He's fighting on the front lines of an epidemic quietly

他悄無聲息地戰鬥在流行病的前線

sweeping India, driven by a new menace:

新的威脅席捲印度：

junk food.

垃圾食品。

We reduce the size of the stomach, which is called a sleeve gastrectomy.

我們縮小胃的大小，這就是袖狀胃切除術。

We have operated from age of 13 till the age of 74.

我們從 13 歲一直經營到 74 歲。

Initially, when I joined my practice,

最初，當我加入我的診所時、

I was seeing maybe one or two patients a month.

我每個月大概要看一兩個病人。

Now I am seeing 15 to 20 patients a month.

現在，我每個月要看 15 到 20 個病人。

In India, almost one in four adults is considered overweight or obese.

在印度，幾乎四分之一的成年人被認為超重或肥胖。

If nothing changes, the country's obesity rate

如果不做任何改變，我國的肥胖率

is set to increase by more than 80% by 2035.

到 2035 年，這一數字將增加 80% 以上。

This is not simply a story of individuals making unhealthy lifestyle choices.

這不僅僅是一個個人選擇不健康生活方式的故事。

In India, and much of the world, larger economic

在印度和世界許多地方，更大規模的經濟活動

and social forces are threatening people's health and prosperity.

和社會力量正在威脅著人們的健康和繁榮。

Much of India's history has been blighted by famine.

印度的大部分歷史都曾遭受過饑荒。

As recently as 1943, the Bengal famine killed up to three million people.

就在 1943 年，孟加拉饑荒造成多達 300 萬人死亡。

Even now, roughly a third of children suffer from stunted growth.

即使是現在，仍有大約三分之一的兒童發育遲緩。

And yet, over the last three decades, obesity has surged.

然而，在過去的三十年裡，肥胖症卻急劇增加。

And it's set to get worse.

而且情況會越來越糟。

That's been accompanied by a rise

與此同時

in cardiovascular disease and diabetes.

心血管疾病和糖尿病。

The economic costs are enormous.

經濟損失巨大。

Premature deaths, health care costs

過早死亡、醫療成本

and productivity losses

和生產力損失

Premature deaths, health care costs and productivity losses

過早死亡、醫療成本和生產力損失

resulting from an overweight population

人口超重造成的

are estimated to top

估計最高可達

$129 billion by 2035,

到 2035 年將達到 1 290 億美元、

are estimated to top

估計最高可達

almost 2% of its GDP.

佔其國內生產總值的近 2%。

It's a double burden of malnutrition now.

現在是營養不良的雙重負擔。

Malnutrition means under and over.

營養不良是指營養不足和營養過剩。

Now we are seeing a lot of overnutrition as well.

現在，我們也看到了很多營養過剩的現象。

Dr. Arun Gupta is a pediatrician and health campaigner.

阿倫-古普塔博士是一名兒科醫生和健康宣傳員。

He is the co-author of The Junk Push,

他是《垃圾推手》（The Junk Push）一書的合著者、

a report detailing how changing food consumption threatens health.

的報告，詳細闡述了不斷變化的食品消費如何威脅健康。

Since globalization, the marketing of processed and ultra-processed food

自全球化以來，加工食品和超加工食品的營銷

has picked up.

有了起色。

That has actually influenced a lot of dietary habits.

這實際上影響了很多人的飲食習慣。

One of the major inputs here is unhealthy diet comprising of ultra

其中一個主要因素是不健康的飲食習慣，包括超量攝入過多的蛋白質和脂肪。

ultra-processed foods, high in sugar, high in saturated fat,

超加工食品、高糖、高飽和脂肪、

or high in salt or sodium.

或高鹽或高鈉。

Throughout the country,

全國各地、

home-cooked meals are losing out to empty calories and sugar.

家常菜的熱量和糖分越來越少。

In the span of a decade,

十年間

India's consumption of breakfast cereals and potato chips

印度穀物早餐和薯片的消費量

have more than tripled,

增加了兩倍多、

while confectionary items and soda sales have doubled.

而糖果和蘇打水的銷售額則翻了一番。

India is a massive emerging market for Western brands.

對於西方品牌來說，印度是一個巨大的新興市場。

Sales of ultra-processed snack food and sugary beverages

超加工休閒食品和含糖飲料的銷售情況

grew from $6.2 billion in 2009 to $32 billion in 2022.

從 2009 年的 62 億美元增長到 2022 年的 320 億美元。

For companies like Nestlé, Unilever or Kellanova,

雀巢、聯合利華或 Kellanova 等公司、

sales are growing at double-digit rates.

銷售額正以兩位數的速度增長。

And who one are of the main targets?

主要目標是誰？

Whenever we go to a party,

每當我們參加聚會

suppose a birthday party of one friend, there'll be various

假設有一個朋友的生日聚會，會有各種

junk food items such as Coke, Pepsi.

垃圾食品，如可樂、百事可樂。

I really enjoy Maggi,

我非常喜歡 Maggi、

and I like noodles and ramen.

我喜歡麵條和拉麵。

Burger King, McDonald's.

漢堡王 麥當勞

Maggi.

瑪吉

Pasta.

意大利麵

Chips.

芯片

Burgers.

漢堡

Pizza.

披薩

That is very delicious.

真好吃

India's new food economy has created a public health conundrum,

印度的新食品經濟帶來了公共衛生難題、

with the packaged food and beverages industry increasingly

隨著包裝食品和飲料行業日益

affecting the diets of 1.4 billion Indians.

影響 14 億印度人的飲食。

One remedy that other countries have turned to is stricter regulation.

其他國家採取的一種補救措施是加強監管。

Chile, for example, has an advertising ban

例如，智利就有廣告禁令

on television on certain foods

電視上關於某些食品的報道

between 6 a.m. and 10 p.m.

上午 6 時至晚上 10 時之間

It also has restricted the use of child-targeted imagery

它還限制使用以兒童為目標的影像

in the marketing of these products.

在這些產品的營銷方面。

After these interventions were introduced,

在採取這些干預措施之後、

sugary drink sales dropped by 24%,

含糖飲料銷量下降了 24%、

as well as calorie consumption,

以及卡路里消耗量、

calories from sugar, and calories from saturated fat.

糖的熱量和飽和脂肪的熱量。

Until now, India has mostly relied on the companies themselves self-regulating

迄今為止，印度主要依靠企業自身進行自我監管

how they convey the nutritional value of their products.

如何傳達產品的營養價值。

The results, some argue, are misleading.

有人認為，這些結果具有誤導性。

If you you see the front of the pack, you will see that they claim that

如果你看到包裝的正面，就會發現他們聲稱

it's like 50% of vitamin D.

這相當於維生素 D 的 50%。

Rich in vitamin C, no added preservatives.

富含維生素 C，不添加防腐劑。

And it says very brightly, 20% protein.

上面清楚地寫著 "20% 蛋白質"。

But if you look at the back of the label, you find that 46% of it is sugar.

但如果你看看標籤背面，就會發現其中 46% 的成分是糖。

More than 13 grams of sugar.

含糖量超過 13 克。

Stabilizers, colors and flavors.

穩定劑、色素和香精。

If you are telling people that it is high in protein,

如果你告訴人們它含有高蛋白、

you very well tell them it is high in sugar and high in fat, also.

你很好地告訴他們，它也是高糖、高脂肪的。

Efforts are underway to introduce a more rigorous system.

目前正在努力引入一個更嚴格的系統。

Throughout 2021 and 2022,

整個 2021 年和 2022 年、

Indian authorities consulted health and consumer rights experts,

印度當局諮詢了健康和消費者權利專家、

and representatives of food companies, about a new labeling system.

和食品公司代表，討論新的標籤制度。

While health and consumer rights groups argued for a traffic light system,

而健康和消費者權益組織則主張採用交通燈系統、

used by much of Europe,

歐洲大部分地區都在使用、

which signals red for products

表示產品為紅色

high in sugar, fat or salt,

高糖、高脂肪或高鹽

the eventual conclusion by the authority was for a Health Star Rating,

當局的最終結論是衛生星級評定、

which assigns star ratings for a product's overall nutritional value.

對產品的整體營養價值進行星級評定。

Not everyone was happy.

並不是每個人都高興。

Health Stars only point that this food is

健康之星只指出這種食物是

either healthy or less healthy.

要麼健康，要麼不太健康。

It doesn't tell people that it is unhealthy.

它沒有告訴人們這是不健康的。

For example, a pack of cookies may have a very high amount of sugar.

例如，一包餅乾的含糖量可能非常高。

But, if the manufacturers add nuts, it could get awarded a star

但是，如果製造商添加堅果，它就能獲得一顆星的獎勵

for containing fiber.

因為含有纖維。

Getting that regulation right

正確制定法規

has been evading us in the country.

一直在國內躲避我們。

So that is one part of the story.

這就是故事的一部分。

But what we are missing out is

但我們所忽略的是

working at community level,

在社區一級開展工作、

with children, with parents, families

與兒童、父母、家庭

to create an environment for healthy eating

營造健康飲食的環境

and sustainable food environments.

和可持續的食品環境。

Pawan Agarwal runs the Food Future Foundation,

帕萬-阿加瓦爾管理著食品未來基金會、

a nonprofit that seeks to educate schoolchildren about healthy eating.

這是一個非營利性組織，旨在對在校學生進行健康飲食教育。

The foundation runs programs in schools like this one

基金會在學校開展的項目包括

in order to educate children and parents.

以教育兒童和家長。

It is so important to focus on preventive strategy

注重預防戰略非常重要

and use diet and lifestyle as the entry point for this intervention.

並將飲食和生活方式作為這一干預措施的切入點。

Government or any regulatory body cannot reach out to individual citizens

政府或任何監管機構都無法接觸到公民個人

at all mealtimes.

在所有用餐時間

So at the end of the day, this is about individual choices.

是以，歸根結底，這是個人的選擇。

While nutrition advocates seek tighter regulation,

而營養倡導者則尋求更嚴格的監管、

that may run at odds with Prime Minister Narendra Modi's

這可能會與總理納倫德拉-莫迪的

strategy to attract more investment from multinational companies.

吸引更多跨國公司投資的戰略。

The fear among health experts is that the burden will ultimately fall

健康專家們擔心的是，負擔最終將落在

upon people to make healthy choices on their own,

呼籲人們自己做出健康的選擇、

with little guidance from the government.

政府幾乎沒有提供任何指導。

One of the tactics they use is putting the onus on the people.

他們使用的策略之一就是把責任推給人民。

That it is the people who are choosing to eat wrong foods.

是人們選擇了錯誤的食物。

It's not us.

不是我們。

Which, probably is one of the strategies

這可能是策略之一

which they have been using for tobacco, also.

他們也一直在使用這種菸草。

That people are smoking by their choice and not because

人們吸菸是自己的選擇，而不是因為

of the marketing.

的營銷。

What cigarette do you smoke, doctor?

你抽什麼煙，醫生？

The brand named most was Camel.

被點名最多的品牌是 "駱駝"。

Smoke Camels. The cigarette so many doctors enjoy.

抽駱駝牌香菸。許多醫生都喜歡的香菸。

The tactic is: industry will become a part of the solution.

策略是：工業將成為解決方案的一部分。

They want to be a part of the solution.

他們希望成為解決方案的一部分。

They enter into policymaking bodies.

它們進入決策機構。

Of course, the government

當然，政府

allows them to do so,

允許他們這樣做、

as stakeholders.

作為利益攸關方。

Strict regulations and education

嚴格的規章制度和教育

have driven down smoking rates across the globe.

推動了全球吸菸率的下降。

Imposing controls on the food industry may be necessary

可能有必要對食品工業實施管制

to fight India's surging obesity rates and the illnesses that it causes.

以應對印度不斷攀升的肥胖率及其引發的疾病。

Diabetes, hypertension, joint pains, back pain, varicose veins, gallbladder stone,

糖尿病、高血壓、關節痛、背痛、靜脈曲張、膽囊結石、

hernia, cancers, infertility, chest problems, heart problems.

疝氣、癌症、不孕症、胸腔疾病、心臟病。

It is putting an enormous strain on our economy.

這給我們的經濟造成了巨大壓力。

A country once blighted by too few calories,

這個國家曾因熱量過低而陷入困境、

must face a new battle with too many empty ones.

必須面對一場新的戰鬥，因為有太多的空白。