A report by Swachh Bharat Mission says that 74.5 per cent of public places are equipped with toilets. Another report by the Ministry of Jal Shakti states that there are 2.23 lakh Community Sanitary Complexes built across all States and UTs under the Swachh Bharat Mission (SBM) since October 2014. Over 92 lakh toilets have been constructed since the launch of SBM Gramin (SBM (G)) in April 2020.

While toilets are there, are they accessible? This is the question one should ask. The National Family Health Survey (NFHS) focuses on 131 health indicators, but not until the NFHS 5 survey did they include the question of accessibility of toilets in the survey. This happened after the inputs from the Department of Drinking Water and Sanitation (DDWS) and the Ministry of Health & Family Welfare questioned the accessibility.

One might ask, why is the question of accessibility so important? The answer is quite simple. Access to water, sanitation and hygiene is the most basic human need and is also included under the Sustainable Development Goals by the UN.

Are These Numbers Real?

This thought crossed my mind because back in 2021, I went on a solo trip, on a bus to Udaipur from Delhi. There, the bus made two stoppages. This was done so people could get a quick dinner and freshen up, relieve themselves and be prepared for the rest of the journey. This was a nightmare. The bus only stopped for 10 minutes. While some men used the washroom, others went to the bushes.

For the women, there were three cubicles. One of them was broken, and the other one did not have a light bulb, which meant only one was usable. There was a long queue for that cubicle, and time was short. There was no point in trying to find an isolated corner, because it was past midnight, in an unknown area.

I waited anxiously. When finally, my turn came, I saw an overused, dirty washroom. The toilet seat is in a horrible condition. I wanted to touch nothing there. But I had to pee. So, I used my mask to cover my nose from the odour, folded my pants so they did not touch the floor and squatted. It was quite a task to balance.

On my way back to Delhi, I made sure to not drink any water for over a 13-hour bus journey. I dehydrated myself so I did not have to use the washroom. When I did reach, I was severely dehydrated and was sick for three days.

I shared my experience with my friends only to realise that many women have faced the same. There are no washrooms for women.

A friend of mine told me that it is because these roads and dhabas are mainly designed to serve men. They are the ones who travel at night or are on the roads most of the time. As a result, the few women who do travel or are on the road suffer.

Health Risks Women Are Prone To

Well, it is true, but partially. While holding your pee for too long can lead to health risks, peeing on a dirty toilet seat cannot lead to infections unless your urethra is in contact with the bacteria present on that toilet seat. However, nobody wants to sit on a dirty toilet seat, even if you do not get an infection. A safe and hygienic toilet is a basic need.

One of the regular saleswomen, Usha, who visits my house shared her experience with me. “Being on the road constantly means I must use the dirty public washrooms. But I do not want to use them. So, sometimes I ask my regular customers to let me use their washrooms. Some say yes, and some say no. I understand they are also concerned about their safety and privacy,” she says. As a result, Usha spends most of her day not drinking enough water and holding her pee when she is at work. Due to this, she also suffered from a Urinary Tract Infection (UTI).

Her friend, Halima too faced similar problems and due to increased levels of uric acid in her body, she suffered from Hyperuricemia.

Other health risks are kidney stones and other kidney problems, headaches, dull skin, xerostomia or dry mouth, fatigue, and urinary incontinence, which means losing control over your pelvic floor muscles leading to uncontrolled leakage of urine, seizures and weakness.

What Can You Do?

Wear comfortable clothes and capris. Capri pants are comfortable and are short in length, which means this won’t touch the toilet floor when you squat or sit.

Carry Essentials

Even though you cannot get a UTI alone from sitting on a toilet seat, it is always safe to carry a toilet seat sanitiser. If nothing, it can help you get rid of the bad odour so you can use your stand and pee device inside the toilet. You can also use disposable toilet seat covers if your knees are weak, and you cannot squat. Always flush with your seat down.

Always keep disposable gloves, a portable bidet (fill it with water before use), a pocket liquid handwash, wet wipes, tissues and sanitiser handy. Do not forget to keep extra sanitary pads. It might sound a lot, but I promise that it all fits in one pouch. Use this travel-friendly pouch every time you are on the road, or using a public washroom.

What Can We Learn From Others?

However, in case we do not get these technologically advanced toilets here, you can always pack a travel-friendly toilet kit!

Walking past a bakery and suddenly craving a pastry, even though you’re not physically hungry.

Seeing an ad for your favorite pizza while watching TV and suddenly thinking about ordering it, even though you’ve just had dinner.

Do you experience this too? This is often referred to as “food noise”—persistent cravings, thoughts or mental chatter about food that can occur even when you’re not physically hungry.

A 2025 study published in Nutrients found that 57% of people with obesity reported experiencing food noise.

Constant exposure to food cues—from social media posts and advertisements to food-delivery apps and supermarket aisles—can further fuel these cravings.

While thinking about food is a natural part of everyday life, for some people living with obesity, these thoughts can become persistent and difficult to escape. This may contribute to overeating and, over time, make weight and metabolic health harder to manage.

HealthandMe spoke to Dr. Jasjeet S Wasir, Bariatric & Metabolic Physician, Director, Medanta – The Medicity, to understand the mechanism behind food noise.

What Is Food Noise?

“Food noise is like having a notification pinging on your phone every few minutes. You can ignore it a few times, but eventually the constant pinging wears down your attention and willpower, and you give in to it and indulge,” Dr. Jasjeet said.

A more formal, non-medical definition of food noise is persistent, intrusive thoughts about food, such as cravings, mental “chatter” about what to eat next, or a preoccupation with eating that some people experience throughout the day, seemingly independent of actual hunger.

Normal Hunger vs Food Noise

Normal hunger, or the “hunger of the body”, occurs when the body needs food and the brain responds to that need. Once adequate nutrition and calories have been consumed, appetite is influenced by satiety signals and hormones such as leptin, GLP-1 and insulin.

With food noise, however, thoughts about eating can persist even when a person is not physically hungry.

The biology behind food noise is not necessarily a primary defect in the physiological hunger system, but may involve overactivation of the reward system. This system influences mood, motivation, pleasure and cravings and can be activated by food-related cues such as sight, smell and memory, Dr. Jasjeet said.

What Can Trigger Food Noise?

Common situations in which people may experience heightened food noise include:

• Chronic calorie restriction or dieting
• Chronic sleep deprivation
• Chronic stress
• Rare genetic disorders of the reward system

Could Food Noise Affect Prediabetes and Weight?

Dr. Jasjeet said that "there is no direct or linear correlation between prediabetes and food noise. The relationship is more complex, and it can be difficult to determine which comes first".

In a healthy state, insulin acts on appetite centers in the brain and helps suppress hunger. Prediabetes, in most cases, involves insulin resistance. Insulin resistance in the brain may alter this appetite-suppression effect and potentially contribute to persistent food-related thoughts.

At the same time, prediabetes, excess weight and increased cravings can share common underlying factors, including insulin resistance, inadequate sleep, stress, dietary patterns, genetics and the food environment.

"Food noise becomes important when thoughts about food begin to influence everyday eating behavior—for example, when a person repeatedly eats without physical hunger or finds it difficult to stop thinking about food," the expert said.

If persistent food-related thoughts contribute to excess energy intake and weight gain, they may adversely affect metabolic health and perpetuate insulin resistance. Over time, this can increase the risk of complications such as type 2 diabetes.

However, the doctor said that food noise is not a symptom or diagnostic marker of prediabetes. Prediabetes needs to be identified through appropriate blood glucose tests.

Insulin Resistance Alone Does Not Cause Food Noise

Dr. Manjunath Malige, Director, Endocrinologist, Diabetologist, Obesity & Weight Management Specialist, Sakra World Hospital, Bengaluru, told HealthandMe that people with prediabetes usually have some degree of insulin resistance, but insulin resistance alone cannot be said to cause food noise.

Appetite and eating behavior are complex and influenced by biological signals, brain reward pathways, environmental food cues, sleep, stress and learned behaviors.

In India, where diets can sometimes be carbohydrate-heavy and low in protein or fiber, some people may experience greater fluctuations in hunger and cravings. When this constant chatter around food becomes excessive, it can take up significant mental space. If it leads to frequent snacking or overeating, it can make weight and blood glucose management more challenging.

How Can Food Noise Be Managed?

Dr. Jasjeet said the first step is not to fight food or impose extreme restrictions, but to understand what is driving the urge to eat.

The doctor noted that ask yourself: Is it genuine hunger, or are you eating because of stress, boredom, habit or simply because food is available?

Having structured, balanced meals with adequate protein, vegetables, fiber and healthy fats can improve satiety. Excessive restriction or skipping meals can sometimes make cravings worse.

Other important factors include:

• Good-quality sleep
• Regular physical activity
• Stress management

Most importantly, the experts noted that the goal is not to never think about food, as food is an important part of our lives and culture. The concern is when these thoughts become intrusive, distressing or start controlling eating behavior. In such cases, it is important to seek professional guidance.

Liver diseases are becoming increasingly common in India, yet many people are unaware of the difference between fatty liver and hepatitis. While both conditions affect the liver, their causes, treatment, and long-term risks are very different. Understanding these differences is important because untreated hepatitis can, in some cases, lead to liver cancer over time.

Fatty Liver And Hepatitis: What’s The Difference?

Fatty liver disease occurs when excess fat accumulates in the liver. In India, it has emerged as a major health concern due to rising rates of obesity, diabetes, sedentary lifestyles, and unhealthy dietary habits. Studies suggest that nearly one in three Indian adults may have fatty liver disease.

Also read: England Set To Become One Of The First Countries To Eliminate Hepatitis C; Here's How

Why Chronic Hepatitis Can Raise Liver Cancer Risk

One of the biggest concerns with chronic hepatitis, particularly Hepatitis B and Hepatitis C, is its association with liver cancer. The infection can silently persist for years without causing noticeable symptoms. During this period, continuous inflammation may lead to fibrosis (scarring), cirrhosis, and eventually hepatocellular carcinoma, the most common type of liver cancer.

According to the World Health Organization (WHO), chronic hepatitis B significantly increases the risk of liver cancer and remains one of the leading causes of liver cancer-related deaths worldwide.

India’s Silent Hepatitis Burden

India continues to carry a substantial burden of viral hepatitis. WHO estimates indicate that nearly 40 million Indians are living with chronic Hepatitis B infection and between six and twelve million with chronic Hepatitis C infection. Many remain undiagnosed because early disease often causes no symptoms.

Warning signs that should not be ignored include persistent fatigue, loss of appetite, abdominal discomfort, unexplained weight loss, jaundice (yellowing of the eyes and skin), dark urine, or swelling in the abdomen. However, many patients with chronic hepatitis may feel completely healthy until significant liver damage has already occurred.

Can Hepatitis-Related Liver Cancer Be Prevented?

Also read: How Chronic Hepatitis Quietly Progresses To Liver Cirrhosis: Why Early Action Can Save Your Liver

"The good news is that liver cancer arising from hepatitis is often preventable. Hepatitis B vaccination is safe and highly effective. Regular screening, timely antiviral treatment, and periodic liver monitoring can significantly reduce the risk of cirrhosis and liver cancer"- said Dr Ashwin Rajbhoj from M|O|C Cancer Care Pune. Similarly, maintaining a healthy weight, controlling diabetes, exercising regularly, and limiting alcohol intake can help prevent and reverse fatty liver disease in its early stages, he added.

The key message is simple: fatty liver and hepatitis are not the same disease. While fatty liver is primarily linked to lifestyle and metabolic health, chronic viral hepatitis can silently progress to liver cancer if neglected. Early diagnosis and timely treatment remain the best defence against serious liver complications.

By Dr Ashwin Rajbhoj, M|O|C Cancer Care, Pune

Over 57 million people worldwide live with dementia, causing 36.3 million disability-adjusted life years (DALYs) and ranking as the seventh leading cause of death. But when it comes to dementia, memory loss is often the first symptom that comes to mind.

While forgetting birthdays or losing keys are commonly considered early warning signs of dementia, this may not always be the case.

Experts say a person can remember every birthday and anniversary and still have dementia.

What Are The Early Signs Of Dementia?

“Dementia may not begin with memory loss. It can begin with smell, language, personality or navigation,” Dr Priyam Bordoloi, an internal medicine resident from Assam, said in a post on the social media platform X.

1. Loss Of Smell: When Coffee Stops Smelling Like Coffee

Dr Priyam noted that loss of smell can be an early sign, but it is often overlooked because it may be attributed to a viral illness, sinus disease, smoking, medicines or a head injury.

“Persistent, unexplained smell loss may also be an early clue to Parkinson’s disease or dementia with Lewy bodies,” he added.

2. Everyday Words Start Disappearing

It is not simply an occasional tip-of-the-tongue moment. “In primary progressive aphasia, word-finding, grammar or comprehension may worsen while recent memory stays intact,” Dr Priyam noted.

3. The Family Says, “They Are Not The Same”

Changes in personality or behaviour may sometimes appear before memory problems.

“In behavioral-variant frontotemporal dementia, apathy, impulsiveness, loss of empathy or poor judgment may come before memory loss,” Dr Priyam said.

4. A Familiar Route Suddenly Feels New

Families may notice navigation problems even when a person has no obvious memory complaints. “Families ask me, ‘He has driven there for 20 years. How did he get lost?’ When it repeats, I look beyond forgetfulness,” Dr Priyam said.

He noted that visuospatial dysfunction can appear early in dementia with Lewy bodies or posterior cortical atrophy.

One Odd Symptom Does Not Necessarily Mean Dementia

Dr Parveen Yograj, a general surgeon from Jammu, added that one unusual symptom alone means little.

"A new, persistent and progressive pattern that disrupts daily life and is noticed by loved ones is what demands attention," he said on X.

How Can Dementia Risk Be Reduced?

Dr Yograj said several lifestyle measures may help protect brain health and reduce the risk of cognitive decline.

• Exercise Regularly: Regular aerobic exercise along with strength training can boost brain blood flow and build cognitive reserve.
• Follow A Brain-Healthy Diet: A Mediterranean or MIND diet, rich in vegetables, berries, nuts, olive oil and fish, can support vascular health.
• Prioritize Good Sleep: Solid sleep helps clear toxic brain waste and supports overall brain health.
• Keep Blood Pressure, Sugar And Cholesterol In Check: Managing blood pressure, blood sugar, cholesterol and weight can help reduce the risk of vascular dementia.
• Stay Socially And Mentally Active: Stay socially connected and mentally engaged by talking with others, reading, learning new skills and playing games.
• Quit Smoking And Limit Alcohol: Avoiding smoking, limiting alcohol and treating hearing loss early can also support long-term brain health.