In the ongoing advisories meted out by health professionals to their peers and the public at large, the focus has been on the content and type of food to be eaten.
Here in Mauritius this trend began in the late 1980s following the first Non-Communicable Disease (NCD) survey that was carried out in 1987.
In fact in the early 1980s the Annual Health Statistics Reports had shown that communicable or infectious diseases were diminishing but diseases that were later to be called NCDs were increasing. The assistance of World Health Organization was sought to assess the situation. WHO delegated Professor Paul Zimmet of the International Diabetes Institute, Melbourne, Australia, which was a WHO Collaborating Centre, and a formal NCD Survey was recommended.
Thus it was that the first NCD Survey was conducted in 1987 by a local team collaborating with the WHO team led by Prof Zimmet with Prof Alberti (UK) and Prof Tuomelihto (Finland). The survey confirmed that Mauritius was already making the epidemiological transition – that is, a shift in the pattern of disease of whole populations – from communicable diseases to NCDs.
In response, the Ministry of Health set up the NCD Unit and a series of core measures (together known as Public Health interventions) were set in motion, such as legislation (hike in price of tobacco, regulation of saturated fats in cooking oils), Health Education and Promotion, Screening campaigns, Ongoing studies of risk factors and so on. The Health Education and Promotion division of MOH prepared the necessary materials for dissemination to the public about lifestyle advice relating to exercise, nutrition – i.e. food and drink, avoidance of smoking amongst others.
In medical circles the nefarious effects of saturated fats and high cholesterol levels on health were already common knowledge, and subsequently with the explosion in the consumption of processed and junk food, as well as carbonated drinks (Professor Zimmet had coined the term ‘coca-colonisation’), these came to be recognised as the main culprits for the equally explosive rise in the rates of the NCDs. But people all over the world were already hooked courtesy aggressive publicity campaigns by the industrial food and drink companies. And so we are where we are today: an epidemic of NCDs across underdeveloped, developing and developed countries.
The question of reversing the trend doesn’t even arise at this stage: WHO is struggling to at least curb the rapid rise. Not at all an easy task, because it involves changing people’s acquired habits and behaviour, which as every student of human nature knows is the most difficult thing to do in the world. It’s like trying to straighten the corkscrew tail of the pig.
For the first time since MOH began to apply and advise on the measures to be adopted by the individual, the latest, 5th NCD survey (2015) has shown that there is a stabilization of the incidence of diabetes at least – after almost 30 years of giving advice! Which confirms the thesis of the tenacity of human habits – in their majority people simply will not do what they know is good for them, a phenomenon referred to as the ‘know-do gap’. Still, national authorities and health professionals have no choice but to try and nudge them into changing their behaviour for their own good, by a combination of legal (tobacco, alcohol pricing) and counselling measures.
As regards food (by which term I will mean drinks as well), the advice has so far been focused on the quality and content. The major food companies and providers/distributors of fast food have made some token changes that have not been enough to impact the incidence of NCDs. There has also been resistance to the introduction of a tax on sugary drinks and calls to ban the sale of soda drinks in schools. Which means that doctors and scientists have to constantly look out for methods and strategies to control the NCD epidemic, in which overweight and obesity are a worrying feature that also complicates all the remaining ones such as heart disease, diabetes and so on.
So the latest now has to do with how food is eaten, according to an article in the French magazine Le Point a couple of weeks ago titled ‘D’une alimentation machinale à une alimentation consciente’. In other words, one must not eat food mechanically but with awareness, ‘mindful eating’ – similar to ‘mindful meditation’ popularized by the Dalai Lama. The mindful means that while eating one must only think about the food and the act of eating without passing any judgement. Any distraction, such as watching TV or playing a video game, must be avoided so as not to divert attention from the food and the eating.
Distraction while eating tends to make one inattentive to both the type and the amount one eats, and is associated with overeating during the meal as well as with ‘snacking’ (grignoter). The result is overweight and obesity. Studies done that involve mindful eating versus ordinary eating have shown benefits in terms of weight reduction, quality of food chosen, and even control of diabetes.
When we were growing up of course there was no television, and eating was done practically in silence. Food was not scarce but was limited, so we savoured every morsel and left clear plates at the end of every meal. Further, there was no habit of eating a sweet dish post-meals, and even fruits were eaten infrequently because many families could not afford them except on special occasions. Just to finish with the fruits issue: nowadays there are fruits in abundance, and most parents would know that they practically have to beg their children to eat fruits daily! For that matter even many adults are defaulters in this regard.
The article mentioned underlines that there are some reservations expressed by scientists about these results and claims, and that further and more comprehensive studies must be carried out before any definitive recommendations are made. But even without these, it really does make sense doesn’t it, to consider the act of eating almost as sacred, and therefore deserving of our full attention so that we not only discover the flavours and goodness of what is at hand, but also gain all the health benefits accompanying ‘mindful eating’.
And so the article ends with a list of about a dozen suggestions that one may take on board, from thinking carefully when you open the fridge or food cabinet about whether you are really hungry or are bored or under stress, to taking a stroll instead if you do not have to eat, and to be conscious of the amount you are going to eat.
Further, take time to sit and eat, and do so from a plate so that you see exactly how much you are about to eat. You could also use smaller plates, because using bigger ones has been found to be associated with eating as much as 30% more than using smaller plates. And of course, switch off the TV and all distracting electronic appliances – including the smartphone! – while you are eating.
Give yourself adequate time, and as you eat spare a kind thought for all those associated along the chain with bringing the food items from the farm to your table, as well as nature’s bounty that has granted you the abundance and the variety of what is in your plate. And don’t forget to clear your plate, and if you can’t then make good use of the remainder, and at the restaurants collect what you have left in your plate as takeaway.
To me all this sounds pretty simple and eminently ‘doable’, and I don’t see why everyone should not put this into practice as from now itself. I must, though, confess to a little sin about myself: I eat my meals while watching the TV… BUT, I take my time, and I already decide on the amount beforehand. And the rule-of-thumb for the amount is: when you finish eating, you must feel that you could have taken another couple of mouthfuls.
* Published in print edition on 20 May 2016