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ANALYSIS: Sharon Friel, Mickey Chopra, and David Satcher Unequal weight: equity oriented policy responses to the global obesity epidemic BMJ 2007; 335: 1241-1243 [Full text]

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Obesity: not yet an epidemic in Sub-Saharan Africa

Niyi Awofeso   (18 December 2007)

Re:Unequal weight equity oriented policy responses to the global obesity epidemic -- Friel et al.

Paul Z Zimmet   (11 April 2009)

Obesity: not yet an epidemic in Sub-Saharan Africa 18 December 2007
Niyi Awofeso, A/Prof. School of Public Health and Community Medicine University of New South Wales, Australia. Send response to journal: Re: Obesity: not yet an epidemic in Sub-Saharan Africa	Friel et al’s article1 appears to over-stress the impact of obesity on the health of people in poor countries. While up to a third of adult urban-based women in sub-Saharan African countries may the classified as obese, the average proportion of obese people in sub-Saharan Africa is less than 5%.2 In contrast, the average prevalence of under-nutrition exceeds 15%. In Nigeria, for example, stunting of school children, even by government estimates, consistently exceeded 30% between 1990 and 2003. Recent work by the author on paediatric nutrition rehabilitation programs in northern Nigeria indicates continuing high levels of childhood under- nutrition. Globalization partly explains the reasons for obesity among adult urban women. In Nigeria, the participation rate of urban women in the workforce has doubled over the past decade. Many urban-based African women subsist on eat cheap, fat-rich ‘street-foods’ (e.g. “akara” and “dodo”), and work long hours in sedentary occupations. Cultural factors also contribute to female obesity, especially in Muslim African societies where female parity is high, and women are discouraged from exercising or leaving home to work or leisure. The biggest nutritional problem in sub-Saharan Africa remains under- nutrition, particularly among children. Relevant interventions include increased agricultural productivity; improvements in food storage, preservation, processing and safety; prevention and effective control of diarrhoeal diseases; community-based growth monitoring standards for children; improved female education, and development of academic expertise in nutrition. For obese adult urban women, useful interventions include changing of cultural norms that tend to normalize obesity; improved nutrition education for women, and regulation of popular fat-rich foods that most poor people subsist on. References 1) Friel S, Chopra M, Satcher D. Unequal weight: equity-oriented policy responses to the global obesity epidemic. BMJ, 2007; 335: 1241-1243. 2) Van der Sande MAB, Ceesay SM, Willigan PJM et al. Obesity and undernutrition and cardiovascular risk factors in rural and urban Gambian women. Am J Public Health 2001; 91: 1641-1644. Competing interests: None declared
Re:Unequal weight equity oriented policy responses to the global obesity epidemic -- Friel et al. 11 April 2009
Paul Z Zimmet, Director of International Research Baker IDI Heart and Diabetes Institute, 250 Kooyong Rd, Caulfield 3162, Australia Send response to journal: Re: Re:Unequal weight equity oriented policy responses to the global obesity epidemic -- Friel et al.	The article by Friel, Chopra and Sackett addresses the very important issue of the social gradient and its role in the determinants of obesity globally. It acknowledges the compexity of the issue in terms of national food supplies, the built environment, transport infrastructure, living and working conditions etc but leaves out one of the most important issues relating to the epidemic. This is the importance of maternal and child health as drivers of the obesity epidemic and as an important part of the solution. There is increasing epidemiological evidence that supports supports a relationship between growth and development during foetal and infant life and health in later years, particularly in relation to obesity, type 2 diabetes and cardiovascular disease. The importance of availability of adequate and accesible maternal and child care is an essential component, in both developing and developed nations, to address the obesity epidemic. It is a major component of the social strategy. Without it, the strategy suggested by Friel et al is incomplete. This is recognised by the World Health Organisation and the Food and Agriculture Organization of the United Nations in their consultation report in 2003:The WHO Report is Diet, Nutrition and the Prevention of Chronic Disease. Competing interests: None declared