Perfectly poised in flared Levi's, cropped top and kohl-rimmed eyes, Shweta is every bit the glamorous woman-of-the-world as she chats on her mobile and sips a cola outside a south Delhi pizzeria. A few moments and an excited squeal later, the Miss Sophistication image lies in tatters as Shweta reveals her age. She is 15. Waving frantically to friends-girls similarly dressed, boys with baggy jeans and Beckham style gel-slicked hair-she joins them and the giggly, voluble group piles into the fast food restaurant. All around them, at the multiplex cinema, in coffee shops and boutiques, the atmosphere reverberates with the heady beat of youth.

TEEN TRAVAILS: A student undergoes a madical check-up at a Delhi hospital

Not quite children, not yet adults, adolescents dominate the Indian cityscape: 250 million between 10 and 19 years of age. Never before have there been so many teenagers in India, and with their lavish consumerist lifestyles, neither have they had it so good. But statistics trickling in from doctors' chambers tell a more sombre story. Hip is not healthy. From obesity to diabetes to depression, Indian teenagers are susceptible to a range of diseases that were earlier the bane of adults. The implications are graver because a slew of studies shows that many adult ailments have their roots in adolescence.

According to a national survey, one in three teenagers has bad eyesight. At least 30 per cent have bad teeth. Seventeen per cent are overweight, says a Chennai study. On the other extreme, a survey of Delhi schools showed 4 per cent of teenagers had tried drastic measures like induced vomiting and drugs to lose weight. A possible one-thirds of young girls could have reproductive tract infections. At least 20 per cent of teenagers are likely to be depressed, and a government working group report says 40 per cent admit to severe anxiety. Another study says that a third of teenagers have imbibed alcohol and addictive substances.

MEDICAL FILE: OBESITY

THE FACTS A WHO-backed survey of Delhi public schools revealed that 53 per cent of children between 10 and 14 years and 45 per cent between 15 and 19 years snack on junk food every day. In Chennai, 17 per cent of teenagers between 13 and 18 years are overweight or obese.

CAUSES Eating junk food and snacking between meals. Lack of physical exercise.

LONG TERM CONSEQUENCES Eighty per cent obese teens grow into obese adults and are twice as likely to suffer from heart attacks.

THE WAY OUT Intake of healthy, balanced meals. Limited snacking, junk food between meals. Regular physical exercise.

CASE STUDY: MICHAEL SAMUEL, 13 EXORCISE: Gym has given hope to Samuel Michael Samuel-5 ft 8 in tall and weighing 90 kg-believes in living life to the full. In his case, it means indulging in his great passion, food. "He knows about every new pizza or burger joint in Delhi," says his mother. When not savouring the latest fad in fastfood, Samuel's favourite recreation is television and his beloved Playstation. Although he plays basketball, his waistline has shown no sign of reducing, which has got his mother worried. "It could lead to all kinds of complications in later life," she explains. So now Samuel has joined the VLCC's slimming programme as well as a gym. This time next year, he hopes, he will be able to present a very different picture of himself.

With raging hormones, teenage problems are hardly news. What is significant is that this generation is particularly badly hit as confirmed by doctors in every discipline across metros, cities and towns. "I attend to at least two to three boys suffering from blood pressure, diabetes or other similar diseases every day," says Lucknow-based paediatrician Shobhit Chawla.

Unable to cope with the rapidly changing world, the bodies and minds of teenagers have taken a battering. Much as the society woke up to women's health problems some decades ago, it is beginning to acknowledge that adolescents have specific needs that require specific care. So adolescent clinics have begun to spring up across the country, from Delhi to Mumbai and Chandigarh to Thiruvananthapuram. In Chennai, when experts found that at least five adolescent patients were visiting the Apollo Hospital every day with disorders ranging from obesity to anorexia, they decided to open a separate clinic for them. Led by Mumbai-based adolescent specialist Swati Bhave, the Indian Academy of Pediatrics (IAP) too has launched an adolescent chapter.

FOOD FOR THOUGHT

The problem is growing, literally. The overweight teenager is now a very visible urban phenomenon. "Adolescent obesity is like an epidemic," admits S.K. Wangnoo, senior consultant endocrinologist at Delhi's Indraprastha Apollo Hospital. In Delhi and Chandigarh, one in every four teenagers is obese, while a study of schoolchildren in Chennai shows 18 per cent boys and 16 per cent girls are overweight. In contrast, teenage obesity in the US is estimated to be below 15 per cent, while in the UK the figure is just 7.3 per cent.

To blame is the cocktail of Indian genes, mindsets and modern lifestyle. Of the 285 obese adolescent patients surveyed by Archana Arya, paediatric endocrinologist at Delhi's Ganga Ram Hospital, only 4 per cent were found to be overweight because of clinical reasons. The others were fat because they ate too much of wrong foods and did not exercise enough.

MEDICAL FILE: EYE/TOOTH WOES

THE FACTS Almost one in three Indian teenagers is shortsighted, according to an AC Nielsen survey of high/middle income groups in the country. Adolescents suffer from cavities, bleeding gums, bad breath, and in nearly 40 per cent of them the milk teeth do not fall out naturally.

CAUSES Reading in poor light and excessive exposure to television and Internet. Soft, carbohydrate-rich, fibreless junk food.

LONG TERM CONSEQUENCES Headaches, increasing loss of sight with age. Loss of teeth at an early age.

THE WAY OUT Physical activities like sports can help reduce eye-strain. Reading should be in well-lit areas. Healthy eating habits, lesser intake of junk food.

CASE STUDY: VRINDA OBEROI, 14 GLARE SCARE: For Oberoi, TV is a cause of eye-strain She is in Class X, and like most teenagers her age, Noida-based Vrinda Oberoi is not allowed to forget it for a single moment. So as soon as she returns home from school, it is homework time. Several hours of studying is strenuous enough but frequent power failures mean doing it in inadequate light. Then, of course, there is the tuition. When she is free, Oberoi tries to forget about studies by watching her favourite soaps on television, surfing on the Internet (till her father disconnected it this year), or reading novels. It helps her mind relax, but her eyes pay the price. But with the intense competition, wearing glasses or contacts is a small price to pay for a good academic record.

Take Sharmistha. The 12-year-old girl from Kolkata is 5 ft tall but weighs 70 kg. Her mother, however, insists she "doesn't eat anything at all-just aloo parathas for breakfast, samosas and rolls for lunch and chowmein for dinner from a local pushcart". Between meals, she packs in chips and colas. Doctors are not surprised. "It is common for parents to encourage their children to eat high-calorie foods, equating 'fat' with 'healthy'," says Bhave. The average teenager's schedule doesn't help burn the calories either. Sharmistha's mother will not allow her to participate in extracurricular activities till after Class X. "It doesn't matter if she is slightly overweight," says the mother, "at least she will have an engineering degree."

Even if she were allowed, the space crunch in overcrowded cities means Sharmistha would probably be reduced to seeking recreation from television and video games. In Ahmedabad, 19-year-old Pravesh Kumari-5 ft and weighing 80 kg-has severe menstrual problems due to her weight. She spends more than six hours a day watching TV. "I blame the serials for all her problems," says her father Tulsiram Chaudhury.

Fat makes adolescents particularly vulnerable to disease. Indians suffer from Syndrome X, or the Insulin Resistance Syndrome, making them genetically prone to high levels of insulin and "central adiposity". This means that fat accumulates around the belly, putting pressure on the organs in the area, instead of being distributed across the body. So the pancreas needs to work harder and secrete more insulin to bring blood sugar levels to normal. In obese people, there is so much sugar that after a certain level the pancreas simply cannot cope and blood sugar levels shoot up. Enter diabetes mellitus, hypertension and high cholesterol levels-diseases that just a generation ago didn't call on you before 40.

So teenagers with adult type II diabetes are no longer an aberration. "Thanks to the McDonaldised culture, I have younger diabetics showing up at my clinic," says Kolkata endocrinologist Vinayak Sinha. In Delhi, 3 per cent of overweight adolescents are diabetic, while many others have high blood glucose levels and are on the verge of diabetes. "It does not occur to most of the obese patients,'' says Arya, "that their weight could be a health problem. They come to me for some other illness, like excess hair." Rarely do these teenage girls realise that thanks to Syndrome X it is a symptom of another increasingly common disorder, Polycystic Ovarian Disorder.

LUST IN THE AIR: Higher Internet exposure and more opportunities to experiment with sex has led to greater incidence of STDs

More worrying are the increasing blood pressure and cholesterol levels. Of every 50 adolescents in Delhi, 19 have high blood cholesterol levels, while every one in 15 has dangerously high levels. This, added to the classroom pressure and the desperation to be accepted as "cool" and look good, results in tremendously high pressure. Anjan, a jovial 16-year-old Delhi boy, agreed to see the doctor when he began to suffer from dizziness and nausea. A routine check revealed the cause-his blood pressure was 150/90 mmHg against the normal average of 120/80 mmHg. In the past five years, cardiologist Brian Pinto of Nanavati Hospital, Mumbai, has seen a 20 per cent increase in the number of teenage patients with hypertension.

Adolescence also provides the first glimpse of what to expect in later life. As many as 80 per cent of obese adolescents grow into obese adults. Numerous studies show that obese, diabetic or hypertensive adolescents are twice as likely to die-and younger-of heart disease.

MOUTHFUL OF ILLS

Will this frighten the adolescents into healthy living? Unlikely. "Teenagers live for today," explains Rakesh Mehta, adolescent health specialist at Delhi's Safdarjung Hospital. "You have to explain it to them in a way that will affect their life now for it to have an impact." Burgers, pizzas, chocolates and colas attack the teeth too. "This generation does not bite or chew food," says Kolkata orthodontist Aabir Mukherjee. "They only have soft, carbohydrate-rich food which does nothing for their teeth." Seventy per cent of 11-18-year-olds who come to Mukherjee suffer not only from cavities but also bleeding gums, bad breath and dental calculus -problems caused by deposition of food in the teeth. The diet shift to junk food is even being held responsible for subtle evolutionary changes. Young people's jaws, say dentists, are becoming smaller and with little need for hard chewing, wisdom teeth come out late, or not at all. Junk food appears to be putting the tooth fairy out of business too. With no hard fibre from fruits and natural foods to grind against the teeth, milk teeth do not fall out naturally in up to 40 per cent of teenagers and dentists have to intervene.

Poonam, 15, does not have to worry about any of these problems. She is 5 ft 6 in, weighs only 42 kg and survives on a diet of skimmed milk and salads. She knows all about being overweight, or at least that is what she has convinced herself. Poonam is anorexic. She doesn't think she looks as good as her friends, so she virtually starves herself, fervently hoping she will be "beautiful like that model on TV". Anorexia is far from common but is rising steadily, with one in 100 teenagers suffering from it. It is also not restricted to girls. One in every 10 anorexic teens is a male. Left untreated, it can lead to a collapse of organs and, eventually, death.

LOW LIFE: Cut-throat competition and high ambition make for a depressive combination

If the Indian teens fail to focus on the big picture, it could be because of poor eyesight. According to an AC Nielsen study, 15-20 per cent teenagers in middle-income group wear glasses or lenses. "For every child with glasses, there is another not even aware that he/she needs them," says Delhi ophthalmologist Mahipal Sachdev. The cause is too much TV, too little nutrition, or even inadequate lighting. Small wonder then that a third of the Indian youth are short-sighted.

DAYS OF DISTRESS

For most adults it is difficult to appreciate the sort of pressure today's average teen lives under. "I used to complain about my son's dress sense," says Gitika Sarin, mother of Aditya, 13. "Till I saw youngsters in London wearing exactly the same kind of clothes." The global exposure has led to soaring ambitions-perfect job, perfect body, the best clothes, latest gadgetry-and the easiest route is through good education. But when even 90 per cent is not enough for university admissions, the pressure is unbearable. Add to it the confusion of zipping hormones, mysterious changes in the body and lack of reliable adult confidants, and it is a pressure situation Superboy would crumble under.

Rishi, 15, a Class X student, went to see a doctor when his hands began to go numb and he was plagued by a constant headache and backache. A few counselling sessions revealed the problem: anxiety over exam results. It is a common phenomenon, says Sunil Nakra, adolescent diseases specialist at Max Healthcare, Delhi.

Emotional exertion also leads to side-effects like anger and irritability, kleptomania or high risk behaviour, and drug abuse. "Late nights, junk food and exposure to audio-video stimuli mean teens have distorted sleep cycles and limited attention spans," says Mumbai psychiatrist Harish Shetty. According to a report by Rajesh Mehta, co-ordinator of the adolescent unit at the Safdarjung Hospital, Delhi, 72 per cent of adolescent deaths are the result of car accidents (often due to drunk driving), unintentional injuries, homicides and suicides.

Faced with rebellious children parents are often at a loss to understand where they have gone wrong. It is their desire to "drive" their children into performing that is to blame. Peer pressure is also intense. The relationship with the opposite sex doesn't make the emotional tumult any easier. Bombarded with snippets on sex on the Internet, unsure about what is right, teenagers whirl in a vortex of uncertainty and anxiety. Many become obsessed with chatting, flirting, or more, with strangers. They live their lives on the Net, losing all social skills. "With the breakdown of the joint family structure, the confused children have fewer people to turn to, so they go berserk," says Delhi psychiatrist Sandeep Vohra. "It is common to have young girls feeling depressed and inadequate because they don't have a boyfriend," he adds.

SMOKE SCREAM: Peer pressure can scar a teen for life

In a recent all-India study reported by the IAP, 75 per cent of adolescents said they could not communicate comfortably with their parents. The result? Giving in to basic instincts, among other things. Which is why the age of first sexual intercourse has dropped from the early 20s to between 16 and18. What also helps is opportunity: nuclear families mean empty houses and greater access to cars. Amorous adolescents are seizing this opportunity with fervour: 6-39 per cent of Indian adolescents nationwide have had sexual intercourse.

Conservative small town India is just as vulnerable to change. "Sexual mores have changed and female companionship is no more a taboo. So teenage pregnancy is on the rise even in mofussil towns," says a worried Bhopal-based gynaecologist Rajesh Patel.

"Often, the first incidence is not planned, so contraception is not used," explains Manju Dhasmana, head of the adolescent unit at Parivar Sewa Sansthan, a Delhi-based NGO focusing on reproductive health. The consequences are frightening. A study of people with sexually-transmitted diseases in Thiruvananthapuram found that 24 per cent of the victims were in the 16-20 age group. As many as 40 per cent of new aids cases are in the 15-29 age group. The fact that HIV positivity takes four to 10 years to develop to full-blown aids means the victims were infected in their teens.

"The situation is grave. It is crucial that doctors, parents and teachers work together to support these children," says Bhave. The IAP will soon begin working with schools to increase sensitivity among teachers and parents and has already brought out an advisory manual. Experts recommend simple measures that could make a difference. Schools should have trained counsellors and the curricula should include advice on teenage problems. For instance, Vandana Luthra of VLCC is planning a curriculum on nutrition for the Delhi Public School chain. The schools also need to ban colas and junk food on the campus, while parents make an effort to keep away chips and colas from lunchpacks.

Most importantly, parents and teachers should be there for the children, should talk to them and help make them accept the various changes in their lives. "Children don't want parents to be friends. They want parents to be parents," says Arun Kapoor, director, Vasant Valley School, Delhi. In the success of their efforts, lies the future of the country.

-with Sandeep Unnithan, Labonita Ghosh, Uday Mahurkar, Stephen David,
Subhash Mishra, Neeraj Mishra and Arun Ram