Dealing with obesity | Political Economy
Pakistanis are very fond of eating. We have a very food-centric society. The love of food is evident from the rapidly growing food and restaurant industry. Festive foods we previously consumed only on special occasions are now included in our daily menus, thanks in part to the availability of spice mixes and cooking shows on mainstream television.
Consumption of traditional sweets, sugary drinks, confectionery, ice creams, and fried and oily foods is high and rising. Most households prefer meat to other food choices. The majority prefer red meat over white meat. Hardly anybody thinks of serving only fruit or vegetables to the guests. Why then should we not gain weight?
In large cities, fitness clubs are a new trend among young adults who want to lose weight. However, many quit when they do not see the desired results which cannot come by without significant lifestyle changes. Cost is another issue as not everyone can afford these. Access to parks etc is also limited for the general public.
The escalating obesity rates among children and adults reported in the National Nutrition Survey of Pakistan published in early 2021 are alarming. The survey showed that the rates of overweight and obese children almost doubled over a decade among children under five years of age; adolescent boys and girls; and women of reproductive age.
As obesity is directly associated with increase in chronic health conditions, such as diabetes, diabesity (co-existence of diabetes and obesity) and cardiovascular disease, it poses an enormous threat to the already resource-scarce healthcare system of Pakistan. So, what is the solution and who has it?
The simplest solution is to encourage people to eat a healthy diet and be physically more active, but obesity would not be a big problem if it were this simple. It is much more complicated than eating healthy and increasing physical activity.
Pakistan does not have a policy on obesity prevention. Health professionals are not trained to identify, counsel and treat people with obesity. In the absence of trained human resource, particularly a well-organised primary care set-up, effective implementation of health initiatives remains a challenge. How many programmes currently are contributing in non-communicable disease (NCD) prevention and control?
The results from the National Nutrition survey identify urgent obesity prevention measures to avert premature deaths among children and young adults and health conditions related to obesity, such as diabetes and hypertension.
Learning by example from the countries that are battling obesity, the government needs some urgent policy decisions to stop the evolving pandemic of obesity. Here are some of our options:
The escalating obesity rates among children and adults reported in the recent National Nutrition Survey of Pakistan published in early 2021 are alarming. The survey showed that the rates of overweight and obese children have almost doubled among those under five years of age in a decade.
1- We need a multi-sector obesity strategy. It should engage health, education, food and beverage industries, media, legislators and civil society organisations. The obesity strategy must focus on changing people’s perception of corpulence and increasing awareness about healthy diet, physical activity and weight. Electronic and print media should be in the forefront to educate people about a healthy diet and healthy activities.
2- The government must initiate a dialogue with the beverage and sugary-food industries, as well as multinational fast food companies and local food chains and restaurants to lower sugar and fat content in their foods. Taxing the industries that promote unhealthy foods and beverages may be one solution to lower sugar and fat content in their products. The food industry should be encouraged to bring a healthy change to their menus, including fewer deep-fried food options and more vegetable and fruit choices. Calorie count display should be mandatory on the food products to help individuals make informed choices.
3- Display of warning messages on television, electronic and print media informing people about the health risks associated with consumption of sugary and oily foods should be made mandatory. Other measures used in lowering smoking rates, such as a ban on advertisements and sponsorship of popular television shows, talk shows can also help. Cooking programs have a large viewership among homemakers, adolescents, and children experimenting with new recipes and foods. Nutritionists and health professionals should be involved to review these shows to make the recipes healthy.
4- Nutrition and lifestyle education should be a part of the school curriculum, starting from primary levels. The Health and Education Departments should work closely together for capacity building in teachers to promote a healthy diet and physical activities in younger generations and to identify children at risk of malnutrition. Trained teachers can be an excellent resource to guide parents in making healthy choices such as fresh vegetables, fruits, legumes, whole grains and high-fibre diets for their children.
5- Physical activity has a crucial role in weight management and a healthy lifestyle. Appropriate physical activities keep extra calories away and help in relieving stress, encourage social interaction and promote healthy sleep. City and union councils should establish and maintain public space for sports, play areas, cycling and walking tracks essential for healthy living. Public places and parks should provide clean drinking water to encourage people to drink water while exercising.
Finally, it is critical to have a trained primary health care workforce to identify and counsel people with obesity. A large body of research recognises that the health workforce at primary care facilities needs the training to diagnose obesity. Counselling patients on body weight is a challenging part of the consultation.
Nutrition education is a neglected topic in medical education as well as in post-graduate training. Overweight and obesity can be managed successfully in primary care settings provided they are equipped to deal with this challenge.
Many patients who consult primary healthcare services need dietary guidance specific to their health condition. Incorporating nutrition and lifestyle education in medical colleges and continued medical education will enable the healthcare providers to educate their patients in developing healthy habits, which will ultimately help stabilise overweight/ obesity rates.
Obesity prevention is a big challenge requiring urgent multi-sector efforts by the government.
Dr Tehzeeb Zulfiqar is an associate professor at the Department of Family Medicine at Health Services Academy, Islamabad
Dr Hina Jawaid is an assistant professor at Department of Family Medicine at University of Health Sciences, Lahore