Tobacco is considered the single most important risk factor of all NCDs (https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(11)60615-6.pdf). Physical activity has also a significant effect as maintaining WHO guidelines of physical activity can reduce the risk of breast and colon cancers, diabetes, and ischemic heart diseases. But with the increased urbanization and industrialization, sedentary behavior, modes of transport, and poor infrastructure and sports facilities, it will be difficult to make progress towards combating NCDs.

Almost certainly. While smoking cessation is very important and could also qualify as a lifestyle choice, shifts in physical activity have been significant with urbanization, including reduced walking (often due to physical insecurity in marginal urban areas), screen time and sedentary occupations. But they have to be understood in the context of rising portion sizes for meals outside the home (also a lifestyle choice), shifts to bulk purchasing of energy-dense foods (an income parameter), and continuous grazing (snacks between meals, which is arguably due to opportunity costs of time, relative prices between nutrient-dense and energy-dense foods, and lifestyle). So there are many variables at play that intersect between dietary composition and lifestyle.

Thanks Dear Belal and Patrick for providing the valid information. If you see the consumption of tobacco, intake of unhealthy diet and alcohol is since a long time but physical inactivity has increased very sharply in few decades. I think the physical inactivity is having synergy will rest of the NCD risk factors including mental stress. For tobacco ,alcohol and unhealthy food we have a demand and supply complex which is not existing for physical inactivity. Hence we need to look again that what is the major change which have happened in the society and contributed the most for the increase in NCDs

Dear Gopal Chauhan , thank you for the question. I agree with Patrick Webb . My submission is; it is important to appreciate the relationship between physical activity and diet, the issue is energy balance. An individual who spends more hours seated at a desk, drives to work, does not carry out any household chores and neither does exercise is not expected to consume the same amount of foods as one who walks to work, seats few hours, carries out household chores, and exercises. The less physically active you are, the less amount of energy through food one should consume. The challenge is with urbanisation and globalisation, there is;

1. Less physical activity as you drive to work, to supermarkets,

2. More consumption of energy dense fast foods due to lack of time to prepare foods at home,

3. More consumption of sugar sweetened beverages,

4. Less consumption of diet high in dietary fibre, due to overly processed foods,

This is called the nutrition transition.

Coupled with; people living longer (demographic transition) as major communicable diseases have a cure, people are majorly affected by injury, and diseases of life style (epidemiologic transition). When other factors are involved; tobacco use, high alcohol consumption, genetic factors, you get the rise in glaring giant; non- communicable diseases (NCD). The other issue is, which of these risk factors do we have control over most; diet and physical activity. If we can watch our diet and carry out physical activity, we reduce the likelihood of NCDs greatly.

Dear Brenda Ayugi Thank you very much for your valuable inputs.

In fact we are developing a cohort for NCDs risk factors,screening output and treatment compliance through E- surveillance in the state of Himachal Pradesh (India). About 50% population aged +18 have been enrolled under the surveillance. It has been found that physical inactivity is the biggest risk factor followed by unhealthy diet. We have demonstrated a good reduction in tobacco use in last 10 years (22%-13.5%). As physical inactivity seems a low hanging fruit so we wish to develop state specific policy for increasing physical activity at all levels.The screenshot of the progress so far is attached for ready reference.Kindly give inputs.

Physical activity can contribute to better health but as Tim Noakes put it: "you can't outrun a poor diet"

Dear Eric van Royen Thank you very much for valuable inputs

Physical inactivity is probably most responsible for the increasing trends of NCD in the world but diet also play a very important role for increasing NCD. On the other hands, physical inactivity and foods are related to each other. For example, laziness can be seen after eating heavy food. Tobacco use also responsible for NCD.

Dear Anita thanks for the reply and valuable inputs