“Food for all” . . . healthy, that isBMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f5084 (Published 13 August 2013) Cite this as: BMJ 2013;347:f5084
“And the lucky winner gets . . . a basket of vegetables,” announced the host on a national radio programme. With soaring prices, vegetables have become a prized commodity. To tackle the situation, the government has fixed prices and set up low cost vegetable shops in some metros. At another level, the National Food Security Bill is being debated in parliament. This holds the promise of consistent food supply and nutritional support, especially to the most vulnerable. Dimensions of implementation through the existing public distribution system and the division of responsibilities between the states and the centre remain blurred however. There might be a long way to go before the promise is met, as Veena Rao discusses in a BMJ blog (http://blogs.bmj.com/bmj/2013/08/06/veena-rao-food-security-by-decree/).
Enabling healthy food choices is essential not just in the context of hunger and malnutrition, but increasingly so in the prevention of obesity, diabetes, and cardiovascular diseases. The concern is even more immediate as accompanying the unaffordability of vegetables is the increase in fast food options. Ranging from ready to eat, packaged foods to greasy preparations doled out at restaurants, these offer a quicker, cheaper, and often more palatable option. Concurrently, people might prefer to pop pills than adopt healthy behaviours as these are often not feasible, accessible, or affordable.
An example of the medicalisation of health, Ron Thomas Varghese reports in his feature (doi:10.1136/bmj.f3391), is the more than doubled increase in the number of bariatric surgeries performed in India in the span of one year. Bariatric surgery might be touted as a radical cure for the growing problem of diabetes and obesity in India. However, V Ramankutty—professor of public health at Sree Chitra Tirunal Institute for Medical Sciences and Technology in Trivandrum—cautions that, “We must look at the ‘built environment’ in which obesity develops, and [at] the heavy advertising for all sorts of unhealthy food. After creating a problem, which is largely a result of market compulsions, we seek to solve it also through offering a new techno-solution, which is definitely going to be driven by the market.”
In an editorial on the Vienna declaration on nutrition and non-communicable diseases (doi:10.1136/bmj.f4417), Debbie A Lawlor and Neil Pearce concur that such individual level solutions may be ineffective and, in fact, exacerbate health inequities. With an increasingly urban design of the living environment and the promotion of energy dense fast foods, it is crucial to deal with these upstream structural factors. The authors emphasise the need to “make physical activity and a healthy diet once again part of daily life rather than a lifestyle choice.”
A point of view that is echoed by responses to the latest BMJ India poll where more than three quarters voted against medical options such as bariatric surgery being the solution to India’s growing obesity and diabetes problems.
Cite this as: BMJ 2013;347:f5084