The Indian government should declare a Pigouvian health tax on junk food.
OBESITY: Excessive body fat isn’t just a cosmetic concern; it is a major cause of serious health issues with reduced productivity and financial consequences to the individual, the community, and the nation. This is why PM Modi has initiated an anti-obesity campaign in his monthly radio broadcast and on social media. A combination of factors like genetics, binge eating of high-calorie processed foods, and a sedentary lifestyle with stress and inadequate sleep, steroid medication, and inadequate thyroxine levels causes obesity. Health risks of obesity include rapid aging, diabetes, high blood pressure, heart disease, stroke(paralysis), some cancers, breathing problems (Obstructive Sleep Apnoea), worn-out joints (osteoarthritis), fatty liver diseases, diseases of the gallbladder, pancreas, kidney, sexual function and fertility (PCOD), pregnancy and mental health problems. Reduced mobility and difficulty in maintaining personal hygiene are other problems. Soon insurance companies, airlines, and other facilities will penalize the obese.
SEDENTARY LIFESTYLE: Prolonged sitting and insufficient physical activity (PA) is a leading cause of many non-communicable diseases and death. Exercise Vital Sign (EVS) surveys have 2 questions to assess PA: (1) the average number of days/week the respondent engages in moderate to strenuous PA and (2) the minutes/day the respondent engages in such activities. The Lancet Physical Activity Series Working Group has validated it. Monitoring seven primary vital signs, heart rate, respiratory rate, blood pressure, body temperature, blood oxygen, body weight, and blood glucose (sugar) can assess your overall wellness, or illness, and monitor recovery. The heart beats faster and stronger to increase cardiac output and maintain blood pressure to supply oxygen-rich blood to your brain and other vital organs during exercise. Vital signs can improve with body fat (weight) reduction and exercise. Exercise also reduces stress and improves sleep quality.
TYPES OF EXERCISE: Jargon like Pilates, High-intensity interval training (HIIT), Functional training, Circuit training, Burpees, etc. discourage people from exercising. There are three types of exercise. Stretching exercises like Yoga improves flexibility and agility. Mobility and stamina-improving exercises (Aerobics or Cardio) such as brisk walking, running, swimming, cycling, dancing, jumping rope, climbing steps, and sports. At least 150 minutes per week of such moderate activity is desirable to stay fit. Strength or Resistance training exercises involve body weight or external weights to strengthen bones and muscles and reduce body fat. Our body efficiently allocates resources and quickly channels supplies away from muscles or parts of the brain or body not in use. Hence it is important to use every essential part of our body.
PROCESSED FOOD: Food processing removes fibre, and breaks down complex carbohydrates, increasing the speed of rise in blood sugar level (high glycaemic index), destroys nutrients like vitamins B and C which are heat (cooking) sensitive, alters essential minerals in absorbable organic form to less absorbable forms. The addition of excessive salt and saturated fat further harms the consumer. What can be digested raw is the natural diet of any animal in the wild. Ruminants feed on grass and leaves, birds have a gizzard to digest whole cereals and seeds. Carnivores have evolved to feed on raw meat. Pigs and vultures can manage rotting food. Just like we are careful to fill petrol in petrol vehicles; not diesel, kerosene, or aviation fuel, we need to check what we put in our mouths.
EXCESS FOOD: Excess food is bad like excessive water or any excess in life. Sugary, fatty (Junk) food allows you to consume far more calories than you can utilize. The excess calories stored as body fat disrupt your hormonal balance, metabolism, and storage mechanisms, leading to serious health issues already stated. Sugarcane is difficult to consume. Its juice is easier to consume. Vast amounts of calories can be consumed once it is processed into jaggery and further into refined sugar. Fats and alcohol are also calorie-rich. Chewing food is important for dental and oral health. It also slows food intake giving our satiety centre to suppress our appetite. Processed and overcooked food does not need chewing nor many calories or effort to digest it. Water has no calories, but lots of calories are consumed to warm it to body temperature, absorb it, transport it within the body, and finally get rid of it with soluble body waste.
EXTREME, FAD DIETS: Atkins, South Beach, Ketogenic, Raw paleo (supposed raw meat diet of hunter-gatherer ancestors of the paleolithic period), Zone, Dukan, 5:2(intermittent fasting), sugar-starch (carbohydrate) free, Single food (only one fruit or vegetable), Juice, Food combining (eg. meat and carbohydrate) diets are promoted on social media. Extreme diets are unbalanced and unsafe, and weight loss is not sustainable. The meat industry advocates an excessively high-protein diet for muscle strength. Elephants, Rhinos, and Buffalos are muscular and strong despite a low-protein diet. A low or no carbohydrate diet does not differentiate between complex natural carbohydrates in fruits and vegetables that get digested and absorbed slowly from highly processed, simple carbohydrates (high glycaemic foods) that suddenly raise the blood sugar. Our natural diet is a high fibre, complex carbohydrate, moderate protein, and unsaturated fat diet found in fruits, vegetables, whole grains, sprouts, and essential fats like in the Mediterranean diet, accompanied with adequate water.
PIGOUVIAN TAX ON JUNK FOOD: Pigouvian tax, named after British economist Arthur C. Pigou, discourages undesirable behaviour, encourages economic efficiency, and generates additional revenue that can be used to counter adverse effects of the tax target. Junk food is much cheaper than healthy food and hence obesity is affecting the poor also. The WHO has reported that the tobacco tax in Gambia reduced cigarette imports by over 60%. Pigouvian or a punitive tax on alcohol, tobacco, and junk food can be used to discourage drunken driving, smoking; and consumption of calorie-rich, sugary, salty, deep-fried, nutritionally poor processed foods. This revenue should be used for public health and education. All forms of advertisement and enticement, especially of children, to consume unhealthy food should be unequivocally disallowed.
GOOD GUT MICROBES: Gut microbiota or microbiome or flora are microorganisms (bacteria, archaea, fungi, and viruses), that are resident in our gut. Gut flora differs from animal to animal depending on the type of food and digestive system. Gut bacteria help digest complex carbohydrates and dietary fibres. They also produce or help synthesize important nutrients like short-chain fatty acids and vitamins (B1, B9, B12, and K). They help regulate blood sugar and our immune system and protect against invasion by harmful microbes. They can affect our emotions and sensory perceptions. Many studies have indicated that the consumption of animal products especially red and white meat can harmfully alter our gut microbiome. Fermented foods like yogurt, kimchi, sauerkraut, and kombucha; and Probiotics (live microbes supplements) add beneficial bacteria to our gut flora. Probiotics are useful in preventing antibiotic-associated diarrhoea, necrotizing enterocolitis, and sepsis in premature infants; for treating infant colic, periodontal disease, and ulcerative colitis. Prebiotics are non-digestible food components that selectively stimulate the growth or activity of desirable microorganisms. Synbiotics are a combination of probiotics and prebiotics. A healthy diet promotes healthier gut flora. A healthy gut flora can reduce the risk of obesity, heart disease, diabetes, and cancer.
Prevention, especially of childhood obesity and correction of obesity is best achieved with a balanced, healthy, nutritious diet, adequate water, and physical activity or exercise instead of resorting to extreme diets, weight-reducing drugs, or bariatric surgery. Both health and wealth need self-control and motivation.
* Dr P.S.Venkatesh Rao is Consultant Endocrine, Breast & Laparoscopic Surgeon, Bengaluru.