Food for thought

Global inequities have become a point of contention. If it is not about global warming, world policies, or commercialism, it is about global epidemics. And the weightiest issue facing physicians today is obesity.

A recent report by the WHO¹ states that the disease burden of the world, in both low and high gross national product (GNP) countries, is dominated less by "communicable" disorders but by "non-communicable" diseases such as cancer, heart disease, and mental disorders. Topping the list are the effects of high blood pressure, increased cholesterol, decreased intake of fruit and vegetables, inactivity, increased tobacco consumption and unsurprisingly, excess weight gain.

It would be a mistake to view obesity as a western issue. In impoverished areas such as Asia, central and South America and specifically the Middle East, obesity is already making its mark on the region's health and economy. Underdeveloped nations, in particular Asian and Central American countries, are even more susceptible to obesity and its effects. Research has suggested that undernutrition in early life may play a key role in promoting adult obesity. In particular, studies among three continents show that "nutritional stunting", which is usually caused by chronic undernutrition, is positively associated with adult obesity. Even more, early malnutrition determinately effects hepatic function of insulin sensitivity and fat metabolism, oxidation, and utilisation. Pre-existing early maternal and child malnutrition - with subsequent rapid weight gain in later years of childhood - sets up a pre-programmed sensitivity to greater risk of cardiovascular disease, hypertension, obesity, and or diabetes.

Obesity is a critical determinant of this dyslipidemia, operating through a number of metabolic influences that include reduced insulin sensitivity and changes in fatty acid metabolism². Variations in the nature and magnitude of the dyslipidemia are due to the interaction of genetic factors with environmental influences, most notably diet and physical activity, and possibly stress³.

These epigenetic effects, attributed to early malnutrition, increase the propensity to developing diabetes, cardiovascular disease, hypertension, hypercholesterimia, and other chronic diseases.

Of course, external marketing and commercial forces also play a key role in the obesity debate. Food and drink marketers seek to establish brand loyalty by directly targeting kids. Manufacturers will compete for shelf space, to ensure these products are sold on a specific shelf height, placed directly at a child's eye level. Children in developing countries are even more intrigued with items that have western images, characters, toys, or playful packaging. What is healthy and unhealthy is often distorted, and children will readily perceive calorie and fat dense foods as ‘healthy' because the packaging features a cartoon character holding a fruit or vegetable. Parents, however, are targeted more subtly. The relatively cheaper price of ready-prepared foods, that are rich in calories and fat and very little fibre, nutrients, or natural substances, is much more appealing to a parent in a rush to provide meals for their families. This is especially true in countries where whole fruits and vegetables are imported with an higher price tag when compared to packaged foods. Here, pre-made meals that are either processed or packaged locally are cheaper.

These nutritional issues are compounded by inactivity. The urbanisation of developing nations not only make it unsafe for children to play outside, but also makes neighbourhoods and communities more restrictive to outdoor activities. An increased numbers of cars in these densely populated areas means safety becomes much more of a priority; particularly in lower income areas where physical dangers are greater.

If physicians, alone, are to take up the challenge of combating obesity and its effects than we are fighting a losing battle if we think we can battle obesity one on one. We need to become advocates for our society in general. First and foremost, children need to be protected from marketing campaigns, and as physicians and parents we need to first recognise inappropriate advertising, internet campaigns, and school promotions. We need to seek programmes that encourage health promotion and establish government facilities where nutritional standards and quality is not compromised. Fast food and specifically soft drinks in our schools, daycares, and outlets in close proximity to schools should be restricted if not curtailed.

In addition, in a city sprawling with construction and new developments, urban designs need emphasis on curtailing heavy traffic, integrating public transport and promoting walking and cycling in safe areas around town. If it is malls we flock to, than those malls should be a place of activity, open play areas, and indoor tracks. Primarily, we need to voice our contentions to socially irresponsible market campaigning on children. We, as consumer, physicians, and health advocates, must recognise the impact obesity is making on our children and address this as a society.

Dr Alya Ahmad is a specialist in paediatric care, in practice at the American Primary Care Clinic (APC-Clinic), Dubai Healthcare City. She was educated and trained at the University of Texas Medical center, and worked at Herman Hospital, Baylor College of Medicine, and St Joseph's Hospital system and Texas Children's Hospital as an assistant professor in paediatrics.

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READERS' COMMENTS

Food For Thought
Posted by Valerie Houghton, Abu Dhabi, UAE on Wednesday 22 August 2007 at 09:00 UAE time


Dr Alya Ahmad,  
Great article!  
I have to add that physicians are not alone in this battle of pediatric obesity or adult obesity. There are registered dietitians here that can support the cause but as a profession are not recognized by the UAE MOH outside of clinical positions in hospitals. What a waste!  
Per your education in Texas, I know that you are aware of the contribution that registered dietitians can make in preventative nutrition initiatives and health education in the public sector. 
 
It is imperative that physicians along with registered dietitians, physical therapists and other qualified healthcare professionals work together to convince the MOH that this combination of skill and expertise is imperative to achieve the desired health outcomes of the country.  
 
Thanks for taking the time to write this article.  
 
Regards,  
 
Valerie M Houghton RD LD

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