May 30, 2017
‘It’s not a war against tobacco, but a movement towards health
BENGALURU: Reducing tobacco consumption should be the main focus in preventing cancer, and Dr U S Vishal Rao is firm on this. The chief of head & neck services, department of surgical oncology, HCG Cancer Centre, has bagged the prestigious Judy WilkenfeldAward 2017 in the US for International Tobacco Control Excellence. In an interview with TOI, Dr Vishal, who is also the member of a high-powered committee on tobacco control in the state, said this is not a war against tobacco, but a movement towards health. Excerpts:
Almost every second patient you treat has a history of tobacco consumption. How does the activist in you gear up for patient care?
I see the effect and deal with it daily. Tobacco accounts for nearly 50% of 18 types of cancer. In the head-neck region it almost accounts for 90-95%. An important turning point in my life was seeing a 30-year-old engineer, a tobacco user and my patient, die due to advanced tongue cancer. A few days before he died, his tumour had eaten up his carotid vessels (the blood vessel that connects heart to brain). Every time I'd walk into his room over a pool of blood and see his family light candles and pray. He died leaving behind his 2 sisters and fiancee. This brought me to the fundamental question of how could I prevent the suffering of people like him? Because by the time the cases come to me, it's often too late. Why are we just working on a new medicine when I can address the cause of the disease itself? So, I embarked on preventive oncology, with an emphasis on tobacco control.
Despite anti-tobacco campaigns, neither farmers nor the government has put an end to growing tobacco. Why?
Most tobacco farmers are exploited. They do not make big money, despite India being the third largest tobacco grower in the world. Every time our country takes a step to control consumption, invariably the tobacco industry portrays farmers as soft targets. The government cannot own this problem fully as farmers choose this based on the markets created by the tobacco industry. The ideal possibility today is to have government facilitate crops useful in ayurvedic medical herbs which have an increasing global demand and market. This way, farmers can turn healers and save lives. The government simply needs to take this decision and not export poison to other countries to improve its revenues.
Recently, the state government lifted the ban on chewing tobacco. Isn't this move contradictory to the fight against tobacco?
The government hasn't reversed the order. The enforcement circular has been modified based on technical interpretations and the same have been put before the courts too. The courts will decide the future course of public health. In my perspective, gutka ban was ordered by Justice Singvi in the Supreme Court on the basis of the directives from the Food Safety & Standard Authority of India, which said no tobacco or nicotine can be added to food, gutka being considered to be food. Later, the government of India wrote to chief ministers and chief secretaries of all states to go ahead and ban chewing tobacco as it is considered a food item. At present, 16 states have banned this. With the recent Supreme Court order by Justice Gopal Gowda, it was clear that they didn't want any mixing of pan masala with tobacco to reconstitute gutka. Chewing tobacco contains food items that come under food components such as flavours, condiments which are added to it. Pointing to the rule, the tobacco industry says they cannot add tobacco to food, but can add food to tobacco. But tobacco is not food and I have my reservations with their interpretations. Moreover, these are serious public health matters where right to health prevails over all frivolous arguments. We need to wait and see how the high courts and the Supreme Court view this matter.
What are the challenges in this fight against tobacco?
This is not a war against tobacco, but a movement towards health. We do not see any hatred against any person working for or with this industry, but simply wish that our love for health will win over their unabated desire for wealth, disease or social destruction. The future is filled with optimism where we see a healthier India standing tall to inspire the world. The major challenges that lie before us are: how do we help tobacco farmers move to alternative crops? How do we rehabilitate beedi workers and provide them with alternatives? How do we prevent the youth from marketing tactics of tobacco industry that constantly wants to target teens who are their potential customers?
FSSAI wants edible oil vending machines
In the absence of such an option, people, who cannot afford to buy large packs, are compelled to purchase loose quantities of edible oil, which is often adulterated. File photo. For representation purpose
India’s food regulator has asked manufacturers to set-up automated vending machines to sell good quality edible oil in small pouches.
In the absence of such an option, people, who cannot afford to buy large packs, are compelled to purchase loose quantities of edible oil, which is often adulterated.
“An innovative idea to provide edible oil at nominal prices to consumers is its sale through automated tamper-proof vending machines. In order to provide quality edible oil to small consumers and reduce the unauthorised sale of loose oil, it has been decided to allow the sale of edible oil through automated tamper-proof vending machines,” the Food Safety and Standards Authority of India (FSSAI) said in an order issued last week.
The proposal was debated extensively within the government and with the industry before the FSSAI came out with the order.
“Edible oil is still not widely available in small packages like sachets and pouches at prices which are affordable to a large section of consumers, who resort to purchasing loose edible oil which is of suspect quality,” says the FSSAI order.
Tamper-proof pouches
The regulator also made it clear to the industry that such pouches and sachets would have to be tamper-proof and follow the FSSAI standards on packaging and labelling.
A recent consumer survey highlighted the poor quality of loose edible oils being sold in the rural and semi-urban localities.
Case lodged for serving poor quality food
GUWAHATI, May 29: The State Health Department on Monday registered a case against Vivanta By Taj, a five star hotel in the city, for not maintaining quality of its food served to customers. Sources told The Sentinel that the case was registered following an express instruction issued by the commissioner of food safety in the State. The commissioner issued the instruction after the food inspection branch of the Health Department confirmed poor quality in certain food items served by the five star hotel.
Eat healthy: An idea whose time has come - smaller food portions
Controlling portion sizes may help prevent food wastage and rationalise intake at a time obesity-related diseases are the number one killer.
WHO projects that more than two thirds of the world population will be overweight or obese by 2030 unless corrective action is taken.
India has too many balls up in the air when it comes to public health and nutrition. Malnutrition — which includes both undernourishment and overweight-obesity — is the number one problem in the country.
In fact, it is a rising menace as urbanisation contributes to more sedentary lifestyles and poor or wrong eating habits promote obesity across age groups. While under-nutrition rates have stagnated (not reduced), they are still a huge challenge (four out of every 10 children are underweight).
One more associated worrying issue with both forms of malnutrition is multiple micronutrient deficiency. Even if we pull children out from undernourishment by feeding them enough calories, we are not focusing enough on providing them high quality, balanced foods rich in vitamin and minerals. In simple words, even if we achieve food security, attaining nutrition security is a far more complex challenge.
Mineral and vitamin deficiencies (also referred to as hidden hunger) are known to adversely impact human potential. This needs urgent attention as it ties in closely with the productivity and economic growth of the country in the long run.
Thus, translating our vision of nutrition security and sufficiency for all into reality may require multiple strategies and consolidated efforts. The vision resonated recently in one of Prime Minister Modis monthly radio talks. He spoke about controlling or rationalising the size of the portion an individual eats, which in most cases will reduce food wastage.
The related ministries were quick to add their support and talk about guidelines to do so. As of now this has largely been directed towards commercial restaurants and hotel industry.
The content and coverage of the prospective guideline for curtailing food portions should be integrated into the food and nutrition policy of the nation - how will we define portion size and how will we monitor it?
Controlling portion sizes will have the obvious benefit of preventing food wastage, but it may also help to rationalise intake at a time when obesity-related chronic diseases are the number one killer.
The World Health Organisation projects that more than two thirds of the global population will become overweight or obese by 2020 if corrective, evidence-based measures are not urgently sought and put in place.
Worldwide, experts have deliberated and unanimously agreed that overweight-obesity is a complex problem and will need multiple participatory approaches, including awareness building, behaviour change strategies, community interventions, nutrition counselling, improving access to high quality local produce of whole grains, fruits and vegetables, taxation policies for ultra-processed junk foods and sugar sweetened beverages.
The Food Safety and Standards Authority of India (FSSAI) convened a panel in 2015, of which I was a member, which prepared guidelines to tackle the problem of high fats, sugar and salt in our foods (currently put out for public review and comments).
In a country where being overweight is still seen as ‘chubby’ or a sign of prosperity, awareness building and behaviour change interventions are needed. Practices change only when people understand the consequences of this rising menace among our children and population at large. The proposal to control portion sizes is commendable and, if implemented, can go a long way in attaining food security and improving public health in India.
We must think creatively and urgently to convert the tons of extra food into safe nutritious forms to feed those who may need it. Systems must be put in place that collect and process the extra food from big and small establishments. Recogn-ising individual responsibility in buying ingredients, preparing required amounts, serving small portions in platters, avoiding over feeding ourselves and our children may go a long way in saving food wastage.
Purabi to fortify ‘Smart Milk’ with vitamins A and D
GUWAHATI, May 29 - To address issues of micronutrient malnutrition and to support the nationwide food fortification initiative of the Food Safety and Standards Authority of India (FSSAI) and Tata Trusts, Purabi Dairy will fortify its toned milk variant (Smart Milk) with vitamins A and D.
Fortification means deliberately increasing the content of essential micronutrients in food to improve its quality.
FSSAI has set standards for fortification of salt with iodine and iron; of vegetable oil and milk with vitamins A and D; wheat flour and rice with iron, folic acid, zinc, vitamin B12, vitamin A and some other micronutrients.
Purabi’s fortified milk is likely to be launched later this week. The new packet will have a logo ‘+F’.
The West Assam Milk Producers’ Cooperative Union Limited (WAMUL), commonly known by the brand ‘Purabi’, has extended its support to the fortification initiatives taken by the FSSAI and Tata Trusts to boost fortification, and address the issue of micronutrient malnutrition – a serious health issue affecting all sections of society, said RN Bhattacharyya, senior manager (marketing), WAMUL.
Milk is a rich source of high quality protein, calcium and of fat-soluble vitamins A and D. Many countries have a mandatory provision to add back the vitamins which may be lost during processing as it is easily doable.
Fortification of milk with vitamin A and vitamin D is required in India because of the widespread deficiencies present in the population.
A recent National Nutrition Monitoring Bureau (NNMB) survey and a report of the expert group of ICMR in 2012 stated that India has a very high burden of vitamin A and D deficiencies, amongst both young children and adults, particularly in urban areas as they are physically less active and have a very limited exposure to sunlight. About 70 per cent Indians are deficient in vitamin D and another 15 per cent are insufficient.
Purabi Dairy procures its milk from nearly 200 village-based functional milk producer institutions (MPIs) and dairy cooperative societies in the districts of Kamrup, Morigaon, Nagaon, Barpeta and Nalbari covering around 5,000 dairy farmers.
Consumption of fortified milk by children in India has shown encouraging results. Studies suggest that the intake not only increased mean serum vitamin D levels but also morbidity rates were decreased (18% lower incidence of diarrhoea, 26% lower incidence of pneumonia, 7% fewer days with high fever and 15% fewer days sick with severe illness). Fortification of milk with vitamins A and D is an effective and safe strategy to reduce related deficiency diseases.
New food packet labels to tell how much dietary requirement is met
Food regulator, FSSAI, is preparing guidelines for elaborate labelling of food packets that must tell a person how much of recommended dietary allowance is met in one serving of that item.
Packaged food labelling is set for an overhaul in India.
All packaged food items will soon have to clearly mention what percentage of your recommended daily nutrients intake is met in a single serving of that particular item.
The country’s food regulator – Food Safety and Standards Authority of India (FSSAI), is coming up with guidelines for elaborate labelling of food packets that must tell a person how much of recommended dietary allowance is met in one serving to make it convenient for people to keep tabs.
“We are in the process of changing labelling regulations,” said Pawan Agarwal, CEO, FSSAI.
The initial guidelines are ready and will shortly be sent to the Union ministry of health for approval.
“We have an expert panel working on formulating the guidelines. New labelling methods will help a consumer in knowing the exact percentage of the recommended dietary allowance of say sugar, fat, salt or other micro nutrients that’s met by consuming a serving of that product,” said Agarwal.
Recommended Dietary Allowance (RDA) provides a reference range to assess daily nutrient intake in a healthy person that tends to vary by age and gender.
Currently, the food packets broadly mention total calories contained and also the quantity of fat, sugar, salt, carbohydrates and a few other nutrients.
“The label hardly says anything about how much of a healthy person’s daily needs are met after consuming a serving and how much of it is left. The labels are quite convoluted for a common man to understand,” said Agarwal.
The panel that has been working on labelling guidelines is the same panel that worked on formulating country’s food fortification guidelines. The panel is also focusing on defining junk food.
“We broadly term high-fat, high-sugar items as junk that lead to obesity and other complications but this panel is getting into the details and coming up with a standard definition,” said Agarwal.
The food regulator, however, isn’t sure about deadline for implementation of the regulations.
“It will be difficult for us at this level to say when the regulations will be implemented, as the process requires several layers of consultations and approval. We are trying our best to be as fast as possible,” said Agarwal.
Food safety drive
As per the direction of the State Food Safety Commissioner, extensive drives were conducted by a team of Food Safety Officers and Food Safety and Standard Enforcement Wing, Imphal East recently.
The team has shut down Hussain Bakery at Yairipok Bazar, Aafreen Bakery at Yairipok Bazar and New Fast Food Bakery at Yairipok Lai Manai Top Chingtha for violating the responsibilities of food business under Section-26 of the Food Safety and Standards Act 2006, rules and regulation 2011.
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