Tackling obesity in Nigeria’s children, adolescents

O BESITY is an emerging public health issue with serious policy relevance globally.The World Health Organization (WHO) defines obesity as a condition of abnormal or excessive fat accumulation in adipose tissues resulting in impairment of health.So why is pediatric and adolescent obesity a significant public health problem? Recent epidemiological data suggests that obesity is not only prevalent in adults, but is also increasing in young children and adolescents. Even though there is no specific national statistic to describe its prevalence, numerous nutritional assessments of Nigerian children and adolescents have found prevalence between 1 – 2 children in 100 with occurrences higher in urban areas. According to other published reports, the number of overweight and obese African adolescents has doubled over the past decade to about 9 per cent and is projected to reach 13 per cent of the under-20 population by the year 2020.

Another significant development is that obesity is no longer a problem peculiar to developed countries; it is now becoming prevalent in developing countries. This prevalence rates are dangerously on the rise in developing countries like Nigeria. While countries like Nigeria are still battling with reducing poverty and nutrient deficiencies, obesity is raising its ugly head. This two-fold occurrence technically referred to as the double burden of malnutrition, which was once termed the disease of the affluent, is now a burden of numerous poor and rich households in Nigeria. This implies that the affected young people, instead of being characterized with increased physical activity, may become constrained by their body sizes. Obesity has short and long-term consequences. Notable among the long-term consequences are their reduced quality-of-life and economic implications.

Another long-term consequence of obesity is that it can significantly affect reproductive efficiency, especially in adult women. In the short-term, prolonged periods of ill health in obese wards can cause persistent school absenteeism and poor academic performance. Obese wards can also experience reduced physical and mental performance in day-to-day activities, compared to their non-obese counterparts. For older adolescents, being overweight can lead to social stigmatization which usually diminishes self-esteem and self-appreciation. Also noteworthy are the indirect costs that are incurred either in maintaining appetite or managing ill health resulting from being overweight. On the whole, an obese child will likely become an obese adolescent and thus subsequently an obese adult. These occurrences have prompted the WHO to identify obesity as one of the most serious public health challenges of the 21st century.

On the surface, increased caloric intake, lesser physical activity and maternal origins are the major causes of excess accumulation of fat. But a more critical look at these surface causes reveals more underlying factors which prove child and adolescent obesity to be a complex health challenge. A major underlying cause is increasing urbanisation and globalisation. With an ever increasing rural urban migration and subsequent urban expansion comes changes in dietary habits and physical activity level which can lead to obesity. While those in rural areas children and adolescents are exposed to traditional home-grown foods which are usually low in fat and calories, urban adolescents are exposed to a variety of ready-to-eat energy dense “junk” foods and drinks which inevitably contribute more energy intake than the body can utilize.

Another implication of increasing urbanisation is that more buildings and other structures now compete for spaces, sometimes limiting the play space for young folks.These shrinking play spaces in comparison with the “village” style of playing around wide fields and playgrounds can result in reduced physical activity for primary and secondary schoolers. Related to the reduced physical activity is also the replacement of field play with in-house entertainment such as video games which can promote a sedentary lifestyle among adolescents who may spend several hours starring  at T.V screens.

Yet another point of note is the maternal origins of obesity. Epidemiological research conducted over decades have established that if a woman is nutritionally  deprived during pregnancy, the foetus can develop a “thrifty” gene which re-programmes it to save as much needed nutrients as possible during this deprivation.The expression of this “thrifty” gene becomes evident when the growing child/adult is exposed to abundant food. The body, anticipating a future scarcity, proceeds to store up more than necessary, which then results in overweight/obese individuals. Also, obese pregnant women who are usually susceptible to having macrosomic (large) babies with higher than normal body fat can predispose infants to becoming overweight as they grow into adolescence. Lastly, inappropriate feeding in infancy can result in unfavorable outcomes in children and adolescents.

Is there any remedy? Yes, numerous interventions are feasible. First, proper behaviour change counselling and support for infant nutrition should be integrated into all points of contact between mothers and health service providers during pregnancy and the first two years of life. Secondly, scaling up several mother-child initiates at the national and grass-roots levels can have a positive influence on maternal health and young child feeding. Examples of existing policy initiatives are the “Baby Friendly Hospital Initiative” (BFHI) which can be revitalised into all health facilities that have maternity services to improve breastfeeding promotion and support. Also, the “Baby Friendly Community Initiative” (BFCI) could also be scaled up to ensure that communities are supporting optimal breastfeeding and are not engaging in discouraging practices. Further policies such as increased maternity (and paternity) leave can further encourage mothers and their families to provide adequate and appropriate nutrition. Another policy approach will be strengthening the existing nutrition education at the level of curriculum development.

There are several initiatives in this regard by health and wellness companies which seek to encourage consumption of healthy foods and adoption of an active, healthy lifestyle. The shortcoming is that most of these initiatives are usually limited because they usually do not provide information beyond the product(s) being advertised. If government provides a platform for learning at primary and secondary school levels, it may provide an opportunity for your children and adolescents to make better and healthier lifestyle choices as they grow up. Overall, taking an active multi-preventive approach to the complex health challenge may be the solution to future burdens of obesity.

• Eyinla is a postgraduate student of the University of Ibadan