• Study says half of world’s population to be overweight by 2035
AMIDST a startling and scary statistics, Nigerians in the throes of obesity lament unending battle with disease. Joke Kujenya, who casts a searchlight on the dangerous trend and the need for accessible healthy diets, also draws attention to the dearth of specialist obesity doctors in the country.
Battles against Obesity
Gazing into space and staring at nothing in particular, Opeoluwa Elijah, 35, seemed lost in a world of her own. She lives in a small town named Mosan, within Ipaja in Alimosho Local Government Area. Her worry stems from a notable alteration occurring within her body, as well as her intending fortitude to surmount it.
Opeoluwa Elijah, a hitherto cheery and spirited lady, tells the story of her current quest to regain her declining health and life from the grasps of obesity, which she called “a story of persistence in confidence.”
She said: “In the last four years, I have been battling with the bodily and emotive burden of excess quid of flesh because I have been trapped in a cycle of fatty diets. Prior to now, my tongue craved everything sweet. I was a regular visitor to the eateries for snacks and other confectionery. I felt I was having the best of life until my system began to crumble.
“Then I began to fall sick and then got better. I became a regular visitor to the hospital. My turning point came during one of my routine check-ups in the year 2019, when a doctor voiced her concerns about my rising health hazards. She told me I had dramatically gained weight and that it was not looking healthy. I became instantly apprehensive. At first, I felt dejected. But with the help of my doctor, I began to gain some confidence that gave me the determination to make the necessary changes.”
Opeoluwa narrated how she began with small steps of swapping sugary finger foods for healthy meals. On her doctor’s advice, she also started taking regular early morning walks, combined with visits to a nearby gym shop.
“At the gym shop, I connected with other people who shared similar struggles and we were able to form a bond and share our victories and setbacks.
“Well, my weight on the scale has lessened and is encouraging, but I can’t say my life is fully flourishing like before. I’m also trying to rekindle the zest I used to have for cooking to try my hands at a new set of healthful recipes recommended to me to curb my taste buds and nurture my obligation to my overall well-being.
“Also, unlike before when I used to avoid people, I am now trying to rekindle lost interactions with friends and family. You can’t imagine the rejections I experienced from people I least expected such from. So, I can’t just jump at anyone in the name of relationships now.”
Opeoluwa’s narration was brewed with watery eyes, as she sobbed and sneezed through it all.
In conclusion, Opeoluwa hinted: “While I continue my journey to full recovery, my heart is filled with gratitude that I got help on time. I also wish to let everyone else on this journey know that they too, can triumph over obesity. There’s a strength that resides within us all to conquer anything.”
A global crisis foretold
In a dire revelation, the 2023 World Obesity Atlas (WOA) report sounded an alarm, predicting an impending crisis as over 50% of the global populace hurtles towards obesity or overweight status by the year 2035.
This unsettling projection echoed the resonating findings of a freshly minted report from the esteemed World Obesity Federation (WOF). A somber forecast was cast, foretelling that a staggering 51% of the world’s inhabitants will grapple with the burden of excess weight within the coming dozen years.
The WOF paints a stark picture, underscoring that the antidote to this impending health storm lies in ushering in treatment regimens and unwavering support to engineer the much-needed metamorphosis in human lifestyles.
Both entities’ revelations serve as a grim reminder that if present obesity trends persist, the specter of childhood obesity could shatter all records, surging past the benchmark set in 2020.
The forecast, reminiscent of a gathering tempest, portends an ominous twofold increase of 100 percent in obesity rates among boys to a staggering 208 million in numbers. A parallel surge of 125 percent is predicted among girls, with an alarming toll of 175 million poised to be ensnared by the clutches of obesity.
In a sobering observation, both institutions concur that the onslaught of this health crisis is storming the gates at an even swifter pace among the younger generation than their adult counterparts. As the world braces for this impending challenge, urgent and coordinated efforts remain the beacon of hope in a landscape fraught with uncertainty.
Defining Obesity:
Obesity, as outlined, refers to the abnormal or excessive accumulation of fat that poses health risks, as measured by body mass index (BMI). The World Health Organisation (WHO) designates individuals with a BMI over 25 as overweight and those surpassing 30 as obese.
Put simply, Obesity refers to a buildup of excess fat that can mess with our health, creating unwanted effects on the human system. It then begins to mess with many parts of our body like the heart, liver, kidneys, joints, and conception. It also leads to lots of health troubles such as Type 2 diabetes, heart issues, high blood pressure, strokes, various cancers, and even our mental well-being. People dealing with obesity are three times more likely to get other big health problems, the WHO has noted.
To curb this, it is suggested that people take smart steps even before a baby is born, with advice to moms-to-be to eat well during pregnancy to set things right from the start.
Mothers have also been counseled to give their babies only breast milk for the first six months, and then carry on with breastfeeding until the child is two or more. Experts posit that making good choices early on can help keep obesity at bay and help live healthier lives.
With the current projections, a striking and rolling exposé arises, which hints at a shift from one in every seven individuals to one in every four to bear the weight of obesity in the twelve years, underlining the urgency of the situation.
Voice of concern
Louise Baur, President, WOF, raised a poignant concern, when she highlighted the distressing swiftness with which obesity rates surge among children and adolescents. She urged governments and policymakers worldwide to rise to the occasion, so they can collectively shield the next generation from the burgeoning health, social, and economic burdens.
She then issued a resounding call for earnest examination of the intricate systems and underlying factors perpetuating obesity, with the imperative inclusion of young minds in crafting solutions.
A global imbalance
Expanding on the complexity, Baur further elaborated that while often perceived as a challenge peculiar to affluent nations, obesity’s grip is tightening in regions with modest means. A stark irony emerges, as these countries grapple with accelerated increases while being least equipped to counteract obesity’s repercussions.
She then cautioned that it’s high time the world recognised and treated obesity as a disease. She said it has also become imperative to consider drugs and surgery early for obesity in kids. As WHO new guidelines suggest: “Waiting doesn’t work!”
Baur further reiterated the report’s caution: “Of the 10 countries with the greatest expected increases in obesity globally for both adults and children, nine are from low or lower-middle income countries.
Grimmer picture
During the 2022 World Obesity Day, it was revealed that more than one billion persons worldwide are obese. Out of these, 650 million are adults, 340 million adolescents and 39 million children.
Yet, the number keeps snowballing.
The WHO previously estimated that by 2025, roughly 167 million people comprising both adults and children will become less healthy due to being overweight or obese. The agency then urged countries to do more to inverse this probable and avoidable health calamity.
WHO also recommended that countries work together to create a better food environment for their citizens to access affordable healthy diets. It suggested effective steps to restrict marketing of food and drinks high in fats, sugar and salt; including taxing sugary drinks to children.
The global health body also added that cities and towns should create space for safe walking, cycling, and recreation, just as schools and families should teach these healthy habits to children early in life.
Bringing obesity concerns home
A closer look at our own doorstep reveals a tapestry woven with concerns. The backdrop is painted with the hues of processed foods reigning as the norm, particularly in our homeland, Nigeria, and other places where incomes are modest.
As the reports unfold, a snapshot from September 2022 emerges, underscoring the numbers that stand before us. Among our ranks, the percentages of those battling excess weight and obesity stand at 20.3 percent and 12.5 percent, respectively. An intriguing gender twist takes the stage, with these burdens more pronounced among our female population.
Further exploration indicates that men aged 60 to 69 bear the heaviest load, with overweight and obesity unfurling at 30.4 percent and 17.4 percent, respectively. Yet, a glimmer of hope flickers among the younger adventurers of 20 to 29, where the figures take a dip to 7.9 percent for excess weight and a mere 2.6 percent for obesity.
In Nigeria, reports say about 2.8 million adults die yearly as a result of being overweight or obese. This is in addition to 44percent of the diabetes burden, 23percent of the ischaemic heart disease burden and between 7percent and 41percent that are all attributed to certain cancer burdens.
Other studies show that in Nigeria, obesity, reported among adults alone, showed a higher prevalence among females and urban dwellers, ranging from 18.1percent to 22.2percent and 64percent respectively.
Another Obese Person Speaks
Cubby and heavyweight at 37, Iyke Ebubechukwu narrated his ordeal to the reporter. Breathing heavily as he tried to tell his story, he said: “Ma’am, it’s not been easy I must confess. What started like something that gave me pleasure is now making each day nightmarish for me.
“Suddenly I was getting tired and I couldn’t explain why. Naturally, I thought it was typhoid and malaria; so, I went to a pharmacist and purchased typhoid and malaria drugs. But after a few days, I saw no improvement, rather the fatigue continued. That was when my mother suggested I visit the hospital.
“I was even fast asleep while awaiting my time with the doctor. Eventually, I went in, saw the doctor and answered all his questions. A paper was handed to me to be given to the Pharmacy department; there I was told I needed to take a lab test.
“I did and was told to return three days later for the result. Meanwhile, I was also given some medications which gave me some temporary relief. On the third day, I went back and was told I weighed about 135kg plus. What? I shouted!
“From that point, the doctor commenced treatment; the condition even took me to other doctors to ward off the possibility of developing other complications, such as Type 2 diabetes and high blood pressure. I was also placed on dieting procedures, early morning walk for exercises, regular food fasting, and prescribed fruits to help avoid fatigue.
Till today, I still visit hospitals regularly and I think that will be a continuous measure for anyone battling with the challenge of obesity. I can tell you it’s worse than any other I can think of. And, it is really very expensive to manage in terms of costs.”
According to the 37-year-old, the condition even deprived him the chance to enjoy a good social life, as he could no longer freely mix with his peers. He hinted that even ladies subtly avoid his love overtures.
How trends in Nigeria narrows gender gaps
Historically, women are reported to generally have higher obesity rates than men attributable to societal norms, cultural expectations, and differences in physical activity levels.
But recent records say that the gender gap in obesity in women is closing up while its rates in men have considerably risen.
Fair-complexioned and good-looking Temilola Tolulope, 39, corroborates this when she said she was once obese and complied with all that was recommended for her. Today, she said she’s almost fully recovered. Asked how she did it; she said: “I don’t want to go back that way. That episode of my life is better left behind me. All I know is, now, I’m out of it. I’m out of being used as a medical experiment ‘guinea pig’ in hospitals. I’m out of different suggestions by different people that almost led me into frustrations and mental health issues. I just want to forget it all.”
Speaking as a non-medical expert, Ms. Olaide Bosun said, “I have never been obese but I know that its seriousness cannot be overstated. I used to have a friend that was once obese. She felt so embarrassed she couldn’t go out by herself unless one of us, her family member or friends she could trust, accompanied her. She felt all eyes were on her, mocking her. It was that serious. And from her diverse lamentations of woes, you would know that it is a complex and chronic medical condition.”
In a study on obesity, results say ‘excessive accumulation of body fats can have a profound impact on various aspects of health, some of which its danger signals include, but not limited to:
· Cardiovascular Disease: such as heart disease, stroke, and high blood pressure, buildup of plaque in the arteries, reducing blood flow that could lead to heart attacks and strokes.
· Type 2 Diabetes: when it interferes with the body’s ability to regulate blood sugar levels, it is closely linked to insulin resistance causing Type 2 diabetes.
· Respiratory Issues: It can impair respiratory function, leading to reduced lung capacity and make it harder for individuals to breath and sleep apnea.
· Cancer: it produces hormones that lead to an increase in developing several types of cancer, breast, colon, kidney and pancreatic cancer, as it promotes growth of cancer cells.
Still, there are several other health challenges associated with obesity such as: joint problems, osteoarthritis, chronic pain, reduced mobility, liver disease, non-alcoholic fatty liver disease (NAFLD), non-alcoholic steatohepatitis (NASH) and cirrhosis, Mental Health, Depression, anxiety, low self-esteem, social stigma, mental well-being, reproductive health, irregular menstrual cycles in women, fertility issues, complications during pregnancy, gastrointestinal issues, gastroesophageal reflux disease (GERD), gallbladder disease, reduced life expectancy, premature death, other health complications.
Given her years of experience and the empathy some obese people evoke, a health reporter based in Lagos said she vowed never to get careless as to allow herself to get overweight. Consequently, she said she had to learn to eat and live healthy. She said she also learned that the severity of obesity dangers in each person can vary, depending on factors such as genetics, overall health, and lifestyle choices.
In her words: “I learned in the course of my journalism career that the cumulative impact of obesity on each person’s body systems underscores the necessity of preventing the disorder by living and eating healthy foods, doing regular exercises to save their lives. People should also seek medical counsel so they can be helped to manage and mitigate its dangers. In some cases, obesity is even worse than many other health situations from what I had gathered. I can say that confidently.”
Continuing, she said, “As of September 2021, it was reported that obesity rates continue to increase globally for both men and women. As a matter of fact, in different parts of the world, its gender gap had shrunken, as men became more obese; although, caution was issued then that the trends often vary due to regional, cultural as well as other demographic factors.
“I believe what is there is that anyone -boy, girl, men and women can be vulnerable to obesity as we all are exposed to its multi-layered and compound contributing factors. So, as all health agencies – WHO, WOF and WOA have cautioned, curbing obesity is our collective responsibility -both the affected and their families, as well as well-wishers.
“Though, some people could be defiant and listen to their throats more than their well-being, but sensitivities must continue. Another very important factor is for the government to keep improving access to affordable nourishing foods. We know that’s a tall order in this country. The National Orientation Agency (NOA), if it is still functional, should also be involved in raising awareness on the dangers and risks that could lead to being overweight and obese, for every citizen to know that anyone could be culpable.”
Obesity on the rise in Lagos
Being the bustling commercial capital of Nigeria, Lagos is known for its fast-paced lifestyle and vibrant energy, but along with this comes a downside – the prevalence of obesity driven by cravings for fast food chains and sedentary lifestyles; the recent highest reportedly observed at 22.2percent
It is ironic that Lagos, being a city of trekkers, due to its perennial traffic logjam, could have its share of obesity.
According to the World Health Organisation (WHO), obesity has diverse classifications whilst the generally known one is identified by Body Mass Index (BMI) of 30 kg/m2 or more. And it is posing an alarming health burden, given its increasing trend, given changes in lifestyle, associated growing cases of major and minor non-communicable diseases.
Another challenge obesity portends is its enormous medical costs, both directly and indirectly, comprising preventive, diagnostic, and treatment as well as matters of morbidity and mortality. With all these is the painful aspect that Nigeria has no specific documented estimates of obesity.
A statistician at a private hospital in Lagos, who would rather speak unofficially said the country has no way of combating the menacing effects of the disease.
“Unfortunately, like other situations, all we can do is trial by error. Even hospitals where those affected attend do not keep records. They just see them and that’s all. So, how can the issue be suitably addressed? Whereas the nation seriously needs to have statistics on how to establish obesity’s prevalence and trends if anything meaningful would be achieved,” he said.
A one-time study on obesity conducted within Ikorodu suburbs of Lagos, Southwest Nigeria, revealed an overall prevalence of 34.62percent with a breakdown of 21.15% in males, and 13.46percent in females, showing a 23.08percent waist circumference. Accumulatively, the study shows that prevalence of overweight and obesity were 13.8percent and 9.4perecnt, respectively.
Sadly, there is an obvious dearth of data on the actual national prevalence and epidemiological trend in all the geopolitical zones of Nigeria, yet, a Nigerian Journal of Clinical Practice (NJCP), 2023, study shows a current unpalatable trend.
In its recently conducted materials and methods systematic review and meta-analysis on the prevalence of obesity in Nigeria using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) format; NJCP’s results show that overweight is twelve times commoner among Lagosians than underweight and more for the females in Southwest, Lagos.
She’s not fat and furious. She is simply fat and frustrated. That was the condition this reporter met 41-year-old Tiwani Amao. Her dejection spoke volumes, even without her uttering a word. She was a perfect replica of exhaustion.
“Do I need to tell you how I am feeling?” She began. “Where do you want me to start from? Ours is hereditary, so I was told. Females in the Amao family are fat but not with my kind of frustration. Modern day foods, I guess, compounded my own case. And my parents had suggested everything we could do and nothing is working.
“The doctor told me that at this age, I should ordinarily weigh either 133lbs or 176.4lbs (about 60.7Kg), but I am said to be weighing 203lbs or more. I feel heavy, slow and draggy. I sweat a lot and it doesn’t make me happy. I wear baggy dresses and feel like someone close to the grave. Worst of all is, I get sick a lot because doctors said I have developed other health challenges.
“Do you know that I can’t even bear fasting, as in not eating for a few days or so?”
No, why? This reporter asked.
“You see this big body? It will be shaking as if I have never eaten in my entire life. That’s how bad my condition is.”
Close to tears, she said: “I really don’t know the remedy to this situation. I have only been managing it. I spoke with one equally obese lady I met at the hospital one time, and she said: “I don’t think there’s any remedy for this condition.” I asked her why and she said: “When an obese person is told to slim down; it usually ends in death for the few people I’d known. So, I’m afraid.”
“Because of that, I have been afraid to think of any natural or ‘tradomedical’ ways. Forget it, I can’t even imagine all those bitter herbs that may not help me at the end of the wahalas. So, for now, I am doing the much I had been doing to manage the condition all along even though it is not easy, I must admit.”
In conclusion, experts agree that there’s need for a larger population-based study to determine the prevalence and risk factors for underweight and overweight persons in Lagos.
Also, suggested was the need for a periodic nationwide monitoring of obesity as a long-term health index, not only for Lagos state, but as a nation-wide measure just like other countries of the world.
Obesity in Children
Albert Ilya, 11, is a lovable child. As a lad, he is fun to be with. But his ecstatic mien is often short-lived. Reasons adduced to this by his apprehensive mom was that he is obese.
Speaking on the condition of her son from her Gemade Estate, Lagos residence, Mrs. Maryam Ilya lamented: “My darling son has become a shadow of himself, and I partly blame myself for it. I thought making him eat as many times as he wanted would make him grow strong and healthy, but it turned out that the foods made him gain a lot of weight. Though we have doctor’s assurances that he could grossly shed much of the weight as he grows up.”
Medical reports note that children’s BMI factors differ from adults. The reasons are that the medical definition of childhood obesity is having a body mass index (BMI) at or above the 95th percentile as recorded on the Centers for Disease Control and Prevention’s (CDC) specific growth charts.
According to the Nigerian study that reflects the prevalence of overweight, obesity, and thinness among children aged 5 to 18 years representing 11.4%, 2.8%, and 13.0% respectively, this trend supports the conclusion that developing countries face the double burden of obesity and under-nutrition.
Lack of obesity doctors sparks concerns
Unfortunately, Nigeria faces a dearth of specialists to combat the growing health crisis.
Numerous research endeavours have even delved into the issue, such as the study estimating overweight and obesity prevalence in Nigeria since 2020, conducted by researchers from the University of Ibadan (UI), and published in the BMC Public Health journal.
However, this study still fails to pinpoint any specific hospitals where experts on obesity can be found anywhere in Nigeria’s medical sector.
Similarly, a study focusing on health services provided in Nigeria, led by researchers from the University of Jos, didn’t identify any particular healthcare institutions in their research where doctors on obesity can be met for medical consultations.
In a remarkable effort to address the scarcity of expertise in combating obesity, the Nigerian Obesity Cohort Programme is on the verge of emerging. It will notably aim at training a new generation of obesity specialists in Nigeria in order to provide a prequalification pathway to SCOPE Certificated for clinical medical students interested in the field.
Notably, the initiative is not yet affiliated with any specific hospital.
Despite the scarcity of dedicated obesity experts, a voice of concern echoes from the medical community.
Dr. Ebun Bamgboye, a Consultant Physician/Neurologist and Clinical Director at St. Nicholas Hospital, emphasised the critical need for Nigerians to adopt healthy eating dietary habits and exercise to prevent obesity.
Speaking at a free screening event organised by St. Nicholas Hospital in Lagos to commemorate World Kidney Day recently, Dr. Bamgboye highlighted the significant link between obesity and kidney failure.
He disclosed that more than 600 million adults worldwide are obese, making obesity the second risk factor for kidney failure and hypertension.
He stressed that individuals affected by obesity face an 83 percent increased risk of developing kidney failure compared to those with a healthy weight.
The World Health Organisation (WHO) also reports that at least 18 million people die annually due to complications arising from obesity or being overweight.
Moreover, Dr. Bamgboye challenged the conventional use of Body Mass Index (BMI) as the definitive measure of obesity, adding that experts in advanced climes are now advocating for alternatives such as waist circumference of waist hip-to-hip ration, which provide a more accurate guide by indicating levels of abdominal fat.
The researchers’ call to action resonates with the cries of people battling with obesity and only being attended to by Nutritionists, not only research institutions but also in healthcare centres across the nation.
The impact of obesity on public health demands a concerted effort to bridge the gap and build a cadre of experts capable of addressing this pressing issue, the researchers plead.
This report was first published in a Sunday edition of The Nation newspaper.