Saturday, 14 January 2012

An Epidemic of Large Proportions

Worldwide, obesity has more than doubled since 1980.  Most of us tend to think of developed nations as carrying most of the burden for the obesity epidemic. However, developing countries are not free from this problem. In fact, developing countries have seen colossal growth in obesity and overweight rates among their citizens. 

Not everybody knows how to determine whether a person is overweight or obese. The answer is found in a simple mathematical equation. Overweight and obesity are measured by calculating a person’s body-mass index (BMI). This index is obtained by dividing a person’s weight in kilograms and dividing it by the square of his height in meters. A BMI greater or equal than 25 means a person is overweight. A person is obese when her BMI is greater or equal to 30.

There are several reasons as to why people seem to be getting bigger worldwide. Sometimes obesity occurs as a result of cultural norms that value plump people on the premise that a full body can only result from a full bank account.  For example, in Mauritania, obesity is still revered among some of the country’s ethnic groups. As a result, girls are sometimes force-fed to obtain a weight that has been deemed as unhealthy by the world’s health experts. Even though there has been a shift regarding the standards of beauty in Mauritania, nowadays eleven percent of girls are still being force-fed in one of the country’s “fat-farms,” a place where girls are taken to gain the desired weight.

It is no surprise that, in Mauritania, 63 percent of women in urban areas and 47 percent of women in rural areas are overweight or obese.

Could this cultural practice be viewed as a form of violence against women? Given the evidence pointing to the association between health problems and being overweight or obese, I think it is.

In South Africa, women are willingly making their bodies larger than life. Surprisingly, obesity rates in South Africa are the same as those of the fattest country in the world: the United States. In South Africa, an estimated 75% of women are overweight and almost half are obese. As a result of this, as many people die of malnutrition in South Africa as of diseases associated with obesity. South Africans still admire bulk in men and contours in women. A good example of this is President Zuma’s four wives, all of whom are corpulent.

However, not all women in developing countries are becoming overweight or obese against their will or due to societal pressures.  In reality, as a result of economic development in urban areas around the world, women are getting bigger and bigger, not because they are forced to eat, but because they now have access to energy-dense foods that are high in fat, salt and sugars. These same foods are low in vitamins, minerals, and other micronutrients.  

Food is not the only culprit. Development also brings a decrease in physical activity due to the increasingly sedentary nature of many forms of work, changing modes of transportation, and increasing urbanization. This simply means that people are sitting more, walking less and not moving enough. In fact, this change in lifestyle has triggered obesity epidemics around the world. A good example of this phenomenon is Chile.

Chile started its race towards development earlier than any other country in South America. Chile also now boasts the highest overweight and obesity rates in the continent. Many countries, like South Africa, are following this same path.

As urban areas grow across the African continent, overweight and obesity become more prevalent problems with long-term effects in the population. In fact, obesity is creating a double burden of disease in Africa. People in the continent are still dealing with problems of infectious diseases and under-nutrition.  Due to obesity, they now also have to face a rapid surge in non-communicable disease risk factors resulting from the growing waistlines. Thus, in the same countries where people go to bed hungry every day, others have to be treated for illnesses caused by being overweight and obese.

Women are more overweight and obese than ever in Africa’s urban areas. In urban areas in Burkina Faso, 29 percent of women are overweight while almost 10 percent are obese. In Ghana, 40.3 percent of urban women are overweight, and at least 14 percent are obese. Approximately 40 percent of urban Kenyan women are overweight and 13 percent are obese. A shocking 73 percent of urban women in Egypt are overweight, and about 40 percent are obese. In Nigeria, 31 percent of urban women are overweight and 11 percent are obese.

Why is it that more people are not talking about this? We tend to only hear about African people being underweight. Do not get me wrong; the amount of women who are underweight and living in these same countries is astounding, and we should be worried about it. In Nigeria’s rural areas, the percentage of women who are underweight is the same as that of those who are obese. And, in countries like the Democratic Republic of Congo, the number of women who are underweight is seven times higher than the number of those who are obese (35 percent versus 5 percent).

Nonetheless, the fact is that being overweight and obese does not result only in larger waistlines, but it leads to life-threatening illnesses. This is particularly true for women, who suffer a disproportionate burden of disease attributable to overweight and obesity.

As if women did not have enough dealing with disproportionate burdens in other areas, they are also more negatively affected by the extra kilograms they carry. Obese women are at higher risk for diabetes and, consequently, a dramatically increased risk of cardiovascular disease. Obesity also increases the risk of several major cancers in women, including breast cancer, endometrial cancer, and cervical cancer.

Obesity in women compromises women’s reproductive health and their future children as well.

Obese causes women to have adverse effects over their pregnancy.  Obesity negatively affects both contraception and fertility. Maternal obesity is linked with higher rates of cesarean sections as well as higher rates of high obstetrical conditions such as diabetes and hypertension. In addition, pregnancy outcomes are also compromised by obesity by increasing the risk of neonatal mortality and malformation. Maternal obesity is also associated with a decreased duration of breastfeeding.

I am not saying that we should only focus on fighting overweight and obesity in Africa, but I am saying that we should definitely start talking about it in order to address this epidemic. After all, the disease burden resulting from too much or the wrong kind of food is starting to match the burden of diseases resulting from no food at all, especially among women.

§  World Health Organization: Global Database on Body Mass Index
§  World Health Organization: Obesity and Overweight Fact Sheet
§  Journal of the American Board of Family Medicine, Obesity and Women’s Health: An Evidence Based Review
§  The Economist: An expanding World

By Paola Brigneti

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