From Poverty’s Hunger to Prosperity’s Danger

The security line at the Orlando airport was discouragingly long. After 10 minutes or so, I noticed a pair of twinkly, crinkled brown eyes looking at the meeting badge I still wore around my neck, and a warm smile all but hidden in a bushy snow-white beard.

The gentleman motioned for me to step ahead of him in line, and said that he too had just attended the annual meeting of the American Diabetes Association.

A resident of Mumbai, my traveling companion said he was a family physician by trade, but a diabetes specialist by necessity.In some regions of India, traditional foods like this are giving way to....

“Type 2 diabetes is a growing epidemic in India, just like in the rest of the world,” he said. “About half my time now is spent treating patients with diabetes and trying to educate them on how to avoid getting it.”

In some areas of India, traditional foods like this... (Courtesy flickr user KingoftheHill (CC))

I expressed some surprise at this, revealing I suppose my own ignorance of the incredibly varied cultures of this vast country. Weren’t many Indians vegetarians, a dietary lifestyle associated with low rate of type 2 diabetes? And didn’t the country’s notorious poverty provide some protection against the obesity that so often presages the disease?

The doctor told me that thanks to global outsourcing, the median income in India is rising like never before. Although grinding poverty is still common, many people, particularly those in large cities like Mumbai, are earning not just a subsistence wage, but a salary large enough to afford some luxuries.

Luxuries like the ability to leave behind the beans, grains, and vegetables that form the basis of most diets in the country, and indulge in the exotic, Western food that so symbolizes their new-found prosperity.

are being replaced with meals like this. (Courtesy flickr user poolie (cc))

We’re not talking duck confit with a Zinfandel reduction here. We’re talking a love affair with The Colonel. “Indians really love the Kentucky Fried Chicken,” he said. “Also McDonalds is very popular.”

Rather than tea or the traditional yogurt-based lassi, the new drinks of choice are full-sugar sodas. Super-sizing is a popular concept—one that really appeals to a people who have struggled so long against hunger.

My friend mourned the loss of interest in local cuisine, which is especially apparent among young professionals. The cooking skills and recipes that have kept their families fed for generations are slowly being lost, and the substitutes are often poor.

“The most nutritious food for any people is the food that comes from the region where they live,” the doctor opined. “The farther we move way from that, the more dangerous our diet becomes.”

Along with dietary patterns, the new Indian middle class is inheriting a host of other unhealthy behaviors—irregular sleep (often due to telephone work that coincides with office hours half a world away), alcohol use, and world-related stresses, he added.

“I believe this new lifestyle is out of control,” he said, but he fears his patient counseling falls on deaf ears. People want to eat what they can afford, and now they can afford to eat in a new, exciting way. But there are all kinds of health implications; not just type 2 diabetes, but hypertension and cardiovascular disease as well. He also predicted increases in cancer in the years to come.

How interesting that all these illnesses are just as common in the U.S., but in an upside-down kind of way. Here, lower socioeconomic status is consistently related to greater risks for diabetes, hypertension, heart attack, and stroke, all of which are related to diet.

In India, the poor fill their bellies with the cheapest foods—rice, beans, grain and little or no animal protein. As their bank accounts fatten, though, so do their waistlines and arteries, clogged with costly Westernized “junk” foods.

In the U.S., the poor stretch their food dollars with cheap, calorie-dense, high-fat foods. The more affluent are turning back to beans and grains, filling up on pricier fruits and veggies, and eating smaller portions of lean proteins.

My traveling companion said that he was bold enough address the issue publicly, in one of the meeting’s presidential sessions. “I stood up and said, ‘When are we going to put a warning on these foods, especially sodas, like we did on cigarettes? People need to know these are bad for their health. It took us 50 years to get that warning on cigarette labels. We can’t afford to wait 50 years to change this problem that is destroying people all over the world.”

Soon enough, we parted ways, knowing we’d probably never meet again but linked by a problem that spans the 12,000 miles between our countries.

—Michele G. Sullivan
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Filed under Cardiovascular Medicine, Endocrinology, Diabetes, and Metabolism, Family Medicine, IMNG, Internal Medicine, Primary care

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