Overwhelming the health system: Obesity and the development challenge in the Caribbean
Guyana and the wider world
By Dr Clive Thomas
Stabroek News
September 11, 2005
While most persons are aware of the deadly threat to the health and well-being of the population in the region posed by the HIV-AIDS epidemic, another epidemic is progressing silently. That is the epidemic of obesity. The Commission on Health and Development's report is brutally frank on this matter. It states that if action is not taken now to contain the spread of obesity, particularly among the younger age population "the burden of chronic diseases associated with obesity will overwhelm our health systems and ultimately retard our overall growth and development."
Unravelling the impact of the disease in the region requires an appreciation that much of it is due to behavioural and social factors and not the biological condition of its people. As the commission report points out, while it is true that obesity would not be possible if the human genome did not accommodate it, it is the energy balance over time that is necessary to realize that potential.
The obese and the overweight: The tragedy of the 1990s
The dramatic rise in obesity among the Caribbean population has been recent, suggesting that behavioural and social factors greatly outweigh genetic predisposition in this outcome. Genetic changes over a population as a whole occur slowly, but survey estimates show that in the 1970s about 20 per cent of adult females and 5 per cent of adult males were overweight and obese in the region. By the 1980s, the respective figures had risen to nearly 40 per cent and 20 per cent. In the 1990s female obesity exploded, and surveys show this has reached nearly 60 per cent of the adult female population and just fewer than 25 per cent for the male adult population. In some countries in the region as much as 70 per cent of adult females are considered to be overweight and obese (St Kitts and Nevis) and 65 per cent of adult males (Belize). In Guyana the survey data reported in the commission report has about 55 per cent of adult females overweight and obese and 40 per cent of adult males. The consistent gender disparity should be noted as far more women are overweight and obese than men. Indeed if we looked at the category obese alone, about one-quarter of Caribbean women are in this grouping. This figure is twice as large as the figure for adult males!
When surveys focus on children the situation is not improved. In Barbados data indicate that 4 per cent of pre-school children are overweight and the corresponding figure for Jamaica is 6 per cent. These figures could be compared with the worldwide average of 3.3 per cent. The survey data also indicate that almost inevitably obese children become obese adults.
Social factors
The report acknowledges that overweight and obesity is largely a social problem and that the epidemic of obesity therefore cannot be tackled only at the level of individuals. And, since the main cause of the observed trends in overweight and obesity reflect the imbalance between food intake and energy expenditure the task is to deal with the social and behavioural factors which create this imbalance.
At the time of Independence in the early 1960s most Caribbean populations were consuming significantly less (about 12 per cent) than the recommended 2250 kcals per person per day. By the 1970s the population overall was consuming an average above the 2250 kcals per day. This level of per person daily intake has increased with every decade and since 2000 the estimated intake is more than 500 kcals above the recommended daily allowance, reaching 2750 kcals per day. In the case of Guyana average daily intake is now about 2600 kcals.
The dramatic increase in calorie intake has come from what the report terms as the "oversupply of calories" in the form of fats and sugars. The region consumes about 160 per cent of the average requirement of fats and in excess of 250 per cent of sugars.
While these factors operate on food intake, Caribbean populations have been, on the whole, reducing physical activity, which offers substantial protective effect against obesity. Through changing jobs and life-styles, Caribbean populations have become less active and more sedentary in their activities. The evidence of this is everywhere: the shift from walking and bicycling to motor vehicles as the primary means of transport; the shift from jobs that require considerable physical effort to jobs that do not; and the shift from rural to urban living spaces.
Economics
The economic costs of carrying a significantly obese population are considerable. There are both the direct costs and indirect costs. The direct costs include personal costs of the persons affected, and health charges, the individual costs includes all the costs of obese-related morbidities, and lower productivity. Thus the report gives the example of one obese-related illness, diabetes and this reaches approximately US$200 million in direct costs and US$800 million in indirect costs (for a total of $1 billion US) for five Caribbean countries - Bahamas, Barbados, Guyana, Jamaica and Trinidad and Tobago.
The report stresses the importance of promotional and educational efforts to encourage healthy eating and an active lifestyle. It encourages the use of taxes, laws and regulations to discourage the consumption of items that promote obesity. It advises that broad-based approaches involving places of education, worship, and the workplace as well as civil society groups, the private sector, and governments should be involved in co-operative health-promotion activities.
The bottom line, however, is that if left unchecked the epidemic will continue to gather momentum silently, reaching proportions that are uncontrollable. Worldwide traditional methods of controlling obesity have failed and the region is therefore encouraged to seek innovative ways to cope with the gathering storm.