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Lara Adejoro
In this interview with LARA ADEJORO, Professor of Public Health at the University of Ilorin and former National Chairman, Association of Public Health Physicians of Nigeria, Tanimola Akande, speaks on how to curb the alarming increase of overweight and obese in Nigeria
What are overweight and obesity?
Overweight and obesity are abnormal or excessive fat accumulation that may impair health. Being overweight or obese is having more flesh on the body than average. Overweight and obesity are based primarily on measures of height and weight. It is determined by calculating Body Mass Index. It is calculated by dividing the body weight in kilograms by the square of the individual’s height in metres. The scores of 25 up to 29.9 are overweight while scores of 30 to 34.9 are regarded as obese, and scores above 35 are extremely obese. So, when the BMI is 25-29.9, it is overweight while it is obese when it is more than 30.
What are the differences between being overweight and obese?
A weight that is higher than what is considered healthy for a given height is described as overweight or obesity. The difference between overweight and obese is in the level of the BMI score. But, that of obesity is higher. That means in layman’s terms, the obese person is fatter than the person who is overweight, though both are not desirable.
How can one determine a healthy weight gain and excessive weight gain that results in overweight and obesity?
Any weight gain resulting in overweight and obesity is not healthy weight gain. The excess calories from food intake are stored as fat, or adipose tissue, resulting in weight gain. Adipose tissue, otherwise known as body fat, is a connective tissue that extends throughout your body. It’s found under your skin between your internal organs and even in the inner cavities of bones.
What are the causes of overweight and obese?
The major causes of overweight and obesity are lifestyles like taking food consumption of far more than what the body is burning; lack of exercise, genetic causes (running in families); side effects of drugs, and the manifestation of some illnesses.
Some of the drugs that cause overweight when used over a long period include steroids, antidepressants, and antihistamines, among others.
The illnesses that can lead to overweight or obesity are arthritis and Cushing’s syndrome. Arthritis prevents mobility and can make individuals overweight. Also, Cushing’s syndrome commonly presents with obesity.
Cushing’s syndrome is a disorder that occurs when your body makes too much of the hormone cortisol over a long period.
There is strong evidence of genetic predisposition to fat accumulation as obesity tends to run in families. Today, being overweight and obese are caused more by major shifts in environmental factors – not having area parks, sidewalks, and affordable gyms make it hard for people to be physically active, and changes in behaviour rather than the genetic factor. Increased dietary consumption of energy-dense foods, high levels of refined sugar and saturated fats (fast food), and sedentary lifestyles are recognised as some of the major causes of the increased prevalence of obesity in Nigeria.
What are the complications of being overweight or obese?
Being overweight or obese puts such individuals at high risk of several non-communicable diseases like hypertension, and atherosclerosis. Atherosclerosis is the build-up of fats, cholesterol, and other substances in and on the artery walls. This build-up is called plaque. The plaque can cause arteries to narrow, blocking blood flow. The plaque can also burst, leading to a blood clot. However, healthy lifestyle habits can help prevent atherosclerosis.
Other non-communicable diseases are coronary heart diseases, diabetes, and arthritis, among other health problems. People who are obese are frequently affected by diabetes; it is reported about 90 percent of type II diabetes cases are caused by excess weight globally.
Do these conditions affect one’s sex life?
It can affect sex life, particularly among those with extreme obesity. Obese women are often affected by infertility, taking longer to conceive than normal-weight women, and obese women who become pregnant are at an increased risk of miscarriage. Also, men who are obese are at increased risk of fertility problems, since excess body fat is associated with decreased testosterone levels (sex hormone in men).
A 2023 World Obesity Atlas report published by the World Obesity Federation revealed that over four billion people risk being overweight or obese by 2035, and nine out of the 10 countries facing rapid increases in obesity are from either Asia or Africa. How does Nigeria contribute to the figure?
The high population of Nigeria (one in five people in Africa are Nigerians) makes Nigeria contribute to the high number of obese people. Studies have shown that the prevalence of obesity among adults in Nigeria ranges from 18.1 – 22.2 per cent. That means about a fifth of Nigerians are obese. The prevalence is much higher in some parts of Nigeria where as much as 64 per cent are overweight. The prevalence in women was higher compared to men. A recent study estimated that there were 21 million and 12 million overweight and obese people in the Nigerian population aged 15 years or more in 2020.
Childhood obesity could double too according to the report. Is this a common trend in Nigeria? Is it more prevalent among boys or girls?
Obesity in children is also on the increase in Nigeria. It is more prevalent among the rich, girls, and among those living in urban settings.
What are the factors responsible for the rise in childhood obesity?
Childhood obesity is more of a lifestyle problem. Calorie consumption is far higher than what the children burn. Parents indulge them with ‘junk food’, and they hardly exercise. Children of the rich are moved around with cars. They hardly walk around or engage in other forms of physical exercise. Overweight children often face stigma and suffer from emotional, psychological, and social problems. Obese children are at high risk of becoming obese adults.
Since the report also said the global economic impact of overweight and obesity will reach $4.32tn annually by 2035 if prevention and treatment measures do not improve. What is the cost implication or Nigeria?
In 2020, a World Bank report projected that in the next 15 years, the cost implications of obesity, including health care and reduced productivity, among others, will amount to over $7tn in Nigeria and other developing countries.
Losing money through the management of obesity and decreased productivity from obese people is a further drain on the resources of the nation. Meanwhile, such resources can be used for some other health conditions. It is unfortunate that while obesity is on the increase, particularly among the rich and those in urban areas, malnutrition or undernutrition is also on the increase among the poor and in rural areas. This also will require significant funds at the household level and at the level of the government.
What are the lifestyle changes one must inculcate to reduce overweight and obesity?
Lifestyle changes to reduce the burden of obesity should include a reduction in heavy calorie intake, intentional physical exercise to burn excess calories, and avoiding sedentary lifestyles as well as regular checking of weight.
Does the country have measures in place to curb it?
Nigeria has guidelines for the control of non-communicable diseases. The control of obesity is one of the measures in the guidelines. However, not enough measures in terms of policies and guidelines specific to overweight and obesity are in place in Nigeria.
What measures can the government put in place to curb this trend in the country?
Some of the measures to be put in place include raising awareness of the dangers of obesity through the mass media and encouraging people to engage in regular physical exercise and avoid sedentary lifestyles. Also, cycling and walking should be encouraged. However, our environment is not quite suitable for cycling and walking. Provisions are not made for this on most Nigerian roads. School health services should have reforms on nutrition education and physical exercise.
Are obesity and overweight problems of the rich people alone?
Obesity and overweight are not just the problems of the rich alone, even those in the middle-income class are also having obese children. Although it is seen mostly among the children of the rich, but it is also seen among the middle class who are obese.
In adults too, we have a lot of middle-class people who are obese and overweight, some of them it is genetic, some of them is about eating wrongly, poor lifestyle or sedentary lifestyle, they don’t get involved in exercises. In adults, obesity cuts across socio-economic status but is more prevalent among the rich. This is also the same for obesity in children. The proportion of children of the poor with obesity is quite low when compared with the high proportion among children of the rich.
This is particularly the situation in Nigeria and other low and middle-income countries.
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