Addressing health and nutrition – the personalized approach to wellness

Authors: Dr. Jamuna Prakash, Adjunct Professor, MLC University, Shillong. 
Former Professor, Food Science and Nutrition, Univ. of Mysore, Mysuru.

Good health is the ultimate goal of every human being and good food is one of the gateways to achieve it. Here ‘good food’ refers to nutritionally balanced, safe and healthy meals and does not mean the taste quality of food per se. Despite being an agriculture dominant nation, India suffers from varying degrees of malnutrition, seen both in adults and children alike. While there are multiple avenues to deal with the issue, the WIN Foundation is very rightly addressing it through its maternal and child health program of developing women’s entrepreneurship to promote healthy foods as well as promoting hygiene and sanitation in the community. These two issues are undoubtedly the most important in addressing malnutrition in children and women.

The recent report of the National Family Health Survey-5 points out both negative and positive aspects of health-related indicators. There has been a decline in neonatal, infant and child mortality rates, and the literacy rates have improved showing a higher percentage of both men and women passing their school education. There are more women empowerment programs and gender equality schemes. However, on the nutritional front, the scenario has been rather depressing. Iron deficiency anaemia is showing a larger and wider spread, and the improvement in growth indicators of stunting, wasting and being underweight have been exceedingly low. This calls for a higher investment and efforts for health and nutrition considering that consequences have a far-reaching effect spreading across adulthood lowering productivity and work efficiency as well as a much higher risk of non-communicable diseases in undernourished children.

Creating a lifecycle approach to nutrition through personalized interactions

The experience in the field of nutrition has shown that one approach towards improving the nutrition of the masses is through personalized interaction and counselling [apart from various ongoing programs]. This can be done using the already existing resources of health workers and wellness centres, which will be operable in the near future. The team of health workers comprises doctors, nutritionists, and other paramedics on a personalized one-to-one basis paving the way for individual attention. These counselling sessions can be on a monthly basis and can deal with the health status and nutritional problems of children, women, men and the elderly from a family. This would create a genuine lifecycle approach and will have a strong psychological impact on the family of caring. This would encourage them to follow the advice regarding healthy diets, desirable food preparation, special needs of children, the elderly or any other diseased person in the family and hygiene as well.

While malnutrition in children is just one of the problems to tackle, there are also numerous instances of lifestyle disorders across the community, which need to be prevented or managed well. These counselling sessions would deal with all the health issues of a family by way of advising them on all aspects of healthcare including self-management advice. 

The process would require the following- A family health record to be maintained with the necessary details of all family members, for example, the age, height and weight, blood pressure, general health, and medical condition along with the treatment history. A diet pattern can also be maintained based on which counselling can be done. The progress and adherence of the family regarding desirable food behaviour and proper management of diseases can be monitored very well with this, and slight deviations will be observed early. This would also bring forth the group of elderly, who are often neglected by families, and they also can be provided with necessary comfort care.

The multi-sectoral approach towards health

A point to be noted here is that health is an outcome of multiple factors and not diet alone. The counselling session will bring forth the non-nutritional issues which could be important for health such as the availability of adequate potable water for drinking or for hygiene purposes, the pollution around the houses, the social issues of drinking, poverty, food taboos, superstitions, unemployment, school dropouts, etc. While the support centre may not be able to solve all of them, it will create an understanding of the prevailing situation. 

The problem needs to be tackled with multiple angles and approaches.  For example, one of the reasons for children not responding to various nutrition supplements in attaining normal growth status is frequent episodes of gastrointestinal and respiratory infections.  Scientific evidence shows that repeated gastrointestinal infections shorten the intestinal villi thus reducing the absorption capacity, resulting in malabsorption syndrome which could be long-lasting.  A morbidity record maintained at the centre would be helpful in knowing if a particular child falls sick frequently. Now, the next step apart from administering proper treatment to the child will be of exploring the causes, is it because of low immunity, polluted water, unhygienic environments, or repeated exposure to infections? An analysis would help to deal with the causes which may not be related to nutrition directly. Once these repeated episodes of infections are arrested, a child can attain normal growth. Similarly, questions need to be asked, if the mother or caretaker is adequately informed or educated, a personalized approach would certainly help these issues.

Unhealthy foods and emerging issues of overweight and obesity

Let us now look at one more aspect of emerging health issues in women and children, that of overweight and obesity, obviously, both linked to transitioning food behaviour. A general perception of obesity is that it occurs in affluent societies or urban areas. However, the trend is changing and so-called unhealthy food is eaten across all regions, whether urban or rural. Many of our own surveys in rural areas show that ‘fast foods’ specifically sold by street vendors have gained popularity even in rural India. Undoubtedly, these are energy-rich, fat-rich sugary or fried foods with a very low content of fibre and essential vitamins and minerals [prepared mostly with refined wheat flour, hydrogenated fats, cheap oils, sugar and salt]. By far, sugar, refined flours and oils are the cheapest sources of calories and foods providing protective nutrients are expensive, [these include whole grams and dhals, milk and milk products, eggs, fish and animal foods, fruits and vegetables, nuts, etc.], hence it is easy to binge on foods which are cheap and satiate hunger, with no consideration for overall healthy nutrient density. This is indeed a very serious and complex issue to tackle as food laws cannot prohibit people from eating unhealthy foods!!! Though only advisories can be issued. Intake of such foods also increases the salt intake. While human beings are genetically programmed to like sweet taste, the taste of salt is adaptive, the more we eat, the more we like. And the taste threshold goes on increasing.  This is very well exploited by the food industry where a higher amount of added salt lures customers. Therefore, a deliberate attempt to lower salt is needed from all angles, though easier said than done. There has been a tremendous increase in online home delivery of catered foods across the country during the pandemic, which has its own plus and minus points, increasing convenience, creating employment, improving business, but also encouraging intake of unhealthy foods. The pandemic also affected the many welfare programs and school attendance of children increasing the rates of malnutrition, as children were deprived of regular mid-day meals on account of school closures. For some of the children, a mid-day school meal is the only substantial meal of the day and a source of important nutrients. 

So, the simple take-home point towards improving malnutrition is an overall continuous effort from all the stakeholders involved to secure the future of our children. Malnutrition is a silent emergency, the voice of which is very loud, but cannot be heard, and we need to act before it is too late.

Contact details of the author:

Dr.Jamuna Prakash
Email:  jampr55@hotmail.com
Profile Link: http://uni-mysore.ac.in/sites/default/files/content/jamuna_prakash_bio-data_for_web.pdf

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If you are keen to introduce Mother and Infant Child Nutrition training in your area or village for field health workers, and thus contribute towards fighting malnutrition, and want to know more about the above training, feel free to reach out to us at info@winfoundations.org

WIN Foundation is a non-profit organization that provides guidance on the above at no cost.