‘Curb lifestyle disorders, incentivise health at personal & systemic level’

On being referred by his general physician two weeks ago, a 34-year-old businessman stepped into the clinic of Dr Rajiv Kovil, a Mumbai diabetologist who attends to patients such as the owner of a Chinese eatery that delivers till 5am. The doctor was not surprised when the man, who had no family history of diabetes, refused to believe what the numbers showed. “His BP was 210/110 mmHg and sugar level was 300 mg/dL. The normal levels are 120/80mmHg and 140 mg/dL. I told him about lifestyle changes he could make but he decided to go to two or three other labs for more tests,” says Dr Kovil, familiar with the drill of ‘denial’ that marks out millennial patients. “Many don’t accept that diseases such as diabetes affect those under the age of 40 too,” says Dr Kovil. “It’s a mental block.”
In the age of food-delivery apps and remote working, factors including stress, unhealthy eating habits, poor sleeping patterns, low recreational levels and addiction to everything from alcohol to devices have bloated the bouquet of lifestyle-related illnesses before midlife. Doctors across the country have noted a sharp uptick in noncommunicable diseases such as young-onset diabetes, young-onset heart disease and young-onset hypertension apart from abdominal obesity and weight gain post pandemic. “We have fasttracked from a physical world to a digital world,” says Dr Shashank Joshi, a consultant endocrinologist, attributing the surge in conditions such as sleep apnea and clinical depression to lockdown-induced behaviour.
Between 2019 and 2021 alone, 31 million Indians became diabetic and the current national statistic of 77 million is expected to jump to over 134 million by 2045. Studies show that a marked rise in the prevalence of Type-2 diabetes in India in the past 30 years has played a major role in contributing to the increased burden of diabetes before the age of 40.

While the link between diabetes and complications such as obesity and heart attacks is well known, recent premature deaths of actors such as 40-year-old Sidharth Shukla and 35-year-old Chiranjeevi Sarja coupled with instances of youngsters collapsing in gyms, parks and dance floors across India have turned a grave spotlight on cardiovascular diseases, which account for one-fourth of all deaths in the country.

According to the Indian Heart Association, half of all heart attacks in Indian men occur under 50 years of age and a quarter of all heart attacks in Indian men occur under 40 years of age. A mere peek into overflowing OPDs such as at AIIMS’ cardiothoracic and neuro centre would confirm the studies that indicate heart disease arrives in Indian bodies a decade earlier than in the rest of the world.
What compounds the crisis is the rising rate of hypertension among the young not only in urban India but also its rural population. One in five young adults in India has high blood pressure, a figure higher than the UK’s population. Besides, ‘systemic hypertension’—a major risk factor for cardiovascular and cerebrovascular diseases—accounts for 24% of heart attacks and over 10% of deaths in India. To explain hypertension’s relation to age, Dr Hemant Gupta, a professor of medicine at Grant Medical College (JJ Hospital), points to the ascent of stress and easy access to sodium-rich processed food.

“The condition isn’t limited to age anymore. It affects everyone from schoolkids to the elderly,” says Dr Gupta, adding overt symptoms such as losing temper, irritability, breathlessness and chest pain are often brushed aside.
“Lifestyle disorders also affect mental health,” says clinical psychologist and counselling psychotherapist Seema Hingorrany, citing cases of chronic fatigue syndrome aches among people in their 30s. Many times, these conditions remain undiagnosed because “unlike youngsters and senior citizens who are much more conscious of their health, people in the age group between 30 and 40 typically do not prioritise getting themselves tested,” says Dr Kovil.

Among the typically under-acknowledged fallouts of shifting lifestyles are certain types of cancer and infertility. Increasingly, infertility specialist Dr Anjali Malpani has been seeing couples in their 30s. “Smoking causes a decrease in sperm motility. Excessive alcohol and obesity may impact sexual life. While exercise helps, some people take their diets and workouts to extremes. So much so that some women stop ovulating. As for the men, wearing tight underwear or using hot saunas could also affect sperm motility,” says Dr Malpani.
To keep the burden of lifestyle diseases from putting a strain on the healthcare system and the economy apart from families, experts prescribe a multi-pronged approach. At the individual level, following a balanced diet coupled with moderate exercise and calming activities such as yoga and meditation are key, they say. “Eat slowly. Eat on time. Move more. Do some yoga. Walk at least 10,000 steps every day and sleep for at least seven hours daily. Try to stress less, smile more and detox digitally too,” says Dr Joshi while Dr Kovil stresses the need for systemic changes. “Taking care of oneself should be incentivised. Accessibility to healthy food and gyms must be improved. The government must levy taxes on wrong food. Unless people are reprimanded for wrong habits, they are not going to take care,” says Dr Kovil, who, besides lobbying for healthy workplace intervention and inclusion of nutrition science as a subject in school textbooks, is pulling other more literal strings to break mental blocks around lifestyle disorders.