Expert explains: ‘Diabetes is a disease of childhood habits; the fight must start from school’

In my clinic in Mumbai last month, I met a 13-year-old boy with Type 2 diabetes, fatty liver and a Body Mass Index of 32. His mother told me: “He hardly eats home food, doctor. Only chips, fast food, biscuits and cola.” For 35 years, I have treated diabetes as a disease of adults. Today, I am treating it as a disease of habits formed in childhood. That child is no exception. Rather, he is an early warning.

This year, on World Food Day, the world has chosen a powerful theme: “Innovate today. Nourish tomorrow.” The core goal is to harness science, technology, data and traditional knowledge to build resilient, sustainable agrifood systems and fight global hunger. It is a timely theme. But as a doctor who sees the end of the food chain in the form of diabetes and obesity, I want to add: We cannot nourish tomorrow if we do not innovate in our classrooms today.

Our Vedas answered this 3,000 years ago: “Annam hi bhootanam jyeshtham, tasmaat sarvaushadham uchyate (food is the eldest of all beings, therefore it is called the medicine for all)”; and: “Aahar shuddhau sattva shuddhi (When food is pure, the mind becomes pure).”

Modern science is now catching up with this traditional knowledge. That is exactly what this year’s World Food Day calls for — blending science, technology and tradition.

The numbers should concern us. The ICMR-INDIAB study estimates that India now has 101 million people living with diabetes and 136 million with pre-diabetes. The National Family Health Survey shows one in four children between five and nine years is overweight. More than half of what urban adolescents eat is ultra-processed, and 70% of adult non-communicable diseases have roots in habits formed before age 15. We once worried about children not getting enough to eat. Now, we must fight both hunger and hidden hunger caused by eating too much of the wrong kind, too early.

This is where innovation must begin — not just in labs and farms, but in schools. A child spends nearly 8,000 hours in school between ages five and 15. More than with a doctor, a playground, or even the family dining table, it is in these hours that taste is formed, that the palate is programmed, that the brain learns what “normal” food looks like. Yet, our education system, even after National Education Policy 2020’s welcome focus on foundational literacy and numeracy, has no foundation for wellbeing.

In four decades of treating metabolic disease, I have come to believe five simple school habits predict fifty years of health. They are the perfect example of this year’s theme in action, using science, data and traditional wisdom together.

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First, the breakfast habit. Data shows nearly a third of urban Indian children skip breakfast. Science shows a child who skips breakfast is 40% more likely to be overweight and performs poorly in attention and mathematics. Our traditional wisdom offers the solution: ragi, peanut, sattu or eggs — local, seasonal brain food.

Second, the water habit. India has recorded the fastest growth in sugar-sweetened beverage consumption among adolescents — over 300% in a decade. One cola has many spoons of sugar. Innovation here requires policy: Water Bells, safe drinking water stations and no-sugar drink zones, as schools in Kerala and Maharashtra have pioneered.

Third, the millet and fruit habit. Millets are low glycemic, high fibre and climate-resilient — the ultimate answer to sustainable agrifood systems. If we can make Millet Mondays and Rainbow Tiffin Tuesdays aspirational, we can build both health and resilience.

Fourth, the movement habit. Data shows only 18% of Indian adolescents meet the 60-minute daily activity norm, according to a study in The Lancet. We have steadily replaced PT periods with extra maths tuition. We are building sharper brains but sicker bodies.

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Fifth, the sleep habit. Research shows average sleep in 12 to 15-year-olds is now 6.5 hours against the required 8-9 hours. Sleep deprivation increases the levels of ghrelin, the hunger hormone, and drives insulin resistance. A 10 pm lights-off rule is more powerful than any vitamin supplement.

All this just requires a new lens — the World Food Day lens of innovation. Seven low-cost, innovative nudges can transform a school tomorrow: fruit birthdays instead of chocolate birthdays; five minutes of mindful eating at lunchtime; teaching children to read food labels using mobile apps and data; a 10×10 feet kitchen garden using traditional knowledge; a monthly parent tiffin workshop; a safe playground hour; and an annual wellbeing report card alongside the marks card.

There is also an economic reason to act. The direct economic burden of diabetes alone will cross $90 billion by 2033. One rupee invested in school health and nutrition returns 16 rupees in healthcare savings and productivity, according to WHO.

Some argue diet is a family matter, not a school matter. In reality, it is both. A child cannot say no to junk if the canteen sells it and the food environment is stacked against him/her. If we truly want to “Innovate today to Nourish tomorrow,” we must start with the tiffin today. A resilient, sustainable agrifood system will mean little if the next generation has lost the ability and desire to eat from it.