The ticking time bomb

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Given the current situation of the country, it is easy to become preoccupied with putting out fires that are already sweeping throughout the country and completely overlook the potential fires that if left unattended, which are bound to catch ablaze in the future. One such example is the war against non-communicable diseases (NCDs) in Sri Lanka. If left unaddressed, Sri Lanka’s population is at risk of a number of health complications that would not only affect the livelihood and happiness of individuals, but also the entire economy and healthcare system.

Speaking with Ceylon Today, Senior Professor in Paediatrics at the Faculty of Medicine, University of Colombo, Prof. Pujitha Wickramasinghe issued warnings of this ‘ticking time bomb’ that is set to explode in the coming decade.

The situation today

“For the past number of decades, Sri Lanka has been able to successfully control its communicable diseases, mainly through the country’s vaccination programmes,” Prof. Wickramasinghe shared. “Diseases such as tetanus, diphtheria, measles, mumps, and rubella are almost things of the past now, and it has been almost 25-30 years since the last polio case was reported.”

With the decline of such diseases in the community, and a rise in the people’s standard of living, Prof. Wickramasinghe pointed out that there has been a change in lifestyle amongst the people of Sri Lanka.

“As a result, we see a reduction in physical activity, increase in consumption of sweetened food and beverages which are known to be high in calories, food with high salt and fat levels, as well as people progressing into stressful lifestyles. All this has paved the way for an increased prevalence of NCDs in the country.”

Prof. Wickramasinghe illuminated that, “Patients with these NCDs; mainly diabetes, heart attacks, strokes and cancers are increasing in number. Not only that, these diseases are increasing in commonality among younger people as well.

“For example, around three generations ago, you would usually find people with diabetes in their 60s. I would say that now, it and other NCDs are increasingly found in people above 25 years of age.” He warned that Sri Lanka isn’t that far behind the diabetes capital of the world; India.

How and why?

Prof. Wickramasinghe places the blame at obesity for causing this large rise in NCDs, of which diabetes is an added concern. “An ordinary person would consider obesity as a person having more weight compared to their height, but biologically, what’s happening is the body storing a lot of fat in their bodies, especially around in their abdominal area, and in the abdomen,” he explained.

Because of how efficient the human body is at conserving energy, any excess calories that aren’t used for sustaining life, physical movement or even growth and recovery is stored for times when food isn’t as abundant. These calories are usually stored in the form of body fat.

“Especially in the South Asian population, this fat is mainly deposited around the abdomen, which is why you see a lot of people in our region having large bellies.”

He went on further to explain that with the current lifestyles we live, with inadequate sleep, physical activity and exercise, in both children and adults, the high caloric intake from the food we eat leaves an excess of calories in our bodies, regardless of the type of food we eat.

“Even if you eat rice and curry for all your meals, it still doesn’t matter because the problem is having too much food,” he explained.

The young in danger

Prof. Wickramasinghe explained that the best time to take action in preventing the occurrence of NCDs is in the early years of a person’s life.

“Parents often think that it’s okay to let children eat a lot, and that they can lose weight when they are older. But in fact, it is very difficult to do so. From our statistics, we know that more than 75 per cent of overweight children end up as obese adults.”

He pointed out that young children are already at risk of falling victim to NCDs due to their lifestyles, and if allowed to persist, will have devastating effects in their adulthood. “10-15 year olds are especially at risk, based on the research we have conducted in both Colombo and Jaffna,” he shared. ”Even in our everyday practice we come across many children who are overweight and obese.”

The COVID effect

“Many are staying at home, not engaging in a lot of physical activity. They spend long hours in front of a computer for their academic work. They may also be staying up late into the night,” he continued.

He notes that the situation has only been aggravated as a result of the COVID-19 pandemic. Working and learning from home, using technology has led to the formation of new habits and lifestyles. And not all are beneficial, especially for children.

“The scary thing is all this accumulates, and what’s even scarier is that the changes that happen as a result start in childhood. But reversing them later in life is not easy. In another 15-20 years, there will most likely be a very high number of NCDs among the young adults of this country. I would say almost half of the population above 30 years of age at that time would very likely suffer from diabetes, and all sorts of other NCDs.”

Prevention is key

Prof. Wickramasinghe notes that prevention is the only solution. He stressed the importance of children being active, playing and engaging in skill-based learning in their early years rather than spending the entire day behind a desk.

He also noted the importance of children having a balanced diet which has more fruit and vegetables, stepping away from the processed food that many of us are used to consuming.

But that doesn’t mean swearing off on tasty treats that we enjoy for all our life.

“Food is not only for nutrition, it’s to be enjoyed as well,” he added. “You can enjoy such food, but remember to be wise in what you eat and drink, and the quantity as well as quality thereof.

“Getting adequate sleep is another crucial thing that should be given attention,” he added. “The ideal time to sleep has been scientifically found to be between 10 p.m. and 4 a.m. Adults are recommended to sleep during this period of time. Children should expand on this.

For children in secondary school, sleeping from around 9 p.m. to 5-5.30 a.m. would be better, while those below ten years of age should ideally sleep from around 8.30 p.m. to 6 a.m.”

He noted that attention should be given to having both the quality and quantity of sleep. “They should not be going to sleep hungry, watch television or use any devices with screens before sleep. Physical activity during the day also promotes good sleep.”

Prof. Wickramasinghe recommends being as active as possible for a healthy life. “The more the better,” he says, sharing that a person’s daily physical activity should include, but not be limited to at least an hour of vigorous activity, “During which you sweat, your heart beats faster and pumps more blood throughout your body.”

Not sitting for extended periods of time, taking breaks to stand up and stretching are also important habits to adopt an active lifestyle and minimise the risk of NCDs. He also recommends that parents take medical advice if there are any concerns about their child’s health.

Early detection

Keeping track of a child’s Body Mass Index (BMI) is a valuable tool to help parents keep track of their children’s health. “South Asians should ideally have a BMI of around 23,” he shared. “For children, this changes depending on age and sex.”

He informed Ceylon Today that parents are informed of these ideal BMI values for children growing up through their Child Health Development Record, a document provided to every parent at the time of their child’s birth.“These values are also made available in the Grade 6 Health and Physical Education textbooks of schoolchildren. 

“If none of these options are available, a great way to monitor BMI can be done using simple measurements with a measuring tape commonly used by tailors,” Prof. Wickramasinghe added. “Remember that the circumference of your waist should ideally be less than half of your height. For example, if you are 180cm tall, your waist should be less than 90cm. It is a simple but effective measurement that is proven to be accurate in monitoring a healthy BMI.”

“Also, parents should be aware of dark pigmentation around the neck, armpits or around the groin of their children. These are early signs of diabetes, and if detected, consultation with a medical professional should be done as soon as possible. Some parents may think its sunburn but it’s not.”

What is being done?

Of course, the Government also has a major role to play in the battle against NCDs. According to Prof. Wickramasinghe, a key element for success is disseminating accurate information to the public, since prevention is the only action that can be taken. There is no cure.

One such example was the 2021, ChildFund Sri Lanka (CFSL), partnered with the Ministry of Health (MOH) for the Global Regulatory and Fiscal Capacity Building Programme (RECAP), ‘Promoting Healthy Diets and Physical Activity in Sri Lanka’ which aspires to  minimise the impact of NCDs by implementing required regulatory measures while promoting healthy diet and physical wellbeing through social mobilisation and community education initiatives. 

 Global RECAP is a collaborative programme between the International Development Law Organization (IDLO), Canada’s International Development Research Centre and the World Health Organisation (WHO). Global RECAP is part of the ongoing global efforts to enhance multi-stakeholder engagement and dialogue to address NCDs. 

“There is a lot being done by the Ministry of Health in order to educate the people. There are various awareness building campaigns and programmes already underway. A new curriculum is also being created that includes more activity based learning. It will also better involve the parents whom we hope to educate through this as well.”

One example on the public being misinformed that he brought up was the use of baby formula for infants.

“Introducing baby formula and other cow-milk products to infants should be delayed as much as possible,” he commented. “Mother’s milk provides all the nutritional needs of infants and is beneficial to both the mother and the baby.”

He noted that breastfeeding in fact reduces the risk of the mother falling victim to breast or ovarian cancer, and also helps the mother lose weight, further reducing her risk of contracting diabetes in the future.

Prof. Wickramasinghe also spoke of new instructional guidelines being developed for the public to help them structure their diet in a more nutritionally beneficial way.

What more can be done?

“I think organisations should also be encouraged to be more attentive to the health needs of their employees,” he added, noting that a healthy workforce is a productive one.

Prof. Wickramasinghe added that the creation of new legislation and strong regulation on the marketing of food and non-alcoholic beverages for children will be a powerful step in protecting the public from disinformation.

“At the moment, we don’t have provisions to prevent false information being used in advertising,” he explained. “We can only take action when the advertisement has already been publicised, and by then it’s too late, the damage is done. There are some provisions being legislated, but it is slow progress. The muscles we have on the legal aspect are still fairly weak.”

Of course, it is also up to parents and all individuals to take responsibility for the food and drink they take, to “critically analyse the messages you see and hear on advertisements. Ensure for yourself if these things are true or not and are of benefit,” as said by Prof. Wickramasinghe. Because the time bomb is ticking, and action must be taken now to diffuse it before it’s far too late.

By Shanuka Kadupitiyage