[afro-nets] Obesity in developing countries

[Claudio Schuftan <claudio@hcmc.netnam.vn>]

Obesity in developing countries
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Ambar Kulshreshtha, MD

A new pandemic of obesity and the accompanying non-communicable
diseases has created a double disease burden on the health ser-
vices of many resource-poor countries, where the challenge of
infectious diseases like HIV and TB has far from disappeared.
Groups most at risk are urban middle-aged adults and, in par-
ticular, women and younger age groups. But even semi-urban and
rural areas are not completely averse from it. The gradual be-
ginnings of this epidemic in low-income countries might obscure
the fact that its rate of growth may be as fast as in the devel-
oped world.

Gambia--a small West African country in the early phases of a
demographic and nutritional transition--is a case in point. A
1996-7 survey reported an overall 4% prevalence rate for obesity
but concealed major variations like the nearly 25% obesity rate
among urban women. There was a 17-fold difference in obesity be-
tween men and women: in the same age group of 35 years, 32.6%
women were obese as compared with <2% men. A strong gender di-
vide has been similarly noted in data sets from several African
countries.

What could be the reasons for this emerging trend?

Environmental factors: Most developing nations are experiencing
a shift from agricultural and energy-intensive occupation to-
wards service sector occupations with lower levels of physical
activity. Also, with an increased use of motorized transport,
sedentary employments, labor saving mechanized devices at home
and in the workplace, and sedentary past times such as TV and
video games have led to an unhealthy macro-environment. Tradi-
tional lifestyles are being infiltrated with globalization af-
fecting initially the wealthier urban members and then penetrat-
ing to become a disease of the poor.

Nutritional transition: A nutritional transition with changes in
global food supply and relative costs of foodstuffs is leading
to a change in the dietary patterns of populations across the
globe. The low cost of highly refined oils, fats, carbohydrates,
and increased market food consumption based on promotional ad-
vertising by multinational corporations has contributed to this
trend. A rapid growth of increased intake of energy density di-
ets, animal source foods and edible oil has changed the struc-
ture and composition of diets across nations.

Socio-behavioral factors: In most developing countries, large
body size has traditionally been prized as a symbol of power,
beauty and affluence. Studies have confirmed a high level of
body satisfaction and obesity acceptance, especially among mid-
dle-aged women, which encourages the desire to gain and maintain
weight. A substantial proportion of Gambian women misuse ster-
oids to gain weight. The association of thinness with HIV/AIDS
also leads to positive attitudes to overweight among Africans.
An interesting finding in urban centers of Gambia was that se-
verely malnourished children frequently coexisted with over-
weight-to-obese mothers.

Genetic factors: It was recently proposed that an undernourished
fetus because of poor feeding in pregnant women could face an
increased risk of chronic diseases and obesity later in life.
(Hales and Barker) More study is needed to corroborate these
findings for future policy implications.

The economic consequences of inaction towards non-communicable
diseases can be disastrous for countries already battling infec-
tious diseases and childhood malnutrition. For instance, China
will lose $556 billion to heart disease, stroke and diabetes
alone in the period 2005-15.

Obesity is a major avoidable risk factor for a wide range of
non-communicable diseases and educational campaigns and effec-
tive public health interventions can offer hope to arrest this
trend.

"The emerging epidemic of obesity in developing countries." An-
drew M Prentice International Journal of Epidemiology
2006:35:93-99.] Link to table of contents for this issue:
http://ije.oxfordjournals.org/content/vol35/issue1/index.dtl