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Hooked on disease

By Manipadma Jena

With a Rs 6,750-crore fast food industry growing at 35% annually, non-communicable diseases such as diabetes and cardiovascular disorders are rising sharply. How is this slow-motion health disaster to be tackled?

Advertising fast food in Ludhiana

Eight-year-old Pupun is getting restless and hungry. It is well past his bedtime. He has kept awake because his mother is glued to the television. Rina Mishra (34) is loathe to leave the riveting Hindi soap she is watching and go into the kitchen to prepare dinner. Anyway, her husband, a medical representative, is on tour. She asks Pupun if he'd like a chicken burger and potato chips with a Coke for dinner. Pupun nods vigorously. This is the eighth time in a month that his mother has ordered fast food for a main meal. She is afraid these regular splurges will upset her modest monthly budget; she has no other reservations.

Like many mothers, Rina is unaware that these expensive, 'happy' meals not only provide no nutrition to her child but could actually be causing his ill health.

In March this year, the Centre for Science and Environment (CSE), a public interest research and advocacy organisation based in New Delhi, carried out a revealing Junk Food and Nutrition Study. The CSE has also studied pesticides in soft drinks and bottled water, and in the blood of population groups in Punjab. Another study revealed the presence of organic chemical phthalates in children's plastic toys that make their way into the infants' bodies.

Most educated people today, including older children, are diet literate, at least about excessive intake of oil, salt and sugar. But why is there a dichotomy between awareness and practice? Why is junk food so destructively alluring?

Unpublished 2010 data from Dr Anoop Misra, Chairperson, National Diabetes Obesity and Cholesterol Foundation in Delhi and 2007 Padma Shri awardwinner, who has been studying children's attitudes and eating habits, says that 51% of children consider homemade food 'old-fashioned'; 43% consume junk food because it is considered the 'in-thing'; 68% of children said interesting advertisements 'inspire' them to buy junk food; and for 73%, watching television and junk food go hand-in-hand.

Children older than Pupun (adolescents and 20-somethings) who hang-out at junk food joints said: "It is a happening place" (32%); 25% said: "It is fashionable"; while the biggest chunk (68%) said: "I saw advertisements".

All these factors motivated almost 65% of children to eat chips, and 30% to consume pizza and burgers between two and three times a week.

According to the CSE Junk Food and Nutrition Study, a 100 gram PepsiCo Lays (Smart Pack, March 2012 batch) potato chips packet contains 3.7 grams of transfats. CSE lab tests found that most 100 gram potato chip packs contain 33 grams of total fats, 57.5 grams of carbohydrates, 1.2 grams of salt, and varying amounts of transfats. Trans fatty acids are formed during the process of adding hydrogen atoms to oil to prevent it turning rancid and ensuring a longer shelf life. Transfats are associated with heart problems, diabetes and cancer, among other health problems. (A PepsiCo India spokesperson clarified that their products do not contain transfats, via email to this writer.)

The CSE study put 23 samples of popular junk food under the scanner including four brands of potato chips, two Indian snack brands, two instant noodle brands, two carbonated beverage brands, six burger brands, three pizza brands, and one fried chicken brand.

What do these numbers mean? According to Chandra Bhushan, CSE's Deputy Director General who also heads the CSE pollution monitoring lab: "The findings are pretty damning." Munching a standard-sized 65-75 gram potato chips pack finishes about half a person's daily fat quota; the Lays March 2012 batch will, in fact, exceed one's transfats quota; and Uncle Chips Spicy Treat will cover 60-70% of a person's daily salt quota.

The World Health Organisation (WHO) recommends no more than 2-2.5 grams of transfats as a person's daily intake; 30 grams of free or natural sugar, and 20 grams of added sugar; and less than 5 grams of salt.

The fast food industry is not confined to urban centres and food courts. Junk food is increasingly consumed by the poor

India already has a serious salt problem; more than 40% of the population consumes above 10 grams of salt a day. The amount of dietary salt consumed is an important determinant of blood pressure and overall cardiovascular risk.

Changing Indian diets -- low on nutrients and high in salt, sugar and fat -- are a direct indictor of disease. Experts say eating junk or 'bad' food now begins at an early age (like Pupun) and is responsible for rising cases of obesity, diabetes, cancer, chronic respiratory and digestive diseases and cardiovascular disease, all of which are grouped under non-communicable diseases (NCDs).

A 2009 seven-state Integrated Disease Surveillance Report by the National Institute of Medical Statistics, New Delhi, found a substantial percentage of people eating less vegetables and fruits, and consuming fast food at least once a week in urban and, surprisingly, also in rural India.

"Unhealthy diet," says the WHO, which considers NCDs the new global epidemic, "is one key cause of the growing global burden of disease."

NCDs such as obesity and diabetes accounted for over 50% of all deaths in 2005; by 2030 they will be responsible for the death of two-thirds of all Indians, says the Delhi-based Public Health Foundation of India.

The latest National Family Health Survey (2005-06) says at least one out of every eight Indians is overweight or obese. In cities, this figure worsens to one in five and increases vulnerability to the numerous health disorders that obesity generates.

"What we in India urgently need is a disease-delaying lifestyle," says V Prakash, president of the Nutrition Society of India, Mysore. "Food is not junk; it is the manner in which it is processed that makes it junk. India's regulations look at process safety but not product safety. Regulations have to be harmonised. We want a building to stand, but our pillars are on a collision course," rues Prakash. Bhushan agrees: "India has no standards for finished products."

The experience of western countries, specifically the US, Dr Anoop Misra's studies, and general consensus are all clear about one thing: junk food advertisements are in large part to blame for initiating youngsters into consuming health-threatening levels of junk food.

Allan Collaco, Secretary General of the Advertising Standards Council of India (ASCI), a self-regulatory body for the advertising industry, pleads helplessness over the fact that sleek advertisements pushed by popular filmstars motivate a high number of youngsters to patronise junk food. He says it is the moral responsibility of filmstars to check the products out carefully and fully understand their impact before accepting high-paying advertising assignments that seek to present junk food as fashionable.

 "ASCI's principles ensure the ad's truthfulness and honesty claims; ensure that they are not offensive; that products are not harmful or hazardous; and observe fairness in product competition," Collaco explains.

The ASCI does have a regulation code for children under 13 years of age, however. Advertisements should not mislead consumers into believing that consumption of a product advertised will result directly in personal changes in intelligence, physical ability or exceptional recognition. All nutritional and health benefit claims in foods and beverage advertisements are required to be substantiated scientifically.

Sunfeast biscuits claimed children who ate its Milky Magic brand grow taller, and Maggi's 'Happy Hearts-Healthy Soups' are some instances where the claims of the advertisement were found to be misleading through independent laboratory tests, and withdrawn, Collaco says.

'It is important that there be policies on advertising and rules that advertisements of junk food are restricted or prohibited during children's programmes and on cartoon channels. "Bad" food should be taxed and the money used to advertise nutritious food and healthy food,' says the CSE.

Globally, the question of aggressive advertising for so-called 'bad' food -- at least during children's TV programmes -- has been under discussion by the WHO since 2002.

According to a National Restaurant Association of India (NRAI) 2010 report, the fast food industry in India is estimated at between Rs 6,750 and Rs 8,000 crore and growing at a compounded annual rate of 35-40%. A major chunk of this market is ruled by global players like McDonald's, Yum! Brands (Kentucky Fried Chicken, Pizza Hut), Domino's, Subway, Coca-Cola and Barista. Domestic players like Nirula, Pizza Corner, Coffee Day group, Haldiram's, however, also command a fair share of the fast food market.

Children and young people are the fast food industry's most loyal customers. Hook them to a brand and you have them for life. And hooking them is mostly about a fat marketing budget. A mint brand could have an advertising budget of 10 million dollars, while a US government campaign like the one advocating five fruit and vegetable servings a day in its best year had to make do with an annual budget of 2 million dollars. In fact, for every dollar spent in the US on nutrition education, the food industry spends 5,000 dollars on food advertisements, says an earlier World Bank report. India's nutrition advocacy is a pittance.

In India, the branded fast food industry, by all evidence is following this practice by 'hooking the young' as its priority target. This "slow-motion disaster", as Margaret Chan, Director General, WHO, calls NCDs, is assuming alarming proportions; significantly, the young are also being 'hooked onto disease' much earlier.

Dr Anoop Misra says: "Today's average age of onset of diabetes in an Indian is 35-39 years, a decade earlier than in other races. Many are in their late-20s." Misra's 2009 study 'Age-wise Prevalence Trend of Risk Factors' finds hypertension, obesity, high lipids, diabetes, and abdominal obesity in India starting as early as 15-19 years, jumping at the ages of 20-24, with the highest being at 25-29 years.

In fact, in 2006, Misra found that with India's growing 'prosperity', the ranks of the obese within a span of just two years jumped sharply from 16% to 29%. According to him, 77% of obese children will be obese adults with high cardiovascular risk. "The diabetes tsunami is rising," he says. "Nearly 51 million Indians suffer from it; it is estimated to rise 150% over the next 15 years."

It is telling that 72% of schoolchildren in Delhi are not willing to cut down on junk food, and that 47% are unwilling to restrict their television viewing to take up some physical activity (70% of students in Classes X and XII are sedentary, Misra's study found).

Earlier timelines for diabetes onset and heart attack could, in future, be dramatically brought forward. About one-fourth of global NCD-related deaths take place before the age of 60. The UK government, which has been campaigning since 1994 for reduced salt in diets, now prevents 6,000 premature deaths and saves 2.5 billion dollars in health costs.

In another worrisome development, doctors now say that Indians with modern food preferences are at greater risk. Indians become classified as overweight or obese at a lower body mass index (BMI is a proxy measurement for human body fat based on an individual's weight and height) than Caucasians because of their genetic makeup. They have less muscle and more fat content compared to Caucasians.

This means that with changes in diet to include more saturated fats, more carbohydrates and less fibre, more meat than vegetables, eating out more regularly and eating more junk food, Indians gain fat really fast. They do not necessarily bloat up, concealing what would otherwise be an obvious warning sign.

Junk food is popular because it is tasty; its low fibre, high fat and transfat, high sugar in liquid form, and high salt content make it an unhealthy choice of food. But what many people don't know is that junk food has a chemical impact on the brain that induces gorging, which in turn leads to obesity.

A 2009 study by Deborah Clegg from the University of Texas at Southwestern, published in The Journal of Clinical Investigation, suggested that when we eat something high in fat, the brain gets 'hit' with the fatty acid. Fatty molecules cause the brain to send messages to the body cells, warning them to ignore appetite-suppressing signals from leptin and insulin, hormones that are involved in weight regulation. Since the body does not get the signal that it is satiated, the result is overeating (http://www.jci.org/articles/views/36714/version/2).

Studies also show that too much junk food altering the chemistry does to the brain what cocaine does, due to its containing high-fructose corn syrup, monosodium glutamate, hydrogenated oil, refined sugar and chemical preservatives (a 2010 study conducted by scientists at Scripps Research Institute).

Another study by researchers at the University of Texas in Austin and the Oregon Research Institute found that prolonged consumption of junk food results in reduced activity in the striatum, a section of the forebrain that registers reward. Hence, like drugs, people addicted to junk food require ever-increasing amounts to get the same 'high'.

Children who are habitual junk food eaters are especially vulnerable to slowing of bodily growth and lower IQ levels. Artificial low grade food colouring can cause hyperactivity and lapses in concentration, other studies have shown.

The Environmental Health Perspective, February 2012 issue, discusses the growing danger of obesogens. Researchers are now finding convincing evidence of chemical obesogens -- industrial chemicals, pesticides, air pollutants -- that alter metabolic processes and pre-dispose people to gaining weight. Research has thrown up an even more alarming characteristic of obesogens. The April 2012 issue of Physiology and Behaviour finds that fat loss triggers the release of obesogens back into the bloodstream, at which point, among other influences, they can suppress thyroid function -- namely our body's energy-burning capacity. This leads to a decline in our body's ability to turn fat into muscle, reducing even our resting metabolic rate. In other words, there is a drop even in the number of calories our body burns without movement or exercise, thus preventing a fat person from losing weight (Angelo Tremblay and Jean-Philippe Chaput 2012, in Physiology and Behaviour 106 (2012), pp 16-21, Elsevier Inc).

While the WHO has consistently been pushing for regulations to control NCDs, the world's food industry has not been an easy beast to leash. In January 2011, the WHO issued a recommendation asking for a ban on junk food in schools and playgrounds in order to promote healthy eating and tackle child obesity. "Children throughout the world are exposed to marketing of foods high in fat, sugar or salt which increases the potential of younger generations developing NCDs during their lives," it warned.

But, critics say, the organisation did not go far enough; it should have also directed governments to ban junk food advertisements directed at children.

Some governments around the world are indeed beginning to act. In March 2012, Scotland proposed to ban advertisements of junk food on television shows aired before 9 pm (http://www.bbc.co.uk/news/uk-scotland-17414707). Likewise Britain, some states in the US, Mexico, UAE, Canada have banned various junk foods from their schools. Denmark in 2011 imposed a fat tax on junk food under which consumers have to shell out a little more than half a krone (1 krone = US$ 01.7) for a packet of chips. This tax will fund the growing cost of treating obesity-related diseases and discouraging junk food consumption.

The India government, however, is still addressing technicalities in banning junk food in schools. 'According to it, junk food is not defined; instead it falls in the category of proprietary food, which is food not standardised under regulations. This category is only expected to declare their composition or nature of food and comply with general regulations under the food laws,' explains a CSE document.

The onus of responsibility has been shifted to state governments and school authorities. And, action on seeking a ban has been left to a public interest litigation by non-profit Uday Foundations for Congenital Defects and Rare Blood Groups in the Delhi High Court.

"Food is about business; big business in our kitchen. It has to be regulated for our safety and nutrition," urges CSE's Sunita Narain.

References
1 Our (Un)Acceptable Daily Intake: Regulating for Good Food and Good Health, a Centre for Science and Environment publication 2012
2 'CSE Junk Food and Nutrition Study',March 2012
3 Resource persons, various, at CSE's 'South Asia Media Briefing on Food Safety and Environmental Toxins', March 29-30, 2012
4 Dr Anoop Misra et al, 'Diabetes and Obesity in India: Focus on Lifestyles of Young Individuals', PPT; various studies in New Delhi; multi-centric study done on 38,000 schoolchildren 
5 Other sources

(Manipadma Jena is a senior environmental journalist)

Infochange News & Features, April 2012