Urban Living can affect health

When Wealth isn’t Health

Published in the Sunday Express on 18th March 2012.

Nita Jatar Kulkarni

(Some names have been changed in the text of this article although the original article has the actual names. The names of medical professionals have not been changed.)

A peek into the life of Mohan Gandhi, a single urban professional working in the events and entertainment industry in Mumbai, takes us to the heart of what’s wrong with modern Indian lifestyles. Rohan works 12 hours a day going up to 16-20 while outstation, eats at least one meal at an odd time, often works on weekends, regularly eats leftovers, eats at least a dozen meals at restaurants in a month and snacks at restaurants every single day. If that’s not enough, his four favourite foods are

red meats, fried foods, processed meats and chicken. He works in event management, listed as the sixth most stressful job ever according to an US study of the 10 Most Stressful Jobs of 2012. 

“Deadlines are unrealistic, hours are long and business is uncertain,” says Mohan. He is aware that his lifestyle is impacting his health and admits to being overweight. “I’ve made changes to my eating habits. I’ve stopped eating lunch out everyday.” Mohan is 23.

Meena Rao is a year older than Mohan. She works in the music industry and doesn’t have it much better. Her working hours are fewer, but as irregular. She often works till the wee hours of the morning and is often irregular with her meals. Her breakfast comprises black tea, a salad sandwich/buttered toast/croissants and lunch is burgers, pasta or noodles, or leftovers. Meena doesn’t have a weight problem, but suffers from frequent colds and allergies. “Headaches are a daily complaint and it’s debilitating at times,” she says. She attributes the problem to sitting long hours in front of the computer.

Sufficient rest and relaxation is needed, but the opposite is what usually happens. “Completion of tasks sometimes leads to an absolute upset of the sleep cycle, and it takes a few days to recuperate/normalise,” says Meena. Sleep studies have shown that irregular sleep cycles not only lead to inadequate sleep, but affect the quality of sleep too. This in turn predisposes one to a myriad of health problems, from weight gain to heart disease.

If sleep is brain food, the young and ambitious haven’t realised its importance. Take Amita Joshi, a ninth grader. She knows what she wants to be: a cancer specialist. Her work day begins at 5 am because “there are tests almost everyday” and after returning from school there’s a short break at home and off she goes for tuitions. Once a week it’s a five-hour tuition marathon, directly after school. She often goes to bed at midnight. How does she cope with the stress? 

“I cry,” Amita confides, “and this starts about a month before the exams.” But the topper that she is, Amita is not going to ease up on her lifestyle any time soon. A product of modern India, she is ambitious, driven, and stressed out, at 14.

Welcome to the new India where industrialisation, urbanisation and migration have played havoc with healthy lifestyles. Whether you are an urban professional working odd hours or an ambitious student with a nail-biting schedule, you have probably got sucked into the a lifestyle far removed from what your ancestors led. This makes you a prime candidate for a variety of lifestyle diseases from diabetes, heart disease and cancer to depression and obesity.

It’s not just the diet, there is the stress too. Stress causes physical changes in the body, a temporary increase in blood pressure, heart rate and respiration. Constant stress puts pressure on the body, and one needs a good diet to prevent chronic physical ailments. “Stressed out individuals need food rich in antioxidants like fresh fruit and vegetables, prepared correctly. We recommend seven colours everyday,” says Shamika Naik, nutritionist at a major hospital in the city. 

But those who have a hectic lifestyle often eat the opposite of what they should. Stomach upsets, headaches, or frequent bouts of flu are common complaints. “Such problems can be caused by a poor diet and in the long-term can predispose one to diabetes, hypertension, high cholesterol, heart disease, and even cancer,” says nutritionist Radhika Toshniwal.

The young and the busy don’t have time to consider the long-term effects. A doctor couple from Bangalore, Ritika and Ajay, work the full day and home-cooked meals are a rarity. Most meals are had in canteens, either hospital or private. Both suffer from work stress. “I feel dull, irritable, and drained after a typical day at work,” confesses Ajay, the one-hour commute adding to his woes. 

Ophthalmologist Ritika says that her favourite foods are fried foods and fast food, but tries to get at least one “wholesome” meal a day. But are traditional meals which are not home-cooked, healthy? Several studies have shown that restaurant dishes contain high levels of sodium and fat. 

A 2012 report from the US Center for Disease Control and Prevention tells us that even our daily bread contains far too much salt. So do cheese, pizza, soups and sauces. These are foreign surveys, and it’s probably worse in India as food regulation for the use of transfats, taste enhancers and chemicals in food is not strictly enforced. 

High incomes can exacerbate the problem. The most recent National Family Health Survey-3 shows that “nutritional deficiencies are widespread even in households that are economically well off.” 

Wealthier states like Kerala, Tamil Nadu, Gujarat, Punjab and Maharashtra are the frontrunners. An older UN University study estimated that a third of all fat in India was consumed by the 5 per cent of the population, the urban rich, and on an average, more than 30 per cent of their energy intake was from fat! 

Youngsters in in their twenties with hectic lifestyles and a poor diet are healthy today, but what happens a decade or so down the line? “Five to 10 years of a poor lifestyle can have an adverse impact on health,” points out Naik. Cardiovascular problems among the young are on the rise, the last decade registering a high increase.

Exercise is as important as diet, but none of the people spoken to had a regular exercise schedule. Exercise can be a great stress-buster as well, but when it comes to unwinding after a stressful day, television and the Internet beckon. Ritika and Ajay's favourite leisure activities are Internet surfing and visiting social networking sites and Meena finds solace in exactly the same. Amita finds it in television watching. “I have to see television everyday,” says Amita, and manages to tuck in two hours of TV daily. No exercise, she admits, except when mom pressures her to walk the 11 floors to her apartment to “keep her weight down.” What’s worrying is that these activities take away from sleep time.

Busy people can lay the blame for an unhealthy lifestyle on lack of time and the pressures of work, but what about housewives, especially those without small kids to look after? Growing affluence has led to an increase in the number of housewives with domestic help, leaving women with few, if any, household tasks. Often, they are without roots in the city they have made their home, without the support of an extended family.

Suhasini Rajarao, 55, doesn’t start her day at a fixed time, and then the hours tend to stretch out before her. TV watching extends up to five-six hours a day, evening walks are irregular, and bedtime is around mid-night. A talented actor, she was robbed of her own career by the shuttling between countries required by her husband’s high-profile career. Today career opportunities for her are scarce, and this leads to dissatisfaction and stress. Her health problems have become a debilitating factor now. “I have a long list of health problems today. Backache, allergic rhinitis, hiatus hernia, acidity, mild arthritis, and neckaches,” she says.

Discontentment can affect the body adversely. Clinical psychologist Narendra Kinger says, “Most individuals do not want to accept it, but constant negativity over a prolonged period leads to excessive wear and tear of the body and brings on various physical ailments.” 

The mind and the body are one system working together and if one part is neglected, the other often shows the ill effects. Not being challenged enough may not seem like stress on the face of it but it affects the person psychologically. 

“Boredom and inactivity and loneliness are types of stress, affecting the immune system leading to susceptibility to illness. It also leads to irritability and low self esteem leading to comfort eating and obesity, excessive TV viewing and shopping addictions,” says Amita Sanghavi, a Mumbai based psychotherapist. 

Suhasini's acidity and allergies may have kept her weight down, but Mrinalini Saigal is not so lucky. She snacks, she says, in addition to regular meals. The premature death of her spouse has left her alone today, and globalisation has ensured that her children live far away. Money is not a problem for women like Mrinalini, but loneliness and depression are not uncommon symptoms. Mrinalini not only suffers from depression, but also high blood pressure and diabetes. The bouts of depression are brought on by stress, she says.

Kinger explains, “Females are more susceptible to psychological and physical problems due to gender discrimination, role expectations and conflicts throughout their life span.” India’s rapid urbanisation and modernisation have added on the stress of the empty hours and loneliness, especially for those housewives whose husbands work for long hours. Stay-at-home urban Indian moms may seem to be living the “perfect lifestyle” with the time to serve up healthy meals and bond with their families, but pressure and conflict always lurk, and there is nowhere to turn.

The Suhasinis and Mrinalinis of India will increase in number with the galloping middle class population, which is to swell to more than 40 per cent of the population in another two decades (McKinsey Population Report). By 2030, their numbers could double, along with the exploding GDP. Life expectancy is on the rise as well, and the proportion of the 35-plus population will rise from 28 to 42 per cent (1981- 2021), and the number of urban dwellers to 43 per cent, says the Indian Council of Medical Research (ICMR).

The lives of Indians are undergoing a remarkable change. Our transportation, occupations, domestic tasks and leisure activities discourage us from doing what human beings were built to do. Move. Many believe that their one hour walk or work-out shelters them from health problems, but the bad news is that there is a link between sitting for long periods and an “increased risk of Type 2 diabetes, cardiovascular disease and other chronic health problems” (see below). 

While no study can point to a single causative or protective factor between a particular habit and a disease, the results of a multitude of studies are telling us to lead a more natural lifestyle. If you work 12-16 hours a day, regularly eat leftovers and junk food, don’t exercise, watch too much television, surf late into the night or drink too much on weekends, then it’s time to pay attention. All of us should. That is what will prevent us from becoming sitting ducks for the diseases of civilisation.

Tips to keep you on the move

◆ In the office, take continuous breaks from sitting even if they are a minute long.

◆ Stand up to take phone calls. 

◆ Go to a colleague’s desk for a minute to talk instead of using an intercom or sending an email. 

◆ Move the rubbish bin away from your desk so you have to walk to use it. 

◆ Use the bathroom furthest from your desk. 

◆ Have lunch away from your desk. 

◆ Pace up and down for a minute during meetings. Helps you think as well. 

◆ Take the stairs instead of the lift whenever possible. 

◆ Stand at every opportunity you get.

◆At home, take over small household duties from the domestic help. 

◆ Open the door. 

◆ Answer the telephone. 

◆ Make the tea/coffee. 

◆ Fetch your glass of water. 

◆ Lay your own plates. 

◆ Clear the table. 

◆ Pick up after yourself. 

◆ Load the washing machine. 

◆ Hand wash your delicate clothes.

◆ Keep your cellphone in the next room. 

◆ Do isometric exercises while sitting. 

◆ Don’t eat in front of the TV. 

◆ Do vigorous exercise for at least 30 minutes a day. 

◆ Walk up the stairs.

Diet Tips

◆ Eat at least 6-8 servings of fresh fruits and vegetables. 

◆ Substitute coffee/tea with herbal teas. 

◆ Substitute freshly squeezed lemon juice for sodas. 

◆ Have freshly squeezed juice instead of packaged juice. 

◆ Breathe deeply. 

◆ Get at least 7-8 hours of sleep. 

◆ Meditate at least 15 minutes a day. 

◆ Stop popping Crocins, aspirins and painkillers for minor aches and pains. 

◆ Cut back on the meat and become a flexitarian. The link between Sleep and Health 

◆ Appetite increases even after one night of sleep loss, making irregular sleep a risk factor for obesity (2012 Swedish research). This confirms a 2004 US study which indicates that even partial sleep deprivation disturbs hunger regulating hormones. 

◆ An irregular bedtime schedule can lead to insufficient sleep and poor sleep quality. (A 2009 Taiwanese study) 

◆ Regular napping is linked to better heart health, reducing deaths from heart disease by as much as 37 per cent. (A 2007 Harvard Public Health study of 23,000 people over six years) 

◆ Among 6,000 women under 65 who exercised, 50 per cent had an increased risk of developing cancer if they slept less than seven hours a day, compared with exercisers who got more sleep. Inadequate sleep cancels out the benefits of exercise. (2008 US National Cancer Institute study) 

◆ Those who slept less were 4.5 times more likely to have higher blood sugar levels (pre-diabetes) than those who slept for 6-8 hours. (A Buffalo University study) 

◆ Less than 7.5 hours of sleep was linked to an almost 70 per cent increased risk of cardiovascular disease. (2008 Japanese study of 1,255 people suffering from hypertension) The link between Sitting and Ill-Health 

◆ For every additional two hours people spend watching television, their risk of developing Type 2 diabetes increases by 20 per cent and their risk of heart disease increases by 15 per cent. (A 2011 study by the American Medical Association where data from eight studies was combined) 

◆ People who sit for most of the day are 54 per cent more likely to die of heart attacks. (A 2009 study of more than 17,000 men and women over a period of 13 years by the Pennington Biomedical Research Center in Louisiana) 

◆ A number of breaks from sitting, even if they are as little as one minute, protect people from heart disease and obesity. (A 2011 study of 4,757 people published in the European Heart Journal)

Read more about Health: Cancer in the city;Decoding food labels.