Lifestyle: Fitness; Fighting Fat

As obesity gains proportions, upwardly mobile India is trying out every weapon in its battle against the bulge.

The politically correct say Sandeep Anand is horizontally challenged. Nutritionists declare he is prone to abdominal adiposity. Tailors blandly categorise him according to his shirt size -- XXL at least. But restaurant manager Anand knows there's no delicate way of saying this: he is fat. Obese. Overweight. Flabby. Pursy. Corpulent. At 105 kg and a piffling 5 ft 7 in, his spread challenges every nut and bolt holding his groaning bathroom scales together. Anand, 25, checks furniture to see if it is sturdy enough to hold his bulk. He hears but does not listen to the sniggers and the cries of "Mote!" (fatso) that follow him. Yes, life is tough out here in the darkness of adipose alley.

MYTHS AND FACTS

Fighting Fat

Myth Fat can be melted or kneaded away
Fact Saunas and heat pads merely get rid of the body's water, causing "instant" weight loss. But who wants to be a human prune? And kneading cannot "redistribute" fat to areas of your choice. Vibrators and vacuum pumps can traumatise your muscles.
Myth Like stringy hair, fat can be fixed at a beauty parlour
Fact Obesity is only indicative of a major illness like hypertension, diabetes, heart trouble or arthritis. Some are fat because it's in their genes. Start a weight-loss programme only after consulting a doctor.
Myth Eggs for a week, fruits for two -- crash diets do work
Fact They don't. It's called "yo-yo" dieting. You do lose weight but all the weight you lose comes right back once you go off the chart. There is no substitute for a balanced diet with a little of everything, topped by a regulated exercise programme.
Myth A magic pill is on the way
Fact It isn't. Two anti-obesity drugs were withdrawn in the US after receiving official clearance. Doctors discovered they were causing leaky heart valves. A new candidate is on the market, but it comes with a host of statutory warnings.

"I was slim once, you know," sighs Anand. He desperately gives up office time now to sweat it out for two hours at the gym. He eats a katori of sprouts for breakfast, an apple for lunch. These are desperate times and Anand is a desperate man. It was only last year that he was a healthy 66 kg. But 12 months and a tidal wave of modern afflictions and seductions -- cramming for career-advancement tests, stress, pizzas, butter chicken -- were enough to sweep him into blubberland.

Forget the picture of the scrawny Tamil, the brawny Jat. The traditional pictures the world sees of the lean, stringy Indian are, in urban middle India, ready to be replaced by tubby caricatures of lard rolling down the heaving streets. India's first organised studies on obesity are in -- and they make for disquieting reading. A study by the Nutrition Foundation of India (NFI), Delhi, released this January reveals that half of all high-income group females were overweight, as were 32.2 per cent of males. Startling when you contrast that with the poor in slums where just 1 per cent of males and 4 per cent of females are overweight.

Several studies over the years at the Hyderabad-based National Institute of Nutrition indicate a steady growth in the number of obese Indians. As economic progress and globalisation spread, so do waistlines. An upwardly mobile society is gathering fat as it attempts to gather its fortunes. The stereotypes are all true: the corpulent lala at the local provision store; the tubby spoilt kid; the fleshy kitty party marm. Traditional lifestyles and food have been eclipsed in the teeming towns and cities, the playgrounds of fatdom. Cheese and sauce-laden pizzas instead of jowar rotis. MacAloo tikki burgers instead of idlis. Fried rice instead of thair saddam (curd rice).

An unreleased study done for the Delhi-based Indian Council of Medical Research (ICMR) in Haryana and Delhi notes that 48.6 per cent of women and 35.5 per cent of men in urban areas are obese. Again the contrast with rural dwellers eating traditional food and living a life of hard labour is stark: 11.4 per cent of men and 7.9 per cent of women in villages are fat. "In the urban population of India ... refined wheat and rice have virtually displaced coarse grains and millet as the staple cereal," observes C. Gopalan, the author of the NFI study. "As the population ascends the socio-economic scale, cereal intake declines and intakes of sugar and fats generally increase."

A fatter society isn't just an uglier society. It is, says Dr K. Srinath Reddy, the author of the ICMR study and professor of cardiology at the All India Institute of Medical Sciences, Delhi, downright dangerous. Obesity is intimately linked with a disturbing urban escalation in heart disease, diabetes, osteoarthritis and hypertension. "Weight reduction is a very important part of treatment for hypertension, diabetes and abnormal lipid profiles, among others," explains Reddy.

FAT BUSTERS
Various new aids promise a slim new you-but do they really?

Computerised equipment

Computerised Equipment
Computers run at the heart of modern gym equipment. With pulse rate, calorie burn and pace of exercise so monitored, as in this exercycle, overweight people reduce chances of overexertion. None of this is cheap of course. Prices of Rs 1 lakh are not uncommon.

Muscle Stimulators and Vibrators
Machines that tone the muscles by vibrating them, with repeated contraction and relaxation of muscles. Considered a basic body workout by some, but the experts think repeated vibrations could mean painful mini-haemorrhages.

Liposuction
Surgical method to pump out fat from the body. The obese flock to plastic surgeons for liposuction but it is not a treatment for obesity at all. It can cause swelling and infection, even blood collection in the affected region.

Vacuum Pumps
A machine that manages to create a vacuum in parts of the body. How does that help? Medical research says it probably does not, but users say it loosens up stubborn fat, making it softer, the first step to a slim body. As for clinical basic: no research at all.

There are today roughly more than 100 million overweight Indians, a rising number of them children. Doctors report a significant jump in the number of obese children between 11 and 16 years who are brought in by parents. "This is a trend we should watch out for because this explains the younger age at which many diseases are getting manifested," says Dr Mandeep Bajaj, endocrinology and diabetes specialist at Delhi's Apollo Hospital. Random surveys in urban public schools show how children are growing, literally. One major reason, say doctors, is the magnetic call of television, creating a generation of miniature couch potatoes.

The NFI study warns that if this trend -- moving up in life and lard -- continues, fat could emerge as the single most important public-health problem among adults. "Obesity may not be considered a specific 'disease', but it is certainly the 'mother' of all important degenerative diseases in adult life," says the study. "Prevention and control of this problem must, therefore, claim priority attention."

Attention? Fighting fat is getting more than attention. It is almost becoming an urban fixation. "One gram of carbohydrate or protein costs four calories whereas one gram of fat costs nine." That's dinner-table talk for Vinita Chowksi, a pretty 33-year-old from Mumbai who likes to, and can, slink into designer clothes. Chowksi breaks every bit of food on her plate into their nutrient components. One small piece of gooey chocolate cake = 11 fat grams + 13 carbohydrate grams + 10 protein grams. Total: 191 calories. "It's a treat that I allow myself only once a week," she says primly.

But of course, such calorie counting isn't directly motivated by health concerns. It's all about a desperation to get the body of a Salman Khan, a Milind Soman, a Sonali Bendre, a Madhu Sapre. The images of superfit movie stars, models and singers are relentless on satellite television, the billboards, the print media. "Earlier obesity was viewed as a sign of prosperity," says Bangalore-based health writer and diet specialist Sheela Krishnaswamy. Those days are clearly fading.

And so weight-loss gurus and slimming saloons are like ants crawling out of the woodwork: they're everywhere, cajoling and coaxing the legions of fat Indians to lose their lard. And the methods of doing that, if you listen to everything you see and read, are as many as there are stars in the sky or grains on a beach. With obesity being popularly treated as a cosmetic problem, thousands today make their living off, well, the fat of the land.

Consider Anjali Mukherjee, queen bee of Mumbai's Diet Gurus. She charges roughly Rs 10,000 for a 10-week "customised diet" along with "ayurvedic pills" that together bring about an average weight loss of 1 kg a week. She's treated about 10,000 overweight patients, and with a weekly column in a popular English daily, her fan following is enormous. In addition, Mukherjee and her husband Saurabh market health food like soya and oatmeal biscuits under the brand name Health Total. "The health-food industry is enormous," admits Saurabh.

Personal Point, one of Delhi's most prominent fitness and weight-loss chains, has grown from a single centre in 1993 to 10 today: its low-calorie food packets will soon be independently marketed at stores citywide. Fitness equipment targeted at weight loss is growing at a galloping rate of 65 per cent. Cost is no barrier, with some equipment and programmes retailing for lakhs of rupees. Very simply, fat is a matter of shame. "No one wants to stand out in a crowd," says personal trainer Kaizad Capadia in Mumbai.

The fat bandwagon, sundry gurus and marketeers realise, is ripe for the picking. So all manner of remedies are flooding the market: pills, potions, crash diets, vacuum machines, vibrators, heat packs, even soaps that claim to melt away the masses of adipose. Do they work? Some might, temporarily, but most, instead of transforming you into those paragons of fitness you see could actually become health hazards.

Doctors are noticing an alarming increase in weight-loss related ailments. Many fanatical weight watchers have destroyed their systems with unscientific diets designed by self-styled "dieticians", says Dr Nadeem Rais, a Mumbai-based endocrinologist. Some women bleed excessively during their menstrual periods when their body biochemicals are thrown out of whack, others faint with the sudden drop in normal sugar levels, and still others begin to lose handfuls of hair.

Vacuum machines and heat-pads mainly get rid of the water in your body. So immediate results can be dramatic. But like water returning to a dried river bed, the weight comes rushing back. Dehydration is another danger. Yet people flock to many of these quick fixes, not really caring that they could become dried-out human prunes.

So is there a surefire way to fight fat? One thing's for sure: there is no easy way out. "There are no quick fixes, but people seem to want them," says Anura V. Kurpad, director of nutrition at the newly opened nutrition clinic at St. John's Medical College Hospital in Bangalore. "Only a long-term sustainable weight-management programme can help."

Weight depends on energy input (food) and energy expenditure (exercise). If your input is considerably higher than your output you become fat. Simple. Some foods "cost" more than others in calorie terms, depending on their content of fat. So half an hour of aerobic exercise burns about 300 calories, the equivalent of just one slice of chocolate cake.

"Good" versus "bad" food is one of obesity's fastest changing concepts -- and very confusing. Cut out carbohydrates, the French say, since they are most fattening; others says don't mix proteins with carbohydrates. The advice doesn't stop. But nothing is as scientific as the old-fashioned balanced diet, says Ishi Khosla, consulting nutritionist at the Escorts Heart Institute and Research Centre (ehirc) in Delhi. Like a car that can't run without air in the tyres, petrol and batteries, there is no way a body can run without the basic elements of food.

"All this chart advice is trash," says Khosla, referring to crash diets. You might eat only boiled eggs for a week and then vegetables for another. This is nonsensical yo-yo dieting that leaves you with a craving that leads to binges and a return of the fat. Making things worse is the great temptation of today's high-calorie fast foods: burgers, pizzas and french fries. Busy lifestyles, high stress and growing salaries have led more people down this path.

But if you really want to fight fat, do what Vimoha Bagla, once a grossly obese 19-year-old college student, did. Instead of getting hooked to crash diets and unproven heat pads, pills or vibrators, the svelte, dusky girl attended the Physician's Weight Management Centre in Delhi and lost 27 kg in a year. Run by Sunita Sharma, a qualified medic, the centre taught Bagla, now 49 kg, to slowly modify her lifestyle -- with exercise and a remodelled diet. Centres like these first make sure the obesity is not due to a medical problem, like a thyroid gland gone wrong or diabetes. The Piramal Fitness Centre in Mumbai puts you through a body composition test, which basically tells you your percentage of body fat. Only then does it suggest a personalised exercise chart.

Indians need such specialised attention. As an ethnic group, we are pretty ungainly and prone to fat tummies, described by doctors as central obesity. Our waist-to-hip ratio, as this index is called, is abnormally high. So instead of fat pears, Indians tend to look like fat apples. This abdominal obesity, to use the technical term, aggravates health problems like high blood pressure.

Don't hold your breath for magic pills. In the US, two drugs called fenfluramine and dexfenfluramine -- both cleared by the respected Food and Drugs Administration as anti-obesity drugs -- have just been withdrawn. "They were found to affect heart valves, making them more leaky," says Peeyush Jain, cardiologist at EHIRC. It's a condition that can call for valve replacements if it worsens. Now, an appetite-suppressant drug called Meridia has just been released in the US and is being touted as a new weight buster. But it comes with a warning that it could increase blood pressure. A successful anti-fat drug could be the Viagra of the next century.

If magic bullets are still your thing, there could be one down the road if someone finds the obesity gene in the helical wilderness of dna. The one that comes closest is the ob gene, which controls the flow of the enzyme leptin. Too little leptin and the brain's satiety centre will never be satisfied. Studies on rats show that leptin injections cause them to lose weight. A pill, however, is a long time away, if ever. Until then, the pundits and the profiteers will rule lard's roost.