Health Is a Common Theme in Most Cultures. in Fact All Communities Have Their Own Concepts
Health is a common theme in most cultures. In fact all communities have their own concepts of health as part of their culture.Among the definition still used probably the oldest is that health is the “absence of disease”. But according to WHO “Health is the state of complete physical, mental and social well being and not merely the absence of disease or infirmity”. Good health is a vital part of great experience of living.So attempts are being made to give every one a fair chance to lead a healthier and fuller life. To maintain good health, a diet containing the essential food and nutrient is very important.Adequate nutrition is necessary for vitality, longevity and sound health. It has direct bearing on the work efficiency and cultural productivity. Food is essential for human existence just like air we breathe or the water we drink (Park, 2000: 1).
Health is not a static phenomenon, but a dynamic life process which begins at birth and is governed by the genetic, nutritional and environmental factors throughout life. The calorie and nutrient intake affect work capacity and output and if the nutrient intake is either too much or too low, it results in obesity and malnutrition. The word obesity comes from a Latin word “Obesus” which originally meant “eaten away” or wasted, but in a relative sense came to mean a person or even a bird that had eaten fat. 17 to 38 percent of the Indian populations are obese. (Thilakavathi and Vijayalakshmi, 2002: 153).
Obesity may be defined as a condition in which excessive accumulation of fat in the adipose tissues has taken place. It arises when the intake of food is in excess of physiological needs.Obesity is the most common nutritional disorders in the western countries and among the high income groups in the developing countries (Swaminathan, 1998).
An excess of twenty percent above the ideal body weight can be termed as obesity.Maintenance of body weight within the limits of facilitating optimum health is of prime importance for maintaining good health. Obesity or excess fatness is the commonest problem of the affluent and it is the night mare of every woman above twenty years and of middle aged men. The prevalence of obesity in our country is high enough to make it a serious health problem. Instrict terms, the diagnosis of this disorder depends on the demonstration of an increased body fat content (Naidu and Begum, 1992: 154).
The prevalence of obesity, aptly described as a genetic misfortune, has reached epidemic dimension worldwide and is continuing to rise at an alarming rate even in developing countries where human hunger is the other side of the coin. It is estimated that more than 300 million people world wide are obese. According to Koon the prevalence rates of overweight and obesity in India are 12.8 and 10.3 percent respectively.Diet, eating pattern, physical inactivity, sedentary life styles, environmental factors, alcohol consumption and psychological factors contribute to obesity. This global epidemic is related to increased mortality and morbidity rates with excess body fat being a significant risk factor for a number of chronic disorders such as cardiovascular diseases, gout, gall stones, intestinal blockage, kidney disease, sleep apnea, hernia and arthritis. It also increases the likelihood of backache and flat foot. So ways and means of reducing the occurrence of this life threatening problem needs to be urgently explored. (Vijaylakshmi and Anitha, 2003: 436).
Obesity is a condition in which there is an excess of body fat. Being too fat, especially to the point of obesity, is positively harmful to the health. Of late, obesity is emerging as one of the most prevalent metabolic disorders. The voluminous researches have been carried out which revealed that wide spread derangements in various metabolic and endocrine functions are associated with obese state. It is associated with number of health hazards like it increases mortality and morbidity rates causing certain diseases such as cardiovascular and cerebrovascular diseases, respiratory insufficiency, diabetes and hypertension. It also reduces the life expectancy and it leads to mechanical disabilities. In women obesity increases the risk of cancer of gall bladder, breast and the womb (Asthana and Gupta: 1999: 263).
The obesity epidemic moves through a population in a reasonably consistent pattern over time and this is reflected in the different patterns in low and high income countries.In low income countries, obesity is more common in people of higher socio economic status and in those living in urban communities. It is often first apparent among middle aged women. In more affluent countries, it is associated with lower socio-economic status especially in women and rural communities. The sex differences are less marked in affluent countries and obesity is often common amongst adolescents and younger children.The standard definition of overweight (BMI≥25 kg/m2) and obesity (BMI≥30kg/m2) have been mainly derived from populations of European descent. However in population with large body frames, such as Polynesians, higher cut-off points have been used. In populations with smaller body frames, such as Chinese populations, lower cut-off points have been proposed and studies are being undertaken to separate appropriate cut off points for a variety of Asian populations (Swinburn, et al, 2004: 124).
Obesity is prevalent in several developing countries, affecting children, adolescents and adults particularly in those countries experiencing rapid industrialization and urbanization, obesity is growing faster and coexists with under-nutrition and infections diseases, becoming one of the greatest public health problems (Ribeiro, et al, 2003: 659).
Obesity is a public health problem in the west. Its prevalence in developing countries is generally believed to be low, but documented information in this regard is scanty. In India, main emphasis has been placed on under nutrition, but over-nutrition another profile of malnutrition has not been investigated in much detail. The magnitude of the problems is not known, but hospital experience has shown that a large number of obese patients need management for obesity (Sood, et al., 1985: 42).
Obesity is essentially a disorder of energy balance characterized by an excess of body fat. It is chronic in nature and often associated with a wide range of metabolic abnormalities and degenerative diseases, some of which could be life threatening. Further, it creates psychological problems and reduces the quality of life. This complex condition of multifactorial origin is considered to be the scourge of modern affluent societies, both in developed and developing countries. The ability to store energy in the form of adipose tissue can be considered as a survival strategy. This trait is, how -ever, not conducive to good health in case of affluent populations with sedentary lifestyles and abundant availability of food. Even in situation in which a genetic disposition to obesity exists, interactions between genetic and environmental factors play a part in the development of obesity. The body exerts a stronger defense against under nutrition and weight loss than over -nutrition and weight gain. The primary form in which the potential chemical energy is stored in the body is fat that is triglycerides. The amount of fat in the adipose tissue is the sum total of the differences between food/ energy intake and energy expenditure. Energy balance is controlled by energy intake and expenditure mediated through endocrinal (hormonal), nutrient, neuronal, gastrointestinal and metabolic signals which are all processed by the central nervous system. Energy requirements of an individual reflect the sum of the basal expenditure, thermo genesis and physical activity. Thus there are several factors involved in energy balance. The amount of body fat ultimately is influenced by age, gender, composition of diet, and level of physical activity. In humans, obesity depends on a variety of social, cultural and behavioral factors which act on physiological and biochemical mechanisms that dictate food intake and energy expenditure. Despite physiological regulation of body weight, small deviations in total energy intake and expenditure over a period of time could result in gain in body weight, with a new set point and physiological / metabolic control for body weight regulation (Krishnaswamy, 1999: 1).
Rapidly changing diets, physical activity patterns, and lifestyles are fueling the global obesity epidemic. Already, there are more than one billion overweight people world wide and some 300 million of these are estimated to be obese. In many developed countries obesity epidemic has already reached crisis proportions. According to the 1999-2000 National Health and Nutrition Examination survey (NHANES), the proportion of overweight or obese adults in the United Stateshas risen to 64%. Once considered a problem related to affluence, obesity is now fast growing in many developing countries and in poor neighborhoods of the developed countries. In many developingcountries with increasing urbanization, mechanization of jobs and transportation, availability of processed and fast foods and dependence on television for leisure, people are fast adopting less physically active lifestyles and consuming more “energy dense, nutrient poor” diets. As a result, overweight and obesity and associated chronic health problems, such as diabetes, hypertension, cardiovascular disease and cancer, are increasing rapidly, particularly among the middle class, urban populations. Even in countries like India, which are typically known for high prevalence of under- nutrition, significant proportions of overweight and obese now coexists with the undernourished.
1.1 WOMEN AND NUTRITION:
India constitutes one seventh (about 1000 millions) of the worlds population of which about 406 millions are women and about 12 million girls are born in India every year. India has the dubious distinction of being the only country in the world where the ratio of women to men has been declining and where the life expectancy of women is low than the men. In 1981, the number of female per 1000 males was 933 and in 2001 it was 929 (Cherian, 1994:32)
Women are more vulnerable to malnutrition for social and biological reasons; as children they are often discriminated against in getting access to healthcare, food and education, and as teenagers they have the risk of early pregnancy and suffer from retarded growth, ill health and deprivation, (ACC/SCN second report 1992:51)
Nutrition is one of the basic requirements of any living organisms to grow and sustain life. But the quality and quantity of nutritionnecessary to keep an organism in good health during its life span vary not only with age of the organisms but also with many other factors. Any major deviation in quantity from its requirements can affect the growth and life span in a number of ways.
The human being needs a wide range of nutrients to keep him healthy and active and he must derive most of these nutrients through his daily diet. Several of these nutrients are known to be quite essential since deficiencies due to inadequate intake of these nutrients are often encountered in the human subjects. The chief source of nutrient is food. It provides energy to keep the body warm and muscle active, supplies building material needed for growth and development. Compensating for the loss incurred by daily wear and tear, food also serves as the protective function. The food requirement varies according to age, sex and activity of the individual. Special demands are made during periods of stress such as pregnancy and lactation. The amount of food requirement of women has been cited in the table 1.1.
Amount of food stuffs (g) required per day for women of different activities groupsFood stuffs (g) / Sedentary work / Moderate work / Heavy work
Cereal / 410 / 440 / 575
Pulses / 40 / 45 / 50
Green leafy vegetables / 100 / 100 / 100
Roots and tubers / 40 / 40 / 100
Other vegetables / 50 / 50 / 60
Fruits / 30 / 30 / 30
Milk / 100 / 150 / 200
Fats and oils / 20 / 5 / 40
Meat, fish and egg / -- / -- / --
Sugar and Jaggery / 20 / 20 / 40
(Source: ICMR 1980 and 1990)
Natural food stuffs containnutrients in minute quantities and each nutrient is responsible for a specific task in the body. The major nutrients are energy, protein, calcium and iron and fat soluble vitaminslike vitamin-A and vitamin D and water soluble vitamins like ascorbic acid and B- Complex vitamins like thiamine, riboflavin, nicotinic acid, pyridoxine, folic acid and vitamin B12. The major nutrients like energy, protein and minerals like calcium and iron are essential for growth and maintenance of the integrity of the body tissues. The other nutrients namely vitamins and trace minerals are required for the metabolisms of these major nutrients and to maintain tissues at an optimum level of activity. Studies have been carried out on the quantitative requirements of these nutrients. The dietary requirement of above nutrients depend upon the age, sex and quality of mans habitual diet. The dietary allowance as recommended by ICMR (1990) for the Indian women in different activity groups are presented in the table 1.2.
Nutrient requirement per day for women of different activity groupsNutrients / Sedentary work / Moderate work / Heavy work
Energy (Kcal) / 1875 / 2225 / 2925
Protein (g) / 50 / 50 / 50
MineralIron(mg) / 30 / 30 / 30
Thiamine (mg) / 0.9 / 1.1 / 1.2
Riboflavin (mg) / 1.1 / 1.3 / 1.5
Niacin (mg) / 12 / 14 / 16
Vitamin C(mg) / 40 / 40 / 40
Vitamin-A (g) / 2400 / 2400 / 2400
Folic Acid (g) / 100 / 100 / 100
Nutrition plays a very important role in the physical, mental and emotional development of human beings. The nutritionalrequirements of females also follow the same pattern in males, but they differ from males in certain important aspect during certain age periods. There is less difference between men and women in nutritional requirements during infancy and early childhood. During adolescent and adult periods, however the nutrients of women’s are lower than men, since the growth rate during adolescence and adult body weight attained are lower in women than in men. During reproductive age period, due to blood loss during the menstrual period, women’s need for certain nutrients concerned with blood formation (viz. Iron, folic acid, vitamin B12) is much higher than in men.
The recommended dietary allowances for Indian women in general are 1800 Kcal energy, 50 g protein, 400 mg calcium, 30 mg iron, 600 g retinol (Vitamin A), thiamine 1.1 mg, riboflavin 1.3 mg and folic acid 100 g daily (Gopalan et al. 1996). A poor Indian mother’s calorie intake is 1400 – 1800 Kcal/ day and her protein intake is 40 g/ day or less. Studies in Gujarat sowed that the proportion of women who consumed less than 2000 Kcal / day was 43 percent (Srikantia, 1990:108)
1.2 WOMEN AND OBESITY:
Adolescents with special reference to girls are concerned about their weight. Obesity occurring in adolescents tends to remain throughout life. Storz and Greene state that above one third of adolescents studied were obese and remained so as adults. In a developing country like India, obese adolescent girls are common these days which may be attributed to changed eating habits of adolescents. Excessive intake of energy and fat has adverse effect on the body dimension and therefore may have an effect in their blood cholesterol levels also. Studies on the prevalence of obesity among Indian adolescent’s girls and blood cholesterol level are very few till now (Sasirekha and Tamilarasi, 1990: 35).
In India, women constitute about 48 percent of all human resources and work force. Thus, their good health is of paramount importance. Obesity, a world wide problem, associated with a reduced life span, has been extensively documented in the western countries. A high prevalence has been reported in the female sex (Dua and Seth, 1988: 338).
Obesity is an established risk factor for post-menopausal, but not premenopausal, development of breast cancer. Evidence for a positive association between obesity and breast cancer mortality is mounting. Avoiding adult weight gain and maintaining a healthy body weight may contribute importantly to decreasing breast cancer risk and mortality, especially in postmenopausal women. The relationship between obesity and breast cancer incidence and mortality is complex and especially difficult to interpret (Petrelli, et al., 2002: 325)
The relationship between weight status and the occurrence of breast cancer is complex. Nonetheless; overweight and obesity have been implicated as risk factors for breast cancer in postmenopausal women (Barnett, 2003; Connolly et al, 2002; Stephenson and Rose, 2003). Connolly and colleagues, in their Metaanalysis of 19 studies, suggested that the risk of breast cancer increased as waist to hip ratio increased. This risk was independent of general obesity (overall BMI), as well as other known breast cancer risk factors. Further more obesity and poor breast cancer outcomes are more prevalent in African American women than in Caucasian women”. (Blackburn, Copeland, Khaodhiar, and Buckley, 2003 :185).
Evidence shows that dietary fat intake may play a significant role in the development of breast cancer (Blackburn et al., 2003). Diets low in saturated fats and high in fruits, vegetables and whole grains may protect against breast cancer. Furthermore, the type of fat ingested, specifically marine fatty acids has been found to inhibit the proliferation of breast cancer cells in animals and in vitro studies (Terry, Rohan and Wolk, 2003). However, similar findings have not been obtained in studies using human participations. Terry and associates (2003) in their review of 7 prospective cohort studies and 19 case control studies concluded that evidence to support this assertion remains unclear. Consumption of fish and marine fatty acids was not associated with a decrease in the incidence of breast cancer. As with cardiovascular health, a diet high in fruits, vegetables and high-fiber carbohydrates and low in fats seem to offer protection against breast cancer. Women who followed the dietary guide liens and ate in this manner decreased their risk of breast cancer by 15% (Blackburn et al., 2003).These investigators concluded that lifestyle modifications, including diet, protect middle aged and older women from breast cancer. There does not seem to be an association between intake of foods high in dietary carotenoids such as lycopene and protection against breast cancer (Terry, Jain, Miller, Howe and Rohan, 2002), unlike the possible association between lycopene and decreased risk for cardiovascular disease (Sesso et al., 2004).