There is obesity crisis in The Gambia. However, because of the society’s notion of the ‘big body’ in terms of it being a status symbol of wealth and success, and as definition of beauty in female folk, not much is being said about it.
Obesity, as defined by World Health Organisation, is a medical condition in which excess body fat has accumulated to the extent that it may have a negative effect on health. It has been classified as a disease by the American Medical Association in 2013. It is associated with adverse health effects such as increased risk of type 2 diabetes and hypertension; certain types of cancer which include breast, ovarian, prostate, liver, and kidney; cardiovascular diseases such heart disease and stroke; hormonal disturbances; obstructive sleep apnea which causes breathing to repeatedly stop and start during sleep; osteoarthritis (joints problems); and depression. Several studies have found obesity to reduce life expectancy.
Obesity is defined by body mass index (BMI) which is evaluated in terms of height and weight; and waist-to-hip ratio (WHR) or waist circumference (WC). BMI is used to assess the extent of general obesity while WHR or WC is used as a parameter for assessing central or abdominal obesity; which is associated with risk of obesity-related disorders. Obesity is diagnosed in individuals with a BMI ≥30 kg/m2, with the range 25–29.5 kg/m2 defined as overweight (pre-obesity). Abdominal obesity is diagnosed when WC is greater than 94cm in men and 80cm in women. Abdominal or central obesity is one of the two major types of obesity in terms of the distribution of excess fat in the body. The other type is peripheral obesity. In peripheral obesity or female pattern of distribution, the extra fat is stored around the hips, thighs and buttocks. This form of fat has protective effects against obesity-associated disorders. In central or abdominal obesity, the extra fat accumulates mostly in the abdominal region. This is associated with increased risk of obesity-associated health complications. Therefore, a ‘big stomach’ is anything but a sign of good health.
Obesity is determined by the genetics, and most significantly, obesogenic environment which comprises of factors that support the occurrence of obesity. These include the cheap and easy availability of high caloric diet and sedentary lifestyle. This is further exacerbated by various individual, societal, and socioeconomic factors.
In The Gambia, the prevalence of obesity as reported by WHO in 2016, nationally, was 9.1% and that of overweight was 28.5%; with prevalence of obesity higher in female compared to men.
In 2018, Cham and his colleagues reported two-fifth of adults in the country to be either overweight or obese, with higher prevalence in female and urban residents. In a 2015 National Nutrition Survey using the Standardised Monitoring and Assessment of Relief Transition (SMART) methods, the National Nutrition Agency (NaNA) reported 24.1% of non-pregnant women, nationally, to be either obese or overweight.
In 2018, NaNA in the The Gambia micronutrient survey 2018 (GMNS), reported this time around, 29.4% of non-pregnant women, nationally, to be either obese or overweight; with the prevalence of overweight and obesity higher among women and in urban areas.
Comparing the above prevalence to the one reported a little over 20 years ago by Van der Sande and his group, which was 2.3% prevalence of obesity and 8.1% of overweight, it would be seen that the prevalence has more than tripled nationally. This is indeed alarming, bearing in mind the health and financial implications this would have on the country. The increment of about 5% in 3 years amongst non-pregnant women as reported by NaNA too is indeed worrying. Because as it stands, if no action is taken, most of these women in the pre-obese (overweight) stage could become obese by the time they become pregnant. Maternal obesity can result in negative outcomes for both women and fetuses. The maternal risks during pregnancy include gestational diabetes and preeclampsia (hypertension in pregnancy). The fetus is at risk for stillbirth and congenital anomalies. The women can later develop heart disease and hypertension; while the children have risk of future obesity, hypertension and heart diseasesby a phenomenon described as ‘fetal origins of adult disease’. This, in female children, could set a vicious cycle of ill health in a family.
The increase in the prevalence of obesity in the country has been attributed to nutritional transition, the increased consumption of processed food; urbanization and physical inactivity exacerbated by individual and societal factors. Migration to urban centers leads to sedentary occupations and plentiful high-fat diets causing rising obesity rates in the urban regions. In comparing with the rural residents, the risk of overweight and obesity among urban residents was reported to be three and six-fold higher respectively. Obesity was also found to be significantly associated with low fruits and vegetable intake. Obesogenic food like oil is greatly consumed as most of our daily meals are cooked with or have oil. These include ‘benechin’ which is cooked in oil, ‘plassas’ which has palm oil, ‘chu dew lin’ or ‘dew tirr’etc.
Obesity, for a long time in our society, has been seen as status symbol of wealth and of success; so, as a result, as reported by Prof. Andrew Prentice and Felicia Webb in a photo essay entitled ‘Obesity amidst poverty’, it is often worn with panache and elegance. Larger women are considered beautiful. And as medical personnel, it is not uncommon to have young women come to you to put them onmedication to ‘give them body’. When asked why, they would tell you that they don’t feel comfortable being ‘thin’ and that they would want to look more beautiful when they put on ‘African’ (African dress). Our society’s notion of obesity is best reflected in a statement given by an obese lady, as reported in the photo essay ‘Obesity amidst poverty’ when she stated: “Day after day if there’s food I’ll eat it. I want to maintain my weight because it doesn’t disturb me. I feel better than thin women, I feel sorry for them. My babies have always been big and healthy.” This is indeed, a serious misconception of big babies being considered healthier.
And, in terms of the effects of obesity crisis in the country, there has been exponential rise in the prevalence of diabetes and hypertension and incidence of stroke and its attendant disabilities and mortality. The prevalence of diabetes, for example, had risen from 0.3%, little over 20 years ago, to 5.8% by 2016. The situation of these obesity-related conditions will continue to worsen as obesity prevalence rises. Personally, over the past years, I have observed that majority of those who I got to know had sudden death, had been obese.
Finally, looking at all the health complications associated with obesity and the alarming rate at which it is increasing in the country, it is therefore imperative to put in place or strengthen preventative strategies in a form of health education directed at raising awareness of its risk factors. These include discouraging harmful beliefs on weight so it is understood that it is better to choose being healthy over vanity; promote healthy dietand healthy eating habits, including limiting energy intake from total fats and sugars and increase consumption of fruits and vegetables, as well as legumes, whole grains and nuts; and engaging in regular physical activity especially in urban areas and among women.
Kebba S. Bojang is a medical doctor and lecturer at the University of The Gambia,
He’s currently a doctoral (PhD) student in Biomedical Science. His research centers on Genetics of Metabolic syndrome).