India is currently undergoing a rapid transition on economic, demographic, epidemiologic, nutritional and sociological fronts. Vowing to combat the rising levels of obesity, the state of Kerala recently imposed a 14.5% "fat tax" on fast food sold by branded restaurants. The move is hailed as an important decision towards public health by the country as it comes in the light of the WHO's advocacy of using fiscal methods to curb obesity.
Governments getting involved in a campaign to lead people into living a healthy is not a new phenomenon. Japan was the first to implement the metabo law in 2008 that helped cut obesity by 3.5%. Similarly, a fat tax was levied by Denmark, but it was a failure since government bodies saw it as a funding opportunity for themselves rather than as a way to improve public health. Mexico levied a tax on sugar sweetened beverages two years ago. After an initial dip in their sales, the sales figures are back up.
We face the prospect of a population that is deprived of protein but suffering from an excess of carbohydrates and trans fats...
We need to be clear as to what we are targeting as a result of such legislation. We are the world capital of diabetes mellitus, thin-fat metabolism and atherosclerotic coronary heart disease.
In India obesity is growing at an unprecedented rate and it has been a major factor in the rising burden of non-communicable disease that has affected nearly two-thirds of the population. Surveillance of NCDs and their risk factors should become an integral function of health systems.
Fast Food And Trans Fat
In the process of demonizing fast food and blaming it for the increasing obesity and decreasing public health, we don't realize that trans fats, which are largely responsible for the increased atherosclerotic risk are also present in the everyday Indian snacks and roadside food that we eat. The samosas and pakodas which are easily available in less than ₹10 at every corner and even in locally branded outlets contain 30% transfats as compared to the permissible 1%.
Trans fats raise your bad (LDL) cholesterol levels and lower our good (HDL) cholesterol levels. Eating trans fats increases your risk of developing heart disease and stroke. It's also associated with a higher risk of developing type 2 diabetes. Health should be the primary agenda for every government. The increasing number of overweight and obese people in the community and the resulting burden of chronic non-communicable diseases (NCD) necessitate systematic nutrition interventions on a massive scale.
What Can Be Done?
With the prices of dal or pulses increasing steeply, people don't have many options to get balanced nutrition and adequate proteins in their diet. Instead of just levying a fat tax, the revenue collected should be used to subsidize healthier options which will benefit the citizens. We face the prospect of a population that is deprived of protein but suffering from an excess of carbohydrates and trans fats – we may have to face a nutritional paradox of having a "thin-fat, sarcopenic generation" if we do not intervene at the earliest.
This "fat tax"... needs to be enforced universally on all the foods containing trans fats rather than partially towards conventional fast foods.
I would like to complement the national blueprint – SANKALP -- for the management of NCDs in India, released by the Partnership to Fight Chronic Disease (PFCD). The blueprint emphasized on several specific recommendations to make the necessary shift in social behaviour and begin instilling "healthy living" choices as a norm at a young stage.
Some of the key action points are:
- Encourage voluntary exercise or yoga across all educational institutions including schools, undergraduate colleges and universities (both public and privately run), and incentivise healthy habits.
- Healthy food items and menus to be chalked out by state-identified nutritionists, in line with WHO-recommended sugar, salt and transfat content. These healthy food items should be provided in all school, college and university canteens as an alternate to unhealthy food and beverages. Healthy eating should be incentivised through subsidised or affordable pricing.
- Ban alcohol and cigarette shops within a two kilometre radius of all schools and colleges across the country.
- Collaborate with RWAs, MCD, municipalities, and build a conducive environment for the citizens to practice a healthy lifestyle: Build and maintain walking/ jogging tracks and parks Construct pavements and safe walking spaces on roads Strengthen public transport system.
We further encourage:
a) Mandatory nutritional education and sensitization in schools/college/workplaces/resident welfare associations (RWAs).
b) Encouragement of physical activity in work and home environment.
c) Sensitization, education and legislation supported surveillance of NCDs and their risk factors.
d) Creating mass awareness on the benefit of prompt reporting of symptoms related to NCDs, especially heart disease.
e) This "fat tax" to fight the menace of obesity by making unhealthy foods expensive needs to be enforced universally on all the foods containing trans fats rather than partially towards conventional fast foods. Without universal application, such laws would only reinstate the belief that only certain foods are unhealthy and not actually help in bringing down obesity.
A healthy population will help reduce burden on public welfare. Changing lifestyles of people, both in rural and urban areas will help transform the overall wellbeing of the nation. While a fat tax as a model is a good beginning, for it to be a success in totality, a mindset change to shift to healthier eating patterns is the key.