At the other end of the malnutrition scale lies the “GLOBESITY” pandemic capturing headlines and spurring research into new directions.
Dramatic shifts in the way people around the world today are eating, drinking and moving is clashing drastically with our biology creating significant transitions in our body compositions, increasing risks of death, morbidity and accelerated aging.
In a short span from 1995-2000, the estimated number of obese people around the world increased from 200 million to 300 million whereas till 2016 it had tripled with more than 1.9 billion or 39% adults were overweight and 650 million or 13% were obese.
The numbers since then are only intensifying.
According to the World Health Organization, “Overweight and obesity are defined as abnormal or excessive fat accumulation that presents a risk to health. The body mass index (BMI) is a simple index of weight-for-height that is commonly used to classify underweight, overweight and obesity in adults.
Shifting market economies, driving changes in the changes in the global food system by providing access to processed, affordable and effectively marketed food is leading to massive passive over consumption. Individual factors interacting with environmental factors (technologies and structure of communities that reduce or replace physical activity, and inexpensive nonphysical entertainment) create a wide variation in obesity prevalence between populations.
Today a 35-year-old man of average height would be 3.9 kilos heavier due to genetic predisposition compared to his genetically protected peers in 1960’s but living in today’s obesogenic environment he would carry approximately 13.9 extra kilos.
According to the National Nutrition Survey Pakistan 2018, Pakistan is facing a double burden of malnutrition with a high prevalence of underweight combined with a high prevalence of overweight and obesity, the best-known precursors for non-communicable diseases (NCDs) – cardiovascular, hypertension, diabetes, hyperlipidaemia, osteoarthritis, obstructive sleep apnoea and certain cancers.
Even though the local food authorities have taken baby steps in Punjab and Sindh in banning carbonated drinks in school and college canteens, but they are not sufficient. What we need is an umbrella policy in sync with United Nations strategies for ending childhood obesity shaping into relevant, focused laws.
One-third of children are underweight (28.9%) in Pakistan alongside a high prevalence of overweight (9.5%) in the same age group. The prevalence of overweight among children under five has almost doubled over seven years, increasing from 5% in 2011 to 9.5% in 2016 wherein children under years of age the obesity prevalence in boys and girls is at an alarming 9.7% and 9.2% respectively which is twice the target set by the World Health Assembly. A provincial breakdown shows that prevalence is highest in KP-NMD (18.7%) and Baluchistan (16.7%), and lowest in Sindh (5.2%) and ICT (5.8%). The prevalence of overweight among young children exceeds 10% in KP, Baluchistan, KP-NMD, AJK and GB.
The trends of obesity are seen to escalate with an increase in ages where according to National Nutritional Survey (NNS 2018) 11.4% and 10.2% adolescent girls and boys were overweight, and 7.7% boys and 5.5% girls were obese in both rural and urban areas of Pakistan. NNS also states that while the percentage of undernourished women had dropped from 18% to 14%, overweight and obese women were seen to be increasing from 28% in 2011 to 37.8% in 2018, which is approximately one-third of the female population in Pakistan.
Obesity was once considered a problem only in high-income countries, whereas now its dramatically on the rise in low and middle-income countries, particularly in urban settings.
Pakistan is currently suffering from the emerging epidemic of obesity. The obesity burdens among adults and children have been increasing with the significant risk factors, including unhealthy lifestyle, unhealthy diet and physical inactivity. Obesity having severe health repercussions, it is a known independent risk factor for many non-communicable diseases.
Obesity leads to catastrophic financial losses in a community by increased health-related expenditure for treatment of NCD’s while reducing the overall productivity of the society with more than 36 billions of DALYs (Disability-adjusted life years) lost globally, in addition to (2-6) per cent total health expenditure of health in many countries.
Current relative risk estimates show that obesity kills one in three obese people around the world. The more recent the birth year, the higher the effect obesity has on mortality rates.
Several global initiatives to halt and reverse the obesity epidemic have been taken such as the Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013-2020 which outlines policy options for promoting physical activity and healthy diets.
Another initiative, the WHO Commission on Ending Childhood Obesity proposes six strategies to end childhood obesity that focus on healthy diets, physical activity, preconception and prenatal care, school health, and weight management. Finally, the Comprehensive Implementation Plan for Maternal, Infant and Young Child Nutrition, endorsed by the World Health Assembly in 2012, has challenged the world to prevent any increase in preschool overweight over the next decade. In light of this, in 2016, the United Nations endorsed the Infant Child Nutrition2 Framework for Action and declared a Decade of Action on Nutrition.
The prevalence of obesity will likely surpass smoking prevalence, but unlike smoking commitments to obesity, control is too weak
The 2011 United Nations political declaration against NCDs targeted four major risk factors: tobacco use, harmful use of alcohol, an unhealthy diet, and a lack of physical activity. The Framework Convention on Tobacco Control (FCTC), MPOWER strategies, and the four?stage model of the tobacco epidemic are useful references for the prevention and control of other risk factors and NCDs.
Even though growing evidence suggests that obesity is currently the second-most important health problem after smoking, with further advances in tobacco control, obesity may overtake smoking as the most critical and avoidable cause of morbidity and mortality.
The prevalence of obesity will likely surpass smoking prevalence, but unlike smoking commitments to obesity, control is too weak.
The World Health Organizations WHO target of a 0% increase in diabetes or obesity by 2025 is only voluntary, meaning that the commitments globally, nationally, and individually are far too weak and are not enough to lead to a decline in obesity in the near future.
Without legally binding commitments and effective global intervention strategies for all countries, the prevalence of obesity in both children and adults will continue to increase, and this voluntary target of a 0% increase cannot be achieved.
Lessons can be learnt from a growing list of countries that have declared war on junk food, by levying new taxes and restricting sale to certain consumers such as Norway, A leader in the war against junk food, taxes sugary drinks, fast food and restricts its availability to children.
The South American nation has intensified its fight against junk food vendors by banning its sale in schools and evolving a healthy eating manual for educational institutes to follow.
In 2008, Japan introduced a novel Metabo tax which sought to curb burgeoning waistlines. Thanks to this law, obesity rates have fallen to barely 3.5 per cent, one of the lowest levels in the world.
Australia’s Obesity Policy Coalition had called for the imposition of a fat tax on a range of unhealthy food items, including junk food. To further solidify these measures, new dietary guidelines were published by administrators to compel their people to eat healthier.
Adding a high tax on unhealthy food and drinks may help slow the rising rates of obesity, according to a study published in the British Medical Journal. A tax of at least 20 per cent placed on sugar-sweetened drinks could drop obesity rates by 3.5 per cent and prevent 2,700 heart-related deaths each year.
Success stories of these countries can help Pakistan learn to tackles its issues of obesity by creating an environment that enables and promotes a healthy diet.
The writer specialises in Health Services Management from Griffith University, Australia. She is an alumina of John Hopkins Bloomberg School of Public Health