By Dr. Toyin Jenyo
WHO defines obesity as a Body Mass Index (BMI) greater than or equal to 30 and BMI is defined as an individual’s weight in kilograms divided by the square of his height in meters (kg/m2) (WHO, 2012). In the public health domain, obesity and overweight almost always go together because the public health implication of obesity has to do with the relationship of this state of abnormal or excessive fat accumulation in the body with the risk of co-morbidities like cardiovascular disease (mainly heart disease and stroke), type 2 diabetes, musculoskeletal disorders like osteoarthritis, and some cancers (endometrial, breast and colon). Although the degree of weight gain was categorized into classes (Underweight, Normal range, Overweight, Obese class 1, Obese class 2 and Obese class 3) based on the BMI values, the risk of co-morbidities was linearly related to BMI from a BMI nadir of 19 or 20 kg/m2 (Willett et al., 1999 cited in James et al., 2001) because the health hazards of different degrees of weight are not substantially changed at any particular cutoff point for each class of weight gain (James et al, 2001; WHO, 2006). With this, it is well known that the risk of health problems starts with only a slight overweight with the increase in weight.
Therefore, in discussing obesity as a public health problem, overweight cannot be left out. Overweight is defined as a BMI greater or equal to 25(WHO, 2012). As of 2008, over 1.4 billion adults (20 years and above) are overweight, out of which more than 200 million men and 300 million women are obese leaving one-tenth of the world’s population obese. Considering the fact that overweight and obesity are the fifth leading risk for global death with about 2.8 million yearly death among adults and 44% of the diabetes burden because of being overweight and obese, these conditions should be considered public health issue that needs urgent attention (WHO, 2012). More so that the problem of Obesity has extended beyond the developed countries (‘rich’ countries), with fast-growing prevalence in developing countries (poor’ countries) where close to 35 million out of 40 million overweight children (under five) reside in 2010 (WHO, 2012). The prevalence of obesity/overweight in urban areas in seven African countries such as Burkina Faso, Ghana, Kenya, Malawi, Niger, Tanzania, and Senegal, and it has increased by about 35% between 1992 and 2005, with a higher prevalence among the poorest compared with the richest (Ziraba, Fotso & Ochako, 2009). Similar association between obesity and poverty was observed in the United States of America ( Drewnowski & Specter, 2004).
Basically, overweight and obesity are due to an energy imbalance between calories consumed and calories expended. This can be because of excessive consumption of calories by consuming energy-dense food or inadequate expending of calories because of a sedentary lifestyle (WHO, 2012). Based on this understanding, the approach to solving the problem of obesity (the accessible target for intervention programs designed to reduce the incidence of diabetes in public health perspectives (Bressler et al, 2010) is based on a behavioural change in physical activities and consumption of energy-dense food (Birm, Pillay & Holtz, 2009). But the increase in obesity prevalence in poor countries, obesity associated with poverty, and continuous increase in the prevalence of obesity/overweight/type II diabetes in our societies call for the implementation of a complementary/alternative approach/political economy (Birm, Pillay & Holtz, 2009)) in solving the obesity problem.
Behavioural approach is related to the investment in the nutrition paradigm, while it is related to the political economy approach to the human rights approach to the nutrition paradigm (Johnson, 2009). The history and practice of different nutrition paradigms, their policy implications, and their influence on the causal explanations and treatment of Obesity/ Overweight and type II diabetes will be examined in subsequent editions.
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