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Dr Kamal Mahawar takes the fight to fat

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In his second book, Fight with Fat, bariatric surgeon Dr Kamal Mahawar take a good hard look at how culture, social norms, superstitions and apathy have made India the diabetes capital of the world. But more importantly, he also tell us what we can do to change this. An engaging self help book that hopefully empowers us with a better understanding of the disease BY VIVEKA ROYCHOWDHURY

If UK-based bariatric surgeon Dr Kamal Mahawar’s first book, The Ethical Doctor, examined healthcare delivery in India at the organisational level, his second one, Fight With Fat, aims to prod individuals to take on their flab.

And he is clearly well qualified to advice the obese on just how they can do this. As a consultant general and bariatric surgeon at UK’s Sunderland Royal Hospital and a visiting professor at the University of Sunderland, he has seen the obesity epidemic from close quarters for over two decades.

Priced at Rs 299, and available on Amazon, the book is written as a self-help book aimed at patients as well as doctors. The book covers much more than obesity, which is increasing its grip on patients worldwide. With India as the diabetes capital of the world, it is good that the book focusses on this country, analysing the social and cultural practices which earned us this dubious distinction. As the doctor author teases apart the social issues which juxtapose health, his apology in the preface prepares readers for some provocative remarks, which he explains as ‘a deep-rooted sense of scientific detachment’ needed to deal with life and death on a daily basis for the past two decades.

His first sentence of the first chapter calls to mind a stereotypical image of a ‘Marwari businessman …with a big belly’ but before anyone can take offense, he explains that he comes from the clan! Thus readers can rest assured that his criticisms may sound harsh but are sympathetic, a shock tactic geared to jolt the reader into remedial action, now rather than later.

The author’s frustration comes through clearly. Sample this sentence: The laws of modern health economics mean that people can no longer die without first transferring a substantial proportion of their wealth to the healthcare industry. (page 24). Conversational in tone, the book makes for a good read, with the scientific information decoded into layman terms (‘think of your blood vessels as drain pipes’: page 43). The witty insights and asides lift the book above the ordinary.

Divided into a dozen chapters, the book starts with the science (an explanation of the the epidemic of obesity, calling it a medical menace and the tip of the iceberg), moves on how patients can understand concepts like calories, hunger and satiety, healthy eating. Readers can pick up useful tips on healthy eating and cooking, lifestyle modification and physical activity. The growing incidence of childhood obesity gets a chapter as does obesity pills and bariatric surgery. He devotes yet another chapter to the role of the government and the last to the future. For the nerdy reader, the appendix has detailed formulae to calculate important obesity related data. Every chapter ends with takeaway points summarising the highlights for the lazy readers.

Most importantly, the book is a myth buster. He is well ware that his target reader, a caregiver or a patient, has access to all the (mis) information in the word at his fingertips, from Dr Google, Mr Wikipedia and numerous health so called health blogs etc. In India, we have our extended family and friends who helpfully pitch in with their ‘advice’. The result is pure chaos which often leads to wrong decisions.

There have been numerous books written on this topic, each with their own merits, but this one written by a doctor who has seen the ravages of obesity scores high on credibility. The technical never interferes with the underlying message that patients need to take their health into their own hands. Obesity is preventable and the underlying message of this book seems to be that individuals ought to take responsibility for their actions and their lives.

Healthy eating tips range from not eating till we are full, the need to watch liquid calories in our chai, cutting down on the accompanying snacks, switching from bad carbs (sweets, sugary drinks even fruit juices) to good carbs (rice, roti, vegetables like potatoes and fruits like apples and bananas). Most of this is common knowledge but knowing is not the same as doing and the book serves up sound reasoning to nudge our choices to be more healthy.

The author joins the dots between childhood obesity and the role of school principals in the fight against the obesity epidemic, and in fact suggests that schools should be measured on the fitness of their students, rather than just how many of their students bag a medical or engineering seat. This would truly be radical but let’s face it, we’re not going to see it any day soon.

The author also discusses why Indians with even the so-called normal BMI are not safe from diabetes, high blood pressure or even coronary heart disease. Thus he warns against a false sense of security around weight and BMI as this is no indicator of fitness.

The chapter on healthy cooking urges us to re-think our traditional ways of cooking, suggesting for instance that instead of frying spices in oil, a better option would be to mix the spice with the tomato puree base and cook with as little or no oil. Other suggestions range from air frying samosas to increasing the intake of raw food like salads.

Interventions like obesity pills, bariatric surgery, liposuction as well as diets do make their appearance in the book, but the author does not hide their risks and stresses that developing healthy eating habits would be more sustainable in the long run.

He is particularly scathing when it comes to the role of the government, commenting that we can no longer blame our colonial masters for our low ranking on the human development index. He then turns the mirror on us, implying that we deserve the politicians (and policy makers) we get if we choose to focus on safeguarding cows rather than health or education. He comes down equally hard on superstitious practices and customs and hope his recommendations on school education, regulation of fast food outlets, food labelling, subsidising good food like fruits reach the right ears. Similarly, he concedes that a few schools and workplaces do provide healthy options but these are still in the minority.

Other suggestions like building a cadre of general practitioners and creating a modern system of primary healthcare centres which would be staffed by this cadre, are as long term as the others and are not totally new. In fact in his last chapter, focussing on the future, he comes back to the individual and stresses that health is first and foremost an individual’s own responsibility, much before school, employers, the food industry, government etc. He admits that as a doctor, he has a limited role and few answers as an individual. But I can confirm that he has asked pertinent questions which deserve our attention. And action, at an individual level to start with.

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