OBESITY IN NIGERIA: THE ROLE OF EPIDEMIOLOGY IN INVESTIGATING POPULATION HEALTH IN RELATION TO OBESITY
Obesity and overweight have become global epidemics, posing a serious danger to chronic disease prevention and wellness. Due to economic expansion, industrialization, mechanized transportation, urbanization, an increasingly sedentary lifestyle, and a nutritional transition to processed foods and high-calorie diets, the prevalence of obesity in many nations has doubled, even quadrupled, in the last three decades (Hruby & Hu, 2015; Tiwari, & Balasundaram, 2022). According to the World Health Organization (2021) “the Body mass index (BMI) is a simple index of weight-for-height that is commonly used to classify overweight and obesity in adults. It is defined as a person's weight in kilograms divided by the square of his height in meters (kg/m2). An individual with a Body Mass Index (BMI) greater than or equal to 30 is considered obese”.
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Epidemiology takes an
organized approach to problem solving especially when it has to do with the
issue of obesity in the society by: confirming the existence of an epidemic and
verifying the diagnosis; developing a case definition and collating data on
cases; analyzing data by time, place, and person; developing a hypothesis;
developing and implementing control and prevention measures to tackle this
problem; preparing and disseminating a public report; and evaluating control
and prevention measures (Brachman, 1996). Epidemiology is a scientific subject
that is built on strong scientific research methodologies. Epidemiology is a
data-driven field that relies on a methodical and objective approach to data
gathering, analysis, and interpretation (Centers for Disease Control and
Prevention (CDC), 2016). Last (2001) viewed epidemiology as “the study of the
distribution and determinants of health-related states or events in specific
populations, as well as the application of this knowledge to the prevention of
disease”.
Overweight and obesity
have been linked to an increase in mortality in epidemiological studies. Data
from the World Health Organization (2021) revealed that obesity has roughly
tripled globally since 1975 and more than 1.9 billion adults aged 18 and over were
overweight in 2016. Over 650 million of them were obese. For adults aged 18
years and above, 39% were overweight and 13% obese in the year 2016 and nearly
340 million children and adolescents aged 5 to 19 years old were overweight or
obese. Two years ago, in 2020, records shows that 39 million children under the
age of five were overweight or obese. Between 1975 and 2016, the global
prevalence of obesity nearly tripled (WHO, 2021).
According to the NHS
(2022), obesity is caused by eating more calories than you burn off through
physical activity, especially those found in fatty and sugary meals. The body
stores the extra energy as fat. Obesity is becoming more of an issue in modern
society, as many individuals consume excessive amounts of low-cost, high-calorie
foods and spend a lot of time sitting at computers, on sofas, or in cars. The
World Health Organization (2021) noted that obesity and overweight are caused
by an energy imbalance between calories consumed and calories burned. A study
by Rauber, Chang, Vamos et al. (2021) reveals that higher intake of
ultra-processed foods is strongly linked to an increased risk of several
obesity markers in the adult population of the United Kingdom. Actions that
increase the consumption of fresh or minimally processed foods while reducing
the consumption of ultra-processed foods should be considered by policymakers.
Worldwide, there has
been: an increase in physical inactivity due to the increasingly sedentary
character of many types of job, changing modes of transportation, and expanding
urbanization; and an increase in energy-dense diets high in fat and
carbohydrates. Environmental and societal changes associated with development,
as well as a lack of supportive policies in sectors such as health,
agriculture, transportation, urban planning, environment, food processing,
distribution, marketing, and education, are often the cause of changes in
dietary and physical activity patterns (WHO, 2021; NHS, 2022; Harvard School of
Public Health, 2022).
Obesity, a modern lifestyle
condition, not only causes major illness, but it also reduces average public
life expectancy significantly. Obesity also affects both the physical and
psychosocial aspects of quality of life, more significant among morbidly obese
individuals (Tiwari, & Balasundaram, 2022). According to Balasundaram and
Krishna (2021), overweight and obese children are more likely to be obese as
adults and are at higher risk for obesity-related noncommunicable diseases at a
younger age. Obesity is one of the most common grounds for discrimination in
the recruiting process (Flint, Čadek, Codreanu, Ivić, Zomer & Gomoiu,
2016). The direct costs of obesity are connected to the amount spent on
recognizing and treating obesity and obesity-related chronic comorbid
conditions including cardiovascular disease and type 2 diabetes. Missed pay
owing to illness and premature mortality, increased expenditures for disability
and insurance claims, and poorer job productivity are all examples of indirect
costs attributed to obesity (Spieker & Pyzocha, 2016; Tiwari, &
Balasundaram, 2022).
Figure 1: The
Public Health Approach to Tackle Obesity
To solve the problem of
obesity, one needs to follow the public health approach as shown in figure 1
above. The steps involve defining obesity, identifying its causes and
protective factors, developing and testing intervention strategies,
implementing interventions, evaluating the impact of interventions and
surveillance monitoring and redefining the problem, reevaluating its causes and
refining interventions.
Environmental variables are frequently a root cause of obesity, hence multilevel approaches that include the individual's surroundings are critical for combating the obesity epidemic (De Mattia & Denney, 2008; McCormack & Virk, 2014; Mayne, Auchincloss & Michael, 2015). Instead of single-level interventions addressing several determining levels, multilevel methods are required (Bauman, Reis, Sallis, Wells, Loos & Martin, 2012). In addition to traditional treatments such as individual counseling and screening, these approaches include intervention components that produce a "healthier environment," such as school curricula and built environment improvements. Changing the classroom interior to facilitate physical activity in all sessions rather than just during physical exercise lessons is an example of an environmental approach to childhood obesity prevention which greatly reduces the incidence of obesity when they become adults. The monitoring of this approach revealed a clear decrease in obesity among Finnish schoolchildren in the school setting—resulting in obesity reduction (World Health Organisation, 2015).
OBESITY IN NIGERIA
According to a study by
Adeloye et al., (2021), the combined prevalence rates of overweight and obesity
in Nigeria from 35 studies with a total sample size of 52,816 were 25,0 and
14,3 percent, respectively. Women were more likely to be overweight or obese
than men were, with prevalence rates of 25,5% versus 25,2% for overweight and
19,8% versus 12,9% for obesity, respectively. Body mass index (BMI) and waist
circumference were both averaging 25.6 kg/m2 and 86.5 cm, respectively. The
predicted number of overweight and obese people in Nigeria aged 15 or older in
2020 was 21 million and 12 million, respectively, representing an age-adjusted
prevalence of 20.3% and 11.6%. Overweight and obesity prevalence rates were
consistently higher in urban than in rural areas (27.2% and 14.4% vs. 16.4% and
12.1%, respectively) (Adeloye et al., 2021),
According to recent estimates, 5.9% of adult men and 15.7% of adult women (aged 18 and over) are obese. However, Nigeria has a lower prevalence of obesity than the norm for the region, which is 9.2% for men and 20.7% for women (Hadiza, 2022). Nigeria has a high rate of overweight and obesity, which had grown over time. The significant financial ramifications make it necessary to stop the trend. Overweight and obesity have both direct and indirect financial consequences. The indirect cost is the price associated with morbidity and mortality, while the direct cost is the price associated with preventive, diagnostic, and therapeutic services (Chukwuonye et al., 2022).
Obesity is the result
of complex interplay between genetics, hormones, and different social and
environmental variables. A public health plan for implementing population-based
policies to prevent excessive weight gain should be comprehensive, include
several levels of stakeholders, and actively involve many other essential
parties. Obesity is a serious public health issue, but it does not pose the
same immediate threat as a disease outbreak would, hence the need to create
programmes to tackle obesity based on evidence
1. Government should closely monitor policies
on obesity prevention and reduction and assess them in terms of impact and cost,
and should be phased out if they are not useful.
2. Programs and services that educate
individuals about the hazards of being overweight or obese, as well as how to
control their weight via healthy lifestyle choices, are needed to address the
obesity epidemic. Communities may also choose to invest in fitness and
health-related infrastructure and services.
3. Because people's eating habits are
influenced by their surroundings, governments should promote policy and
environmental changes that improve the availability and marketing of nutritious
foods while decreasing the availability and marketing of unhealthy foods.
4. To increase the physical activity
level among the population, the government should work with relevant agencies
in creating a wide variety of recreational sports facilities in communities.
This should also be prioritized in low-income neighborhoods.
5. Individual lifestyle changes are
ultimately accountable for the prevention and reduction of overweight and
obesity, and further research on the motivations for behavioral change could
help combat the obesity epidemic.
OBESITY IN THE
UNITED STATES OFAMERICA
While experts argue that the obesity epidemic in the United States began in the 1980s, obesity rates have risen rapidly in the last decade (Levy, 2018). According to data published in JAMA in 2018, around 40% of all adults in the United States over the age of 20 are obese, resulting in a population of 93.3 million people (Hales, Fryar, Carroll, Freedman & Ogden, 2018). More than 20% of adults in the United States are obese, according to the CDC, a considerable increase since 1985, when no state had an obesity rate higher than 15%. Obesity rates are higher in some states than others, with the South (32.4%) and Midwest (32.3%) having higher rates than the rest of the country (CDC, 2021; Newman, 2019). A report by the CDC (2016) revealed that over 40% of adult Americans were obese in 2015–2016, up from 34% in 2007–2008. Extreme obesity prevalence increased from 5.7 percent to 7.7 percent within the same time period. In 1985, no state had an obesity rate higher than 15%. In 2016, five states had rates of more than 35% (CDC, 2016).
Figure 2: Trends in Adult
Obesity in the United States
*BMI ≥30, or ~30 lbs. overweight
for 5’ 4” person.
Source: Behavioral Risk Factor
Surveillance System (1985, 2008, 2016), CDC.
In the United States of
America, people's capacity to maintain a healthy weight is heavily influenced
by demographic trends and life circumstances. In general, statistics shows that
the higher a person's income, the less likely they are to be obese (Zare,
Gaskin & Thorpe, 2021). It was observed that obesity was also more common
among those with less education. Records show that obesity and severe obesity
are more common in rural settings than in suburban and metro areas (Kirby &
Kaneda, 2005). Obesity rates are higher among specific racial and ethnic groups
due to socioeconomic reasons such as poverty and prejudice. Black people have
the highest rate of adult obesity in the country, at 49.6%; this number is
mostly driven by a 56.9% adult obesity prevalence among Black women. Obesity
affects 44.8 percent of Latinx people. White adults have a 42.2 percent obesity
rate. The obesity rate among Asian people is 17.4 percent (TFAH, 2020; Zare,
Gaskin & Thorpe, 2021).
Data from a survey by
various state health departments in the United State of America and the CDC
(2020) which comes from the Behavioral Risk Factor Surveillance System (an on-going
state-based, telephone interview survey), it was observed that obese adults are
at higher risk for a variety of major health problems, including heart disease,
stroke, type 2 diabetes, several malignancies, and poor mental health.
According to several studies, some people of Asian heritage may experience the
health problems linked with obesity at a lower body mass index (BMI) (CDC,
2020).
It has been predicted
that if the rate of obesity continues to rise, annual health-care costs
connected with obesity-related disorders might rise from $48 billion to $66
billion by 2030, with annual productivity losses ranging from $390 billion to
$580 billion (Gonzalez-Campoy, 2019). However, the price is more than
simply monetary. Obesity can cause early death and raise susceptibility to
various diseases, as well as having an incalculable impact on quality of life
and family life.
The federal, state, and
local governments have all taken steps to combat obesity. On the federal level,
several programs – such as the Supplemental Nutrition Assistance Program
(SNAP), the Healthy Food Financing Initiative, among others – as well as the
U.S. Departments of Agriculture and Health and Human Services are all working
to make healthier meals more inexpensive and available in underprivileged
communities. There are also school and early childhood policies to prevent
childhood obesity, such as Head Start – a comprehensive early childhood
education program – school-based physical education, and Safe Routes to School,
which encourages students to walk or bike to school while increasing healthy
eating and physical activity and lowering obesity risk. The American Academy of
Pediatrics and the American Heart Association made several policy
recommendations, including increasing the price of sugary drinks, encouraging
federal and state governments to limit sugary drink marketing to children and
teenagers, having vending machines offer water, milk, and other healthy
beverages, improving nutritional information on labels, restaurant menus, and
advertisements, and assisting hospitals in developing policies to reduce sugary
drink consumption (Newman, 2019)
RECOMMENDATIONS FOR
PUBLIC HEALTH PRACTICE, POLICY AND POSSIBLE FURTHER RESEARCH TO ADDRESS THE
GROWING RATES OF OBESITY.
Obesity is on the rise
all throughout the world, with lifestyle choices, cultural contexts, education,
social position, and environmental variables all contributing. It's important
to remember that all of the possible causes for the rise in obesity rates are
speculative. It is vital to develop long-term strategies for a healthy
lifestyle. The following recommendations have been made based on this article;
1. As the first and most critical
step, people must assume personal responsibility for their health. Primary
prevention is without a doubt the most effective method for dealing with this
rapidly growing public health problem.
2. Despite the growing obesity
epidemic, many schools fail to provide enough atmosphere and time for exercise
among students. Schools should ensure they create the right environment for
student to engage in regular physical activities. There should be dedicated
time for sports in the school weekly calendar to encourage mass participation
in sports and exercise.
3. The government should provide
resources to combat obesity through access to fresh and healthy foods and
nutritional interventions in low-income communities. This will not only promote
access to healthy foods but also generate higher income for low-income
communities and reduce income inequalities as a long-term sustainable strategy.
4. The government could also limit
easy access to junk food, provide subsidies to make healthy foods more
accessible, raise labeling standards, regulate advertisement of sugary drinks and
place high tax sugary drinks.
5. There is no single or simple solution to the obesity pandemic. It's a complicated situation that necessitates a multifaceted solution. To build an environment that fosters healthy lifestyles, policymakers, state and local organizations, corporate, school, and community leaders, childcare and healthcare experts, and individuals must collaborate.
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HOW TO REFERENCE THIS ARTICLE
Ademola, V. D (2022). OBESITY IN NIGERIA: THE ROLE OF EPIDEMIOLOGY IN INVESTIGATING POPULATION HEALTH IN RELATION TO OBESITY. Retrieved from https://www.youdread.com/2022/11/obesity-in-nigeria-role-of-epidemiology.html
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