The Centre for ‘Food, Mood, Exercise and Education [CFME]’ as Evidence-Based Clinical and Community Preventive and Management Healthcare Model in Dharmapuri District, Tamil Nadu, India
In Support of Association of Health, Food, Nutrition and Dietetics (AFND), an NGO
An enormous increase in the onset of metabolic diseases has overburdened public health of both advanced and developing nations alike. The incidence of metabolic diseases has its precursors in the continuity of the life course which has been mapped to both undernutrition (“in terms of deficiencies”) and overnutrition (“excesses”) in addition to various risk factors. India also shoulders this burden of both under nutrition and over nutrition in the same population across the life course. The effects of imbalance are evidently manifested and recognized worldwide, and much more in specific to Indian context owing to its social, cultural, economic and political diversities. Being underweight is also associated with greater risk of morbidity and mortality as much as overweight and obesity are risk factors for type 2 diabetes, cardiovascular diseases, respiratory, hepatic, and several cancers related morbidity.
Assessment and directive measures are critical to addressing this overwhelming health issue. However, to mitigate the dual burden, it is also imperative to understand the prevalence and distribution of malnutrition in society, a representative unit of a nation at large, during the strategic decision of prevention and mitigation of metabolic diseases. Conversely, the assessment of metabolic diseases prevalence and thereafter planning control measures for an entire nation is time-consuming, amidst the rapid widespread of the disease. Although surrounded by detrimental influences towards the development of metabolic diseases, the contingency also offers an opportunity for prevention and management of such ailments.
Dharmapuri: A right place to start
Preeminently, the risk factors for the incidence of metabolic diseases are prevalent for all ages and conversely, all ages are inclusive of the prevention and management measures with the objective of addressing the ailments. The prevention and management of metabolic disorders can be equated to addressing individual risk factors significantly initiated within a society which is a smaller representative of the wider population, otherwise known as a nation. The district of Dharmapuri is one among rapidly developing districts in Tamil Nadu in all aspects. When considering from nutritional and health perspective, despite unpublished statistical data, the district exhibits the incidence of diabetes and other metabolic diseases on the increase among its locals. It is also well acknowledged that the prevalence of female infanticide, low birth weight, and its associated mortality, dental mottling are significantly higher in Dharmapuri district due to poverty, worm infestation, and fluorosis. The children have a higher risk of developing malnutrition, recurrent infections, and neuro-developmental impairments. Although precise factors are not known due to the lack of published data, it is hypothesized that the fetus adapts its structure and physiology in response to an adverse environment in the uterus, which predisposes it to chronic diseases in later life - the thrifty phenotype hypothesis. The applicability of the hypothesis cannot be much befitting to any other district as it is to the people in Dharmapuri district, where there is a comparatively higher prevalence of low birth weight infants.
Contemporary healthcare systems are facing economic challenges to provide services and solutions at affordable rates to already distressed people of metabolic disorders. The town of Dharmapuri has approximately 50-60 hospitals with only a few gym centers, and without any nutritionists or dietitians to address the health issues collectively. Although exact numbers are not known given the high rate of hospitals with huge crown based on the observation indicates that the district needs attention in terms of public health. In much resemblance to the state of despair prevalent among the population affected with metabolic disorders in and around India, the people of Dharmapuri are also perplexed in addressing their ailments with a scientific and result oriented approach.
Astonishingly, researchers in the past decade, established evidence-based (EB) interventions with lifestyle modification and behavioral changes (e.g., DPP Trials) which significantly inhibited the contributive and causative factors for the incidence of the deadly CD , thereby alleviating the symptoms, conditions and eventually reduce the associated morbidity. Despite many preventive strategies emphasized (Clinical /or Community-population based) which involved several stakeholders (State and national government, local community, service providers), to our knowledge these interventions have failed to deliver solutions under one roof, which is perhaps the biggest hurdle to translate EB research at both clinical and community (CC) level. Conclusively, the dire need of providing result oriented and precise solutions to the affected population have always remained questionable, until the emergence of Centre for Food, Mood, Exercise, and Education, which bridges the gap of providing a result oriented, affordable, the holistic approach under one roof to the distressing health affected population. Centre for Food, Mood, Exercise and Education (CFME) founded Radhika Ganesan, (in.linkedin.com/pub/radhika-ganesan/4b/884/a73/) is a unique initiative to translate evidence-based research to clinical and community level. CFME focuses both phases in parallel, where one commission is the assessment of prevalence through epidemiological studies and through the other (Guires Wellness Centre) prevention and management measures are undertaken.
The CFME embraces the CC based preventive strategy with measurable outcome under one roof. High-risk individuals identified are given intensive lifestyle intervention involving food, mood, exercise and education in right proportion based on the individual’s diseases status, socio-demographic and cultural factors. However, to make this intervention more practical, feasible and sustainable, the delivery of these services are made available in the form of the healthy supermarket, and kitchen guided by food philosophy principles [food], gym, physiotherapy, yoga [exercise], psychology, meditation and beauty and spa [mood] services. Another extension of the holistic approach is self-management education support employing a variety of tools, aids, and models along with GuiRes® i-wellness online program. The model relies on availability, accessibility, affordability of healthier options, specialized healthcare professionals (e.g. diabetes Nutritionists), and awareness and support for EB approach from stakeholders. Hence, the model is integrated with R&D and NGO (social enterprises) to initiate these activities.