by Dr. Toyin O. Jenyo
As of 2010, WHO estimated that over 180 million people worldwide have diabetes and predicted that the number will double by 2030 considering the trend of the prevalence of diabetes and factors like unhealthy diet, physical inactivity, harmful use of alcohol and tobacco, and obesity (WHO, 2010). In Africa, the prevalence of diabetes ranges from 1% to 20%. Eighty-five percent of the diabetes cases in Africa are type II diabetes and the prevalence of type II diabetes is 19.3% in Mauritius (WHO,2009). This level of type II diabetes in Africa shows the importance of obesity in this region due to the strong association between type diabetes and obesity. Lifestyle factors that are related to obesity, eating behavior and physical activity are known to play a major role in the prevention and treatment of type 2 diabetes. (Wing et al, 2001).
To deal with type II diabetes at the population level, we can consider obesity a good accessible target for intervention programmes aiming to prevent type II diabetes. It is found that for every kilogramme of weight loss, there was a 16% reduction in the risk of having type II diabetes after adjusting for changes in diet and activity. (Hamman et al, 2006).
Epidemiological studies proved that obesity and a sedentary lifestyle are independent risk factors for diabetes (Bressler et al., 2010). The lowest risk of diabetes occurs in individuals who have a BMI <21, with increasing prevalence seen as obesity levels increase (Colditz et al.,1990). Reducing the prevalence of obesity in our society will not only prevent the occurrence of diabetes but also decreases insulin resistance, reduces physiological defect related to the development of diabetes, and improve glycemic control in diabetic patients reducing the progression of type II diabetes (Maggio & Pi-Sunyer, 1997).
Other factors that are associated with the incidence of type II diabetes are family history of diabetes (genetic predisposition) age greater than 40 years, diabetes during a previous pregnancy, high blood pressure (greater than or equal to 140/90 mmHg), Impaired glucose tolerance, Low activity level (exercising less than 3 times a week), etc, among all these factors, the largest environmental influence on the prevalence of diabetes in a population is the degree of obesity in that population (Maggio & Pi-Sunyer, 1997; Wing et al., 2001; WHO,2009).
Having established the influence of obesity on the prevalence of diabetes, the concern is how to cob the escalating rate of obesity in our world, particularly in Africa. Currently, most of the strategies in place for handling the menace of obesity are conducted at the level of individual patients. The intervention is typically as follows:
a) Moderate caloric restriction
b) Macronutrient alterations
c) Very Low-Calorie Diets
2) Behavioral therapy
4) Pharmacological therapy
5) Bariatric surgery (Maggio & Pi-Sunyer, 1997)
People are also encouraged to join weight loss programmes. Considering the epidemic level of obesity today, an individualized approach may not be cost-effective and thereby sustainable. Also, this approach is effective in reducing people’s weight for a short period. Most people get tired along the way and give up the diet or reduce the time used in exercising. A more global public health approach may be needed to achieve a desirable and sustainable outcome on obesity and type II diabetes eventually. (Maggio & Pi-Sunyer, 1997; Wing et al, 2001).
In other to achieve this, there will be a need to examine the nutrition paradigm backing the present approach and the possibility of a shift in the nutrition paradigm to accommodate a new approach to solving the problem of obesity and type II diabetes in Africa and globally.
To be continued, watch this space…
Toyin Olawale Jenyo, MBBS(Ilorin) MPH(Liverpool) is a member of Fiji College of General Practice (FCGP). He is a Public Health Physician with vast experience in General Practice in four countries. He has more than 10 years’ experience in treatment and effective application of public health interventions in CDs and NCDs at PHC level. He has also been involved in training and mentorship of medical officers and medical students over the years of practice. He works at Olivet Medical Centre, Nakasi Suva, Fiji Islands