Generally, in the Himalaya, the poor population eats vegetarian food, consuming meat only on special occasions. The situation, however, is quite different for the burgeoning middle and upper-middle classes. Although, on the average Nepal is not getting any richer, the size of the nouveau riche has increased considerably in the past two decades. And what is happening to the dietary pattern of this group is quite startling.
Traditionally, people ate meat (goats slaughtered at home) only occasionally. Now, professional butchers sell meat every day except on certain holidays. Those who do not observe religious holidays can get frozen meat any time. This is a reflection of increased buying capacity and a changed lifestyle. Today, there are many more social get-togethers and vastly increased consumption of alcohol, both of which is said to call for meat-eating. Not only is the khasi eaten with skin and fat, but the liver, kidney and entrails are fried in oil and eaten as tidbits with drinks.
With more disposable income, the middle class´ food has become much richer. More sweets, chocolates and soft drinks are consumed. People are also getting much less exercise. Walking has more or less been abandoned in favour of motorised vehicles. Midriffs have widened all over. To add to all this, stress has become a part of daily life for many. Smoking has become a growing national pastime and non-smokers inhale from others who are. Very few Nepalis have regular medical check-ups and are, therefore, not even aware of deteriorating health.
With dietary habits changing for the worse, and with less exercise, high consumption of alcohol, higher stress and increase in smoking, middle class Nepal is all set for an explosion in the incidence of Coronary Artery Diseases (CAD). Evidence so far indicates that the process has begun. While two decades ago, one rarely heard about people dying from this dreaded disease, today, hardly a conversation is carried out without a mention of someone going abroad for bypass surgery.
Without sound epidemiological data, it is hard to know whether there is a real increase in the incidence of CAD or only that more of it is being discovered because of better diagnostics. But, if the world trend is anything to go by, we are headed towards a dangerous precipice. And if we are to benefit from the lessons learned by others, we should change our life styles early on. What should we do?
We should: stop smoking, cut down eating khasi and animal fats, eat fish, use polyunsaturated oils for cooking, do regular exercise, minimise alcohol intake, control weight-gain, and have regular medical examinations.
Dr. Narayan Bahadur Thapa
Dr. N. B. Thapa is Director of Kanti Children´s Hospital in Kathmandu.