Diabetes and obesity have reached epidemic proportions in Gujarat owing to the rampant consumption of empty calories, says Dr Tiven Marwah, President of Endocrine Society Of India (Gujarat). Following is the lowdown of his conversation with us: What are the biggest lifestyle-related endocrine health challenges faced by Gujarat? The four biggest endocrine diseases which Gujaratis battle are diabetes; obesity; thyroid disease; and Polycystic Ovarian Syndrome (PCOS) afflicting young girls due to hormonal imbalance, making them prone to irregular periods and later to diabetes, obesity and heart disease. In fact, diabetes and obesity have reached epidemic proportions in the state, recording almost three-fourfold rise in the past decade. What are the reasons for this alarming rise in diseases? In Gujarat, junk food and sweets -which give empty calories -dominate the diet. Carbohydrates constitute almost 65% of daily meals, and protein intake is limited. People are highly competitive, which means most of them follow highly stressful and busy schedules. Balance is missing as jobs are sedentary and exercise is not a part of daily life. All these factors combine to make people here more prone to lifestyle diseases. Last but not the least, growing levels of air, water, and food pollution are also emerging as new threats. How is pollution affecting us? Few scientific studies have been done on the Indian situation but there are many research papers published in foreign countries which pinpoint how pollution in air, water, and food are leading to hormonal changes. Pollution is increasingly suspected to be a beta cell disrupter which damages betacells that produce insulin in our body. This could be leading to higher incidence of diabetes. Thyroid disease has become rampant. What are the reasons? Thyroid disease has recorded an eight-tenfold rise in the state over the past decade. Lifestyle does not have any major contributing role in causing thyroid disease as it is more auto-immune in nature. Ironically, people have attached a lot of myths to the disease. For instance, the majority women with hypothyroidism would blame that condition for their obesity. The truth is that if thyroid is controlled with medication, weight gain has to be due only to bad lifestyle and women should get up, tie their shoe-laces and start exercising. A manifestation of an even worse myth is seen when many families break off marriages with girls with thyroid problems, assuming that they would have difficulty in getting pregnant and become obese. This makes girls jittery and persuades them to hide the disease. I have personally had a hard time counselling future in-laws, making them accept that thyroid is comparatively simple disorder which can be easily managed by taking regular medication! Obesity is striking younger people across the country. What is the scene in Gujarat? Obese children as young as 10-11 years are consulting endocrinologists. This is an alarming phenomenon. I personally see three to four obese children daily. Mobile gaming, little play and abundant food laden with empty calories are making kids obese. Kerala has become the first state in India to introduce the fat tax. Should Gujarat follow suit? What other preventive measures need to be taken? The Gujarat government should seriously consider imposing 'fat tax' and 'sugar tax' to discourage the rampant consumption of fast food and soft-drinks. These items are pushing empty calories into the young. The taxes could save them from early onset of obesity and diabetes. The second important thing is that playing should be made mandatory both at school and at home. Schools should compulsorily have physical education period daily while parents should encourage children to play real games rather than virtual ones.