (there was no gutka then), got coaxed by peers to try that first puff, coughed and choaked but went back to prove our manliness, took to it to gain acceptance of our friends, made it a habit, and finally got hooked and became daily smokers.

Ramesh’s addiction took him to become a chain smoker, puffing  40 cigarettes a day, and finding it difficult to do without tobacco for long stretches. His wife, Jorgen’s repeated reminders, pleas and naggings fell on his ears like water on a duck’s back.

Then came his two lovely children, Renata and Renee (now 19 and 14) who soon became his life’s newly found purpose and for whom he wanted to be the best father in the world. When his wife reminded him that his habit could make them vulnerable to asthma, ear problems, heart disease and cancers through passive smoking, the loving father would leave home for every smoke.

When the children started growing up they often wondered why dad had to go out so often to return smelling like a stale ashtray. At 10 years of age, the kids confronted their father and asked him if he loved them at all. If he indeed did, why could he not give up smoking, that their school teacher had said damaged a person’s and his family’s health. Did he want to die early and leave his children before they were settled, as smokers often did due to their 7 years’shortened life-spans?

Ramesh realized that if he died early of heart disease, breathlessness or any of the 5 cancers that smoking causes (mouth, lungs, foodpipe, pancreas and bladder), from which he saw many patients die in the hospital, his children would have to grow up and fend for themselves without a father’s guidance and support. And their love for him would turn sour as they would ask “If dad indeed loved us as much as he claimed, why could he not make a small sacrifice and give up cigarettes for our sake?”

Ramesh mustered up his will power and stubbed out his last cigarette 8 years ago. He and his children were honoured in a ‘World No Tobacco Day’ function on May 31^st at SGPGIMS in 2006. His children are as proud and fond of their father today as he is of them.

The 140 million tobacco consumers in India can become heroes for their families, just as their children and families can make heroes of them. Quit tobacco today if you indeed love and care for someone, as Ramesh did.
As published in HT City( Hindustan Times) dated 5 May, 2011.