Over the past 20 years, as many developing countries have been trying to tackle the problem of undernutrition, especially amongst its children, a new health threat has quietly been emerging – namely, overnutrition.
Across the world, this more modern form of malnutrition has been increasing ominously, and Africa has been particularly badly hit. The statistics from the continent are startling.
According to a 2009 report, the prevalence of urban overweight and obesity in sub-Saharan Africa increased by almost 35% between 1992 and 2005. In Madagascar, the rate of overweight children nearly quadrupled from 1.6% to 6.2% between 1992 and 2004. The International Association for the Study of Obesity claims that 39% of women in South Africa and Egypt could be suffering from obesity. And the World Health Organisation (WHO) predicts that by 2030, nearly one-fifth of African adults will be obese.
As Hester Vorster from the Centre for Excellence in Nutrition at North-West University, South Africa, puts it, “The problem in Africa is [that] both under- and over-nutrition are the worst in the world. We really are facing a double burden.”
The dynamics behind Africa’s problem are similar to those driving overweight and obesity in other parts of the world.
Firstly, urban populations have been growing and many people are leading more sedentary lifestyles.
“New technologies for work, transportation, and the home – a rice cooker, a fridge, a propane gas stove, taps instead of dragging water for miles or wood for fire – all of these save time and energy and they are related to the increase in overweight,” says Barry Popkin, professor of nutrition at the University of North Carolina and author of The World is Fat. “It’s because of huge reductions in activity.”
Indeed, according to Popkin, “modern technology is a mismatch” in terms of how human beings have evolved over several thousands of years. “We were designed to run and work hard, eat basic foods, and drink water,” he explains.
Secondly, this shift in ways of life has been compounded by changes in diet. “Instead of water, people are encouraged to drink soft drinks, energy drinks, fruit juice, all of which are sugar water in biological effect,” says Popkin. “Junk food is prevalent, and it’s sugary, fatty, salty, tasty.”
This shift in diet has also been driven by a highly lucrative global industry, increasingly pushing people towards cheaper, but less healthy, foods. “Trillions of dollars globally go into product placement in movies, newspapers, computer games, advertising in every medium, at every international sporting event, pushing food,” continues Popkin. “Food systems are becoming omnipresent in every country – it’s beginning to occur across the globe.”
Less exercise, more sedentary lifestyles, and the wide availability of highly calorific foods – at a low cost – thus underpins Africa's widening belts. However, again drawing parallels with dynamics in the rest of the world, the impact of these problems is far from uniform, but rather very unevenly distributed along socio-economic lines.
According to the Biomed Central study, the rate of urban overweight/obesity in sub-Saharan Africa increased by 50% amongst the poorest strata of society between 1992 and 2005, while it rose by just 7% amongst richer groups. In the same period, the rate of overweight/obesity amongst women with no education or only primary education rose by 45-50%; while amongst those with secondary or higher education, the rate actually dropped by 10%.
Lack of education regarding good nutrition can contribute to people adopting poor diets, while poverty can restrict the food options available to many, driving them to opt for cheaper but less nutritional foods. As Yoni Freedhoff notes, “Crop subsidies that allow highly processed, hyperpalatable, hypercalorific foods to be sold for pennies” is an important factor in overweight, while food subsidies that allow for imported and nutritionally-lacking food to be sold cheaply mean that poverty and overnutrition often go hand-in-hand. As with under-nutrition, poverty is thus also a factor in over-nutrition.
The rising issues of overweight and obesity present Africa with a serious public health problem. But as of yet, the issue has not received sufficient attention either domestically or internationally.
“Everyone knows that HIV/AIDS is the biggest cause of death in South Africa – but the second biggest is cardiovascular disease,” points out Ama deGraft Aikins, Senior Lecturer at the Regional Institute for Population Studies, University of Ghana. “The challenge is to make NCDs [non-communicable diseases] visible in a way that captures the attention not just of local policy makers but also their development partners."
Indeed, the experiences of other countries around the world suggest that if African countries want to tackle obesity, concerted and targeted action is necessary. According to Popkin, almost all countries have seen a shift from underweight to substantial obesity in the face of decreased physical activity and increased availability of calorific foods, but the exceptions – namely Scandinavia, South Korea and Japan – managed to avoid this fate through highly proactive governmental efforts.
Denmark, Sweden, and Norway, for example, “had some very aggressive programmes to ban media and all promotions of junk food towards children,” says Popkin, while “they also have a system that tells you which foods are healthy.”
But so far in Africa, little is being done. If this continues and obesity rates keep climbing – along with the accompanying problems of diabetes, heart disease, osteoarthritis and other issues – a widening Africa will soon face another deepening public health crisis.
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