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Journalism of Courage
It’s lunch hour at the Symbiosis Primary School in Pune. Kitchen attendants ladle out fresh, hot meals — khichdi, a light curry and salads — ensuring a healthy balance of carbohydrates, proteins and fibre. There are no burger buns, sandwiches, poori-sabzi, bread pakodas or colas. Over the years, the school menu has been designed and monitored by nutritionists, who have a zero-tolerance policy for junk and fast foods in the premises, especially during festive occasions and birthday celebrations. “We restrict use of salt, sugar and fat in the mid-day meal programme, all of which shape our eating behaviour and food addictions,” says Dr Rajiv Yeravdekar, provost, Faculty of Medical and Health Science, Symbiosis International University, who has worked for 30 years in preventive and promotive healthcare.
He realised that school meals would become a pillar of a child’s foundational and growth milestones from conversations during parent-teacher meetings in the 1990s. He noticed that parents kept on complaining about how children were skipping breakfast before rushing to school. Working mothers, too, admitted it was nearly impossible to cook fresh meals in the early morning hours. Children often carried leftovers from the night before or grabbed easy options — chips, wafers, sandwiches, bakes, snacks and other fast foods. Since these are all refined carbohydrates, these are digested easily, causing blood sugar to spike and drop rapidly, then leading to feelings of hunger. Dr Yeravdekar observed that children would be ravenously hungry by the time school ended at 2 pm. These children would then quickly head home for a delayed, heavy lunch.
“We realised that such habit-forming routines would lead to larger consequences for children’s health. In 1999, we launched a scientifically designed mid-day meal programme at Symbiosis schools in Pune and Nashik to ensure that each child has access to hot, freshly cooked and nutritionally-balanced meals during school hours. Subsequently, in collaboration with pediatricians and nutritionists, a SYM-KEM study, a five-year school-based intervention in Pune, was conducted that found how children in the programme showed improved strength, endurance and flexibility,” says Dr Yeravdekar.
Waist circumference, a key marker of metabolic risk, was found to be lower in students compared to that of their peers. The waist circumference is a true indicator of your visceral fat, which is more metabolically active, meaning it produces and releases substances that negatively affect your health.
It releases hormones and proteins that contribute to inflammation and insulin resistance. It also reduces the production of the appetite-regulating hormone leptin. Increased visceral fat leads to a higher risk of chronic illnesses in adult years.
“While the overall body mass index (BMI) of students did not change dramatically, the study proved that school-based nutrition programmes can reshape children’s fitness and lifestyle habits,” Dr Yeravdekar says.
Studies from India have shown positive changes in dietary behaviour and, in some cases, small reductions in waist circumference, BMI, or body-fat percentage after school-based nutrition and health education. For example, a study conducted in four urban schools in Puducherry reported significant reductions in waist circumference and calorie intake over nine months. Most importantly, protein intake in the study group increased by the end of the intervention.
At the start of the study, overweight students had their waist size and eating habits assessed. The study group then attended two 45-minute sessions over two days in their school auditorium. Using PowerPoint, the researcher explained why a balanced diet matters — encouraging more protein, vitamins and minerals and less high-calorie food (session 1) and the harmful effects of obesity on health (session 2). After the first week, posters about healthy eating were displayed on school notice boards and pamphlets with tips and sample menus were distributed. Over the following nine months, the researcher met the students twice a month to reinforce the importance of healthy eating.
Experts have welcomed the government’s move to establish sugar boards in CBSE schools to create awareness. According to Tejas Limaye, clinical nutritionist with KEM Hospital, Pune, schools can also work on action points like counselling parents, conducting awareness sessions for students, displaying infographics on obesity (similar to sugar boards in CBSE schools), providing healthy snacks in schools, holding healthy tiffin and recipe contests for students and parents, assessing height, weight, waist circumference periodically and displaying trends/ graphs on report card. “Giving special marks for healthy BMI, daily PT/sports period attendance, cycling or walking to school can be other actionable points,” Limaye says.
Dr Aparna Govil Bhasker, general, laparoscopic and bariatric surgeon, has called for restricting marketing and advertising of fast food brands in schools. “Many schools now discourage junk food in tiffins. However, this is not enough to curtail the rapid rise of childhood obesity in India. We must have a regulatory mechanism for curbing the advertisement and promotional drives of packaged fast foods. Social media channels are bombarded with advertisements of junk food in the most attractive and colourful ways. Make healthy foods affordable and accessible. Fast foods, on the other hand, are cheaper and available at every kiosk. That’s why rates of obesity are now increasing rapidly in the lower socio-economic strata too. We are the youngest population in the world. If we do not act now, we may be looking at a sicker, less productive adult population in the next few years. This will lead to an additional burden on the already struggling healthcare system,” Dr Bhasker says.
Obesity affects 380 million children and adolescents worldwide, low and middle-income countries being the most affected. WHO data shows that the number of overweight and obese children under five years has increased from 32 million to 41 million in two decades. India will contribute to approximately 11 per cent of the global burden of child obesity by 2030, as per a report in Clinical Epidemiology and Global Health (2023). Globally, obesity surpassed underweight as a more prevalent form of malnutrition this year, affecting one in 10 – or 188 million – school-aged children and adolescents, and placing them at risk of life-threatening disease, UNICEF has warned.
