(Dr.Zahida Shah, 42, was born in Srinagar and finished her schooling from the Presentation Convent School , Srinagar. Dr.Zahida completed her Medical degree from the Government Medical College, Srinagar, in 1995. After a brief stint of 3 years in Government service, she quit and set up her own Medical center, "Mothercare Clinic" to provide comprehensive health care for women . Apart from routine medical facilities, Dr.Zahida, having specialised as a Clinical Exercise Specialist provided the State with the first exclusive female health counselling and fitness center. Customised supervised physical activity programs as supportive and preventive adjunct to medical management of disease is her speciality. The clinic has now 3 branches in Srinagar. Dr.Zahida is the founder member of the “Care Kashmir International”, the “Chottay Tarey Foundation“, and trustee in the “HELP Foundation“. Constantly striving to realize her dream of empowerment of Kashmiri women, Dr.Zahida Shah has dedicated her life to improve physical and mental well being of women, setting new benchmarks in women’s health in Kashmir.)
Obesity in Kashmiri Women – Our Experience
Globally we see the increasing number of obese population and Kashmir is no exception. An experience of working with more than 1000 obese Kashmiri women , 90% from the urban poplulation, 10% of the rural population , housewives to professionals ,from upper middle class , lower middle class , elite class to few from lower socio economic strata , and the age groups between 14-70,has brought forth the peculiar reasons for the vulnerability of Kashmiri women to this condition,the gravity of which is still largely undermined.
1.Acceptability of obesity in the society.
Generally speaking every society has a listening and that has its roots.The listening about obesity in Kasmiri society is “khaatey peetey gharaaney ke log”.Slim,healthy ,well maintained people who have made an effort to keep fit are usually discouraged by expressions like" hai kya chu gomut"....”.You don’t seem to be well”and sometimes one feels guilty of not being obese.
Courtesy some patriotic people of our society......we are able to see the century old photographs of Kashmiris...all of us look underfed,marasmic n sick.
Decades back global economic growth found way into few Kashmiri families too and they say when finances improve the first thing the people spent upon is the food.Over years these people could be distinctly recognised as well- to- do from their well fed structures and glowing faces .This information was passed over generations as a mindset till date.And if the society is in a comfort zone about anything ,changing it becomes a real challenge.
Mindset needs to be changed through continued public awareness programmes such that within few years obesity is considered to be disease of ignorant people who do not know how to live and eat.
2.Well knit social fabric:
Hardly we come across a woman in Kashmir who does not make 2 or 3 visits in a week either to a friend,,relative or neighbour.The reason being ,firstly it is a very well knit society and secondly people in small towns have ample time to spare.No problem about that,infact it seems to be very good for soul.But if it is only food-oriented then it plays havoc with health.Such people cannot regulate their food habits,cannot maintain a log of intake,and end up adding a pound after pound.
While counselling about weight management ,I ask my patients do you ever offer a glass of water to your guest.90% were amazed themselves that they never had done so and rest offered only on request.Generally the trend nowadays is that guest is served minimum 3-4 courses starting from Rani juice, dry fruit, lipton chai with all kinds of bakery,then a non-veg dish and finally the namkeen chai with another set of bakery items.Even a simple visit will not be short of so much food.Fresh fruit and fresh water is probably dishonouring the guest.So there is lot bad for health in a good host who never listens to your excuses no matter how grave they are.
Need for hospitality to be simple cannot, but be overemphasised.
3.Ever expanding courses in wazwan:
Wazwan .....inseparable part of our culture has literally become a hazard.Earlier there were few delicacies that everybody used to relish but now the number of dishes drenched in unhealthy fat and spices is ever increasing.Earlier it used to be served only on marriages but now it is served almost on all occasions........happy or sad,formal or informal...Earlier people would wait for the occasions to have it but now anytime you can order because of its easy availability in restaurants or in cans in the departmental store.
Extravagance cannot be nurtured in the name of culture.
Majority of women especially in urban areas have washed their hands from household work. They are now used to helpers 1,2 and even 3.... full time or part time.
This has made most of the women especially the housewives quite sedentary and their routine is only restricted to supervision of things.Your neighbour may not be knowing the name of the master but he knows the name of your helper because from dawn to dusk you are calling him aloud for one thing or the other.This is not only a compromise on health but also on basic manners.
The working women having less time for housework use all kind of energy saving gadgets, so practically for women especially working in schools ,banks,corporates etc life is almost sedentary with very low physical activity quotient.
If help is unavoidable,let us use the helper as helper and not as servant.This will make us physically more active,give us less stress and not make us guilty of human rights violation.
5.Unhealthy habits in children and adolescents:
There is no concept of self help among children and adolescents.And when it comes to day to day routine work at home ,this young generation feels it is not for them to participate because it is the job of mothers and helpers .So even after seeing people around their house slog they will never offer to help ,they will continue the routine of sitting in front of TV , laptops,PSP’s,or listening to music or busy on books munching away their favourite junk foods.When a girl weighing 100 kgs enters the clinic with a relatively smarter mother,one is bound to question the love ,and you will only hear these mothers say ,”I didn’t want to disturb her in studies,I would even serve food in her bedroom”Sure a professional is added to the community whose own health issues may never let her deliver upto to the potential she had.
Parents need to understand that children have to be prepared for life not just academics,and luxury is the greatest enemy of strife.
6.Weight reduction....a luxury .
Weight reduction is still considered to be a luxury in Kashmiri society. Even if women believe in it ,they do not get the right kind of support from their families especially the in-laws and husbands.Young women suffering from obesity and related disorders are taking all kinds of medications and visiting a chain of doctors but when it comes to maintaining weight ,their families raise questions.Many times it is a pain to watch them suffer for want of some support that can actually make their lives more fulfilling.Some women do join with a promise that so and so relative should not come to know about it.It is a shame on our society ,why a women should feel embarrassed about taking care of her own self when she is sacrificing her whole life taking care of her home and kids.
Woman is the backbone of every family.Her health, happiness and peace is reflected in the whole family.Men need to understand it.
7.Obesity ... generally a disease of lazy ones.
This holds true for 90% obese women.And it is these lazy women who look for short-cuts like diet pills,belts,vibrators etc.May be it is good for achieving short term goals ,but losing weight is not a month or two affair, it is the lifelong habits that need to be changed and the constant energy deficit to be maintained.And unless the people move, even the bariatic surgeries fail in few years.
There is no substitute for hardwork.No pain no gain.
8.I have to live with it :
Many women attribute their reason for obesity to Diabetes,Hypothyroidism,PCOD,Genetics and so on....Yes it is true either way,but does it mean that these women need not make any effort.Infact this population needs to be working harder than the normal people .If a normal woman misses her work- outs ,these women cannot afford that.It is a matter of health and wellbeing and supportive treatment for them.Sometimes even if it is a real uphill task for them to loose weight atleast they maintain a certain BMI,have controlled levels in labs, and are better and easier managed by their physicians.
Do not find excuses to ruin your ownselves.
9.Weight reduction for wrong reasons:
Weight reduction for a better appearance can be a motivation for most females irrespective of their age but not a good enough goal for consistency.Only the women whose professions depends upon their appearances,or sometimes young adolescent girls succed.For majority it is a wrong reason because the goal is short lived and as soon as they are near it ,they feel they have accomplished what they wanted and they fail to continue.
So health should be a priority at all ages and looking and feeling better is one of the side-effects of work-outs and it is bound to come .
Kashmiri women have time for absolutely anything , be it six hours wait for wazwaan at weddings , searching the market and shopping for the best dresses and jewellery,gossiping about whole town on telephones,cooking varieties in kitchen for the family,watching TV shows one after the other but once you ask them to take out sometime for exercise ,their expression accuses you of as if you have abused them n quickly without wiasting time like Corporate Heads they answer..”No Time”.Probably it is not a priority for them.
They need to learn time management and prioritize things and list physical activity for better health and future somewhere on top of the priority list.They should realise that they can enjoy all the luxuries on which they are wasting so much time only if they are fit and healthy.
11.Pregnancy and Post pregnancy:
Majority women complain weight gain after pregnancy .I am yet to meet a woman who has not mentioned her weight to be 55kgs before marriage.This is probably because of lack of nutritional counselling during pregnancy and post pregnancy ,prolonged lack of movement and physical activity(for normal delivery our culture gives 3 months rest and for C-sec it is extended to 6 months or more depends how lenient the in-laws are) and ignorance about the advantages of breast feeding particularly in weight reduction.
Regular antenatal and postnatal classes should be attended,nutritionists consulted and we have to remember with due respect that what worked for our grannies may not work for us because of different times and lifestyle changes.Postnatal exercises can be started from day first even after C-sec and prolonged rest is not necessary unless recommended by the obstetrician.
12.Practitioners...not doing enough
Kashmiri women start physical activity only after the recommendation of the practitioners.Practitioners rarely recommend it as a preventive measure and patient usually approaches them when disease is fully established.Infact many a times they stop their physical activity temporarily as a necessary measure for their existing condition without further directions.Barring few gynaecs and orthopaedicians ,majority hesitate to motivate women for physical activity.The new belief that is nurtured among young primis is that 9 months bed rest is the only way sure of their safe pregnancy.
Practitioners have to understand their key responsibility in awareness among women about the importance of physical activity as a preventive measure for better health.They have to realise that for every disease nowadays physical activity is recommended as foremost non pharmacological therapy.Also there are variety of physical activities and they can be designed into a program as per the needs of the individual.
13.Regular walk .....is it possible?
“Do you go for a walk?” “How much do you walk daily?” I have not gone for a walk for few days now” “ I have started to go for a walk” Now I go for a walk daily ,my doc has asked me to do so”. Universally how unnatural we have made the most natural activity of our lives i.e WALKING.... for which our body was so well designed that it still forms the easiest and safest physical activity which does not usually need any specific screening or preliminary check-ups before starting.Other places may have there own reasons but for Kashmiri women the reasons for non compliance of even this simple and natural therapy are....erratic traffic,no walking tracks in parks, dog menace,presence of security personel all around the place,pollution and dust on roads,and ofcourse harsh winters.
We all have to somehow find a space in our lives atleast for this basic physical activity .It does not have to be a morning or an evening walk specifically...it may be a walk to work place,it may be a walk to the shop with your kids,it may be a walk in the garden with your spouse.We only have to believe in its worth to make it a part of our lives.
To conclude , customised physical activity programme is the only way to substitute for the activities our body was designed to perform naturally and maintain the highest ability of its function.