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Earlier type 2 diabetes was prevalent among adults but now it is witnessed frequently among children. Poor lifestyle choices and unhealthy eating habits are blamed for the increasing diabetes cases among children. According to the Diabetes Altas 2017, there were 1,28,500 children and adolescents reported to be suffering from diabetes in India. Also, a study published in the Indian Journal of Endocrinology and Metabolism stated that nearly 97,700 children are affected by type 1 diabetes in India. Moreover, a report published by the WHO in December 2021 revealed that more than 95 per cent of the Indian population suffering from diabetes are prone to type 2 diabetes.
In its report, the WHO also mentioned that a healthy diet and regular physical exercise can reduce the risk of attaining diabetes. Therefore, it is important to teach children the value of right eating and encourage lifestyle chances that can help them avoid several health conditions in the longer run.
Schools can play a big role in this regard, says Dr. Nalini Saligram Founder & CEO, Arogya World - a US-based global health non-profit organization working to prevent non-communicable diseases (NCDs), through health education and lifestyle change.
"It is imperative to engage everyone in a diabetes prevention strategy from an early life. It is important for schools to educate the kids regarding the importance of a heathy lifestyle and wise lifestyle choices," she adds.
In an exclusive interaction with TheHealthSite, Dr. Saligram sheds light on the current scenario of diabetes in India (in adults and children), and suggests ways to prevent type 2 diabetes among children.
Noncommunicable diseases are increasingly recognized as one of the biggest health and development challenges of the century causing more than 2 out of 3 deaths in the world, including in India. In addition, the economic fallout from NCDs is a staggering $47 trillion by 2030 (cumulative global economic output loss over 20 years).
India, also referred to as the diabetes capital, creates more burden on the poor family's income, 25 per cent of which is spent on one person with diabetes. Further, NCDs pose a huge challenge and have overtaken the combined burden of maternal and child mortality, plus infectious diseases like TB, HIV, malaria, etc. India faces a longstanding challenge of malnutrition since decades. We are 94th among 107 countries on the Global Hunger Index (2020) which is calculated based on total undernourishment of the population. The recent NFHS 5 (2019-21) study reports high (20-30 per cent) prevalence of stunted, wasted, and underweight children and alarmingly high levels of anemia 67 per cent. But in a country traditionally known for terrible hunger and undernutrition, the recent NFHS 5 also shows that obesity rates are rising, that obesity affects nearly 25 per cent adults, and India is now among the top 5 countries in the world with respect to obesity.
The prevalence of diabetes increased tenfold, from 1.2 per cent to 12.1 per cent, between 1971 and 2000. 77 million people live with the disease, and an equal number are estimated to be pre-diabetic. In metros, up to 3 out of 4 adults are either diabetic or pre-diabetic. The epidemic is devastating the poor and underserved and is rapidly overwhelming rural areas too. Moreover, Indians get diabetes 10 20 years earlier than their Western counterparts, often in their 30s. As India is a young country, with median age 27 years, the public health picture over the next few decades is truly alarming as today's young people grow up and get diabetes in huge numbers. The demographic dividend may become a demographic disaster unless we act now.
Our lifestyles and diets do not help. Some alarming numbers:
Family history of diabetes, urbanization, inadequate and limited healthcare capacity, modern sedentary lifestyles, increasing emphasis on convenience foods and eating out, widespread availability of cheap unhealthy foods and aggressive marketing by big food and tobacco companies are some of the reasons why diabetes has become so widespread in India.
Fortunately, non-communicable diseases are largely preventable. According to the WHO, 80 per cent of heart disease and type 2 diabetes can be prevented with three lifestyle changes by eating right, increasing physical activity, and avoiding tobacco. We cannot treat our way out of the NCD crisis - it is simply too widespread. Prevention is a smart solution. For prevention to be successful we must start young.
We must teach 11 14-year children what diabetes is, how serious a disease it is, that unhealthy eating and physical inactivity lead to diabetes, because they are old enough to absorb this important information. Then we must go on to tell them that diabetes can be prevented through healthy living, and the meaning of physical activity (not just formal exercise and sports but also includes household chores like sweeping, washing dishes, etc.), the meaning of healthy eating, what unhealthy foods and sugary drinks to avoid, what the different food groups are and how to choose healthy foods to eat every day that give them adequate nutrition and also help them prevent diabetes when they grow up.
Every fifth person in India's 1.4 billion population is an adolescent. There are >250 million adolescents in India (CNNS Thematic Report, Issue 1, 2019). Adolescence is a nutritionally vulnerable time when rapid physical growth increases nutrient demands. Moreover, many unhealthy lifestyle habits are acquired at this age, thus educating adolescents about the basics of healthy living i.e., eating right, exercising, and avoiding tobacco, before their lifestyle habits are set, is a smart solution to the NCD crisis.
A key recommendation of India's National NCD Monitoring Framework is school-based programs to integrate good dietary practices and exercise into daily routines. The framework mentions implementing these models among schools in low-income areas where the need is most pressing. The recently launched Ayushman Bharat School Health Program identifies schools as ideal platforms to facilitate healthy behaviors in children and adolescents and mobilize parents and communities around health.
Studies also indicate that adolescents should be prioritized as target groups for interventions due to their high adaptability and likelihood to be motivated for appropriate lifestyle modifications, and the fact that most of the NCD risk factors are behaviorally acquired during adolescence.
The school setting is ideal to teach middle school children (11-14 years old), the basics of heathy living in fun and engaging ways. Technology and digital games help make learning about health more compelling. Children at that age are like sponges, eager to absorb new things, and can easily be taught literacy and health at the same time.
Arogya World has done just that in our school health program that has reached >500,000 middle school children to date and shown 15 per cent improvement in awareness and health behaviors. As one child from Sri Saraswathi High School in Hyderabad stated in her feedback, " I have learned so much about diabetes and how can it be prevented and how it will occur in a person, and what are the reasons and what are the preventive methods we have to follow it was such a nice, wonderful, and useful session for us."
We believe health is a life skill, a 21st century skill, that must be taught during adolescence so that healthy living becomes a habit. This way kids can grow up to have a lifetime of health and become productive global citizens contributing to improving the world we live in, to the best of their potential.
Arogya World has implemented a programme called 'The Healthy Schools', which is focused on establishing a two-year school-based program for diabetes awareness and prevention education with compelling age-appropriate activities for 11-14-year-olds. Developed in partnership with NGO HRIDAY in India, this program uses influencers such as teachers and peer leaders to reach and educate 11- to 14-year-olds about diabetes and its prevention. The comprehensive program includes classroom and school-based activities, as well as outreach efforts in student's homes and communities. The initiative aims to bring a behavioral change among children to increase the physical activity and improve dietary intake which is the prime challenge in diabetes prevention.
The organisation claimed that it has been successful in creating diabetes prevention awareness in the rural areas of India like Bihar, UP, Haryana, Assam and impacted nearly 5,00,000 middle-school children. It is also scaling up the programme through digital schools.
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