The Toxic Dichotomy

I love pizza. It’s a real addiction. The combo of a warm crispy crust, tomato sauce, melted cheese, a little basil and garlic…a slice of heaven! Despite its amazing taste I realize that pizza is not healthy, but it is one of the many foods from the American culture that has made its way to India.

Last weekend Priyal and I were able to experience some of India’s healthy and classic snacks along with the food that has infiltrated over from the U.S. Early Sunday morning our host and his family along with three other friends piled into the car with our eyes drooping as we headed to a nearby hillside fort. We spent two glorious hours climbing up steep trails and enjoying the amazing views. At the top of the mountain we were met by multiple venders selling lemon water, raw green mangos, boiled peanuts, peeled cucumbers, and salted yogurt. Priyal and I just stuck to the peanuts for our stomachs’ sake, but everyone flooding to these healthy snacks amazed me.

The traditional Indian cuisine is filled with nutritionally packed options. Of course, there are snacks that are fried and packed with salt, but for the most part the Indian diet is balanced and nutritious. Despite this, there is a present dichotomy in the country between malnutrition and increasing obesity rates.


Malnutrition is the leading cause of child and adult morbidity, mortality, cognitive and motor development by India’s Integrated Child and Development Services (ICDS).  It’s apparent that when we start to eat terrible diets (night shifts will inevitably lead to 3 a.m. pizza or mocha binges in my experience) our mental and physical capacity is not top notch. To an even more detrimental effect it has been shown that children who are malnourished can experience lasting effects that will make them more vulnerable to infections, decreased cognition and motor skills. The report by ICDS explained that the primary cause of the malnutrition in India is the high rate of infections and poor feeding in children aged 2-3 years.

One initiative that has been formed in response to this problem is the HealthPhone, which is a project formed by the Indian Academy of Pediatrics and the Ministry of Women and Child development, UNICEF, Bollywood actor Aamir Khan and support from Vodafone. The initiative’s primary goal is to reduce malnutrition in India. They are focused on educating women and their families on proper feeding and care for young children.

The women are sent four different short educational videos on their phone and will receive phone credit if they watch all of them. After I watched the videos myself I realized what a great concept this initiative is. I would love to see a similar initiative started in our community in hopes to help the families of our patients who struggle with obesity and poor nutrition.

That leads me to the other half of the dichotomy for India, the rising rate of obesity. Even though the rate of malnutrition in India is still lingering around 50% the signs of obesity are now being felt more strongly, but there is not as much data these rates in rural populations (stay tuned for info on a comparison between rural and urban BMI from Priyal and I after this month). However, more studies about the increasing rates of obesity and overweight children in urban settings are now appearing. When looking at children ages 8-18 years in urban India, 18.5% are overweight and 5.3% are obese (using the WHO guidelines for obesity cutoffs). For a reference, the average obesity rates for children in all developing countries is 10%. In the U.S., 18% of children ages 6-11 and 21% in children ages 12-19 were found to be obese. In Franklin County, 1 in 3 children were found to be overweight and 1 in 4 children were found to be obese of which 1 in 3 children are predicted to eventually have type 2 diabetes!


I can keep throwing out these discouraging numbers, but I think that we can all see the real struggle. Between malnutrition and obesity, finding a good balance for our children’s nutrition is difficult, but possible. The HealthPhone initiative in India, in my opinion is a great way to get basic nutritional information out to a large number of people. I see a lot of potential for this mode of parental and even teen education in the U.S. to help combat obesity rates.

There are some good efforts already in motion in Columbus. Healthy Choices for Healthy Kids is a law that is designed to improve vending machine and a la cart options in schools. It also includes a pilot program for schools, which allows for 30 minutes of physical education EVERY day at shook. Routine BMI screenings when children first enter school and also during the 3rd, 5th, and 9th grades are also apart of the program.  Check out your BMI here.

There is also an initiative called F.A.N. club (Fitness and Nutrition club). This is a 30-week afterschool fitness-training program with a social cognition-based nutrition program for high risk and obese children.

I could talk about this for a long time, but I’ll finish by sharing some advice from Nationwide Children’s Hospital’s website on how to keep a balance, healthy diet for yourself, your family, and the community:

          1. Advice for the family
          • Eat a quality diet
          • Be better consumers
          • Eat together as a family
          • Cut back on sugary drinks
          • Know you and your child’s BMI
          • Stay away from fast food

2.) Advice for schools:

          • Measure BMI and intervene
          • Increase opportunities for physical activity
          • Insure all food and drink choices are healthy
          • Advocate and provide learning opportunities

Healthy habits start early and everyone can be an advocate. The simplest thing to do is start by having a healthy diet yourself and then reaching out to those around you to spread that contagious and much needed lifestyle!

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Meredith Merkley

More about Meredith Merkley

Meredith Merkley was born in the mountains of Colorado, but moved to Ohio, New Mexico and then Arizona. She has a B.S. in Biology with a minor in Chemistry from Northern Arizona University. Afterwards, she packed her bags again and moved to Ohio where she graduated as a D.O. from the Ohio University College of Osteopathic Medicine. She is currently completing her second year of pediatric residency.


    1. Wow! You are learning so much, I am learning so much! I want to be a part of this process!

    1. Very interesting post. Thanks for writing these.

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