The Likely Effect of Obesity on Morbidity in Low-Income Countries - Literature review Example

?Life Span Epidemiology in global perspective: the likely effect of obesity on morbidity in low-income countries The world has been changingrapidly in the last decades. In the past, obesity and relatyed considitions were know as for developed nations. This trend has reversed and many people in the low income countries are also affected by this problem. Governments and health care professionals are all concerned about the problem and are working towards it. Several strategies have been proposed and governmental institutions have proposed reguialtions to address the major causes of the problem. Schools are also trying their best by regulating the type of food students take when they are in schools. At the same time, international organizations like the World Health Organization, Center for Disease Control and other organizations have been working together with local governments and institutioins to address this menace. These organizations together with the local governments are involved in drafting necessary policies, monitoring and evaluating the progress. Introduction Obesity is well recognized by most people in the world today. The condition is risk factors for many diseases and affects adults, teenagers and the children. While obesity in adults and teenagers is well defined, child obesity is a challenge to quantify. Prevalence of childhood obesity varies from country to country. Research indicates that obesity has more effect on the low income countries compared to the high income ones. These countries are in the process of development and have started to adopt western culture. Genetic factors, globalization, urbanization and availability of processed foods has increased the body mass index of the children in the low income countries increasing risks of becoming overweight and obese increasing morbidity and mortality in these countries. Epidemiology of obesity Obesity is one f the primary health hazards in the world today. The measurement to determine whether a person is obese is done using the weight and the height of a person. The weight is divided by the height squared to obtain the body mass index. People with a body mass index of above 30.0 are said to be obese while those with the index between 25-30 are said to be overweight (World Health Orgnization, 2008). As stated above, obesity in children is not easy to determine. Children are constantly growing and the BMI is likely to change from time to time. In that case, BMI in children is determined by growth charts that were prepared by the Center for Disease Control (Cole et al, 2000). Establishing obesity standards in children was important in the determination of the total number of children obese and the number at risk. It was also important to understand the prevalence of the condition in the different countries. Overweight in children is defined at age specific percentile in which 95% BMI percentile is considered overweight and 85-95% percentile is considered risk of overweight in children (Nguyen and El-Serag, 2011). In Europe, data above 85% percentile is considered overweight and data above 95% percentile is considered obese. Researchers also use certain experiments to determine the amount of fat beneath the skin. More fat above the set threshold point is associated with obesity (Dehghan, Danesh and Merchant, 2005). Obesity among children is on the increase just like adults and teenagers. The number of people with obesity has almost doubled from 1980 to 2008. The number of children with obesity has also increased significantly within that time frame in most countries. Only a few countries have reported a decrease in childhood obesity like Russia and Poland (Wang and Lobstein, 2011). There are more than 40 million children considered to be overweight and at high risk of becoming obese. Unlike the previous times when obesity was common problem in the developed countries, obesity has now taken root in the developing and low to medium income countries. Social economic differences in these countries have been found to influence the prevalence of the condition among the children (Wang, 2001). Researchers have found out that children with obesity are likely to be obese later in life. In fact, more than 70% of children obese become obese in adulthood (Black, 2013). These children are also at high risks of myriad diseases and conditions. Recent research indicates that obese and overweight children get type two diabetes which has been known to affect adults only, neurological, pulmonary, endocrine, orthopedic, cardiovascular and gasteroenterological conditions (Han, Lawlor and Kimm, 2010). They are becoming popular among children and the trend is worrying. There has been increased morbidity and mortality among children across the world and obesity and associated conditions are to blame for this (Must and Strauss, 1999). Methodology Data to estimate the number of children overweight and at risk of becoming overweight and obese was based on two facets. One, children from various schools were selected randomly and their height measurement and weight established. The data was used to calculate the BMI of each child and was measured against the known standards of percentile. The data of interest was that which was either above 95% percentile or between 85 and 95% percentile. Estimation of the fat under the skin was also determined. This is based on a simple strategy of folding the skin. The thninner the skin the less fat under the skin and the larger the fold, the more fat there is under the skin. Children with larger skin folds were also found to have higher BMI which was from 85% percentile. Results Basing on these methododolies, more than 40 million were overweight children in the world today, around 30 million are in the developing and low to medium income countries. Table 1 shows that the prevalence has been increasing steadily in the low income countttries. Only about ten million are in the developed countries (World Health Organization, 2013). The number of children at risk of becoming overweight was estimated at 92 million in 2010. Prevalence has increased from 4% in the early 1990s to close to 7% in 2010. The prevalence of obesity in children is expected to reach between 9 and 10% by 2020. Prevalence was found to be higher in low income countries in Africa compared to middle income countries in Asia and across the world. Current prevalence of childhood obesity in Africa is at 8.5% and is expected to reach 12.7% by the year 2020. Prevalence in Asia is 4.6% currently and expected to reach 6.5% by 2020. Despite low prevalence in Africa, the number of children overweight in Asia is much higher. Population in Asia is much higher compared to that of Africa (Onis, Blossner and Borghi, 2010). Literature Prevalence of child Obesity in Low income Countries factors. Ethnicity, culture and lifestyle Every person comes from a certain ethnic group which has its own cultural beliefs and customs. In most societies, children are taught the beliefs and customs from a very tender age. At the same time, they are exposed to the different aspect of the customs through food and perceptions of the society. Most of the people are unlikely to change even when they relocate to other countries. For example, Indians who relocate from India to other countries like United Kingdom or Netherlands and other developed countries are unlikely to change their customs. They will look for the same food they take and even perform their rituals in their homes or in communal places. Research by Dr. Nazleen Bharmal, on the possible impact of religion and obesity indicated that there could be a link between religion and obesity among Asian Indians. It was found out that the very religious Asian Indian Immigrants were close to two times likely to be obese compared to the less religious Indians. Most Asian Indians are vegetarians but are known to take a lot of alcohol, high fat content and refined sugar foods. (Global Indian, 2013). This research was supported by another independent research done on Indians in the Netherlands. The research also confirmed that the customs had an influence on obesity on Indians living there (Hendricks, 2012). Though the research focused mainly on adults, it is certain that the children of the very religious and lowly educated Asian Indians could be at high risk of becoming overweight and obese. After all, they would be taking whatever they are provided with by their parents. Globalization However, it cannot be ignored that there are Indians and people from other developing and low income countries that are willing to embrace change. These people are inspired by the western lifestyle and they start embracing it. Some of the things they have embraced are taking junk foods which have high fat and soluble sugars content. Affordability of such foods was an issue in the past but it is not currently. The world has been changing through globalization and more people in the low to middle income countries are making more money. They can now afford to buy television sets, computers and processed foods from convenient stores (Kearney, 2010). The main driver of change in the low to medium income countries globalization. This includes the development of infrastructure, industries and introduction of companies owned by investors in other countries. Most of this happens in the urban centers which have recorded remarkable growth in the low to medium income countries. Most people in the rural areas are encouraged to move to the urban centers to look for greener pastures. With the availability of money and foreign owned companies and hotels like McDonalds, these people are more likely to take junk and high fat content foods. McDonalds is in almost every middle and developing country in the world today. Where it is not found, there are other equivalents for example McFrys (Ezzatti, et al, 2005). Children in the low to middle income countries are introduced to these lifestyles at a very young age. It is interesting that globalization should lead to development and construction of new healthcare facilities. However, the pace at which health care facilities are provided cannot match the rate at which, globalization and changes in preferences regarding food is changing. The wealthy people in the low to medium income countries can afford the fat rich foods and high sugar content drinks. At the same time, they are likely to engage in alcohol occasionally. These changes in behavior have made the wealthy in these countries to be overweight and obese. This is in contrast to the developed and high income countries where the wealthy are fit and the poor overweight and obese (Popkin, 2011). Poor Nutrition It is interesting to note that most low to middle income countries are heading in the direction of the developed and high income countries. The number of poor people in both urban centers and rural areas becoming overweight and obese is growing very fast. This can be explained by poor nutrition. The poor in the urban centers take the cheap, high fat and sugar content foods. They are cheaper than balanced diet foods. Since most of the people do not have a lot of funds, they prefer to take the cheaper option. At the same time, they cannot afford fruits and vegetables which can reverse the implications of the high fat and sugar content. This explains why soda, processed foods and fast food outlets have been increasing in countries like China, Brazil and India (Monteiro, Conde, and Popkin2007; Astrup, et al. 2008). In fact, as table 2 indicates, there is a high correlation between socioeconomic status and obesity levels in developing countries. A few developing countries have gotten to the list of the countries where people take high fructose dite like China, Mexico and Egypt, Table 3. Overweight and obesity in most rural areas in the low to medium income countries has just been a theory. However, things are changing fast. People in the rural areas are quickly becoming overweight and obese in most low to medium income countries. The main contributing factors are poor nutrition and access to processed foods and high sugar content drinks. Soda for example can be found in even the most remote regions in the world. While soda and refined foods are available, vegetables and fruits are rarely available. If they are available, most people in the rural areas cannot afford. Some of the ethnic groups in some of these countries believe that being fat signifies wealth (Prentice, 2006). Genetics Most people in the low to medium income countries do no understand just how they become more overweight compared to especially Non-Hispanics White. Research indicates that most of the population in the low to medium income countries have genetic predisposition to overweight and obesity. Recent genetic studies indicate that FTO, SNPs and PFKP genes are associated with increased BMI, Hip circumference and weight (Scureti et al, 2007). Mutations in any of these genes may affect the body mass index significantly leading to obesity. Mutation in the FTO gene has actually been studies enough to confirm that it has an effect on obesity (Frayling, et al, 2007). These three factors have a high influence on obesity. Research among minorities in the United Kingdom confirmed that those with bigger waist circumference or waist to hip ratio were at high prevalence to be overweight or obese. In that case, Indians, Pakistanis and Bangladeshi minorities had highest prevalence to obesity in the United Kingdom. Using the body Mass Index, it was found out that Africans had the highest prevalence followed by Bangladeshi and Pakistanis (National Obesity Observatory, 2011). Low Physical Activity Low physical activities contribute a lot to child obesity. Research indicates that most children like watching television when they are at home. Parents nowadays are cautious with their children. They like to keep an eye on them all the time especially for the relatively well up in the low to middle income countries. In fact most parents claim that they would rather have their children watch television or play video games at home than go out and play. Children are likely to take snacks while they are watching television or playing video games (Strasburger, 2011). It has also emerged that most of the advertisements done during normal television programming are related to unhealthy foods. Food producers and hotels are aware that children like trying out the different foods and spend billions of dollars to market to the children and adolescents (Weber, Story and Harnack, 2006; Harris, et al 2009). They inform their parents they would like to take a certain type of food from a certain place as per the television programs. The relatively well up parents in the low to middle income countries usually go extra lengths to make their children happy. As such, they are likely to take their children to take such unhealthy foods. Some children are allowed by their parents to watch as much television as they would like. Some even have television sets and computers in their respective rooms. Such children are likely to change their sleeping patterns which could affect the body leading to obesity (Tremblay and Willms, 2003). At the same time, most parents prefer their children to be taken to school by school buses or they drop and pick them, decreasing their physical activity. It has also emerged that such children do not like to participate in sports. Girls are the most effected in this case. No wonder prevalence of child obesity is high in girls compared to boys (Gordon et al, 2004). Urbanization in the low to middle income countries has led to development of gated communities. Most of them are relatively squeezed and may not have play grounds and parks for the children to play. Even in the gated communities, most of the houses are segregated from the others in which each has a small compound on its own. The small compounds are not enough for the children to do required physical activity (Frenk, 2012). Intervention School-based intervention Schools have a responsibility to reduce the obesity epidemic in the low income countries. Schools can implement physical activity and nutrition classes for the children. They should be taught on all types of food and how they should be combined to make up a balanced diet. Each class should have at least two or three physical activity classes a week. Children should be encouraged to exercise as per the instructions provided by the teacher or physical education trainer. They should also be encouraged to exercise when they are at home and play with other children. Schools that provide meals to the children should ensure that the meals are well balanced to reduce the risks of obesity. Schools should have data on the children BMI and check the progress from time to time (Ebbeling, Pawlak and Ludwing, 2002). Parental intervention at home Family and parents is the role model of healthy eating. They should stock their kitchen shelves and fridges with healthy foods like fruits and vegetable. At the same time, they should ensure that meals cooked are balanced. Parents should detest from taking junk and high fat and sugar content foods. They should also discourage their children from taking such foods at all costs. Parents should have a responsibility of ensuring that their children exercise at least every day. They can prepare a schedule for the children to follow when at home. The schedule should include the waking, television watching, exercise, and meal and sleeping hours. Parents should ensure that their children follow the schedule to the letter (Haby, et al. 2006). Community intervention The community also has a role to play in reducing child obesity. Awareness programs can be organized by communities to educate the society about childhood diabetes, the risk factors and prevention strategies. At the same time, the community can have an influence on the kind of stores that can be established and licensed. A community focused to reduce the prevalence of obesity would license few fast foods and convenient stores and license more groceries and unprocessed foods stores. Some communities in some countries have done this successfully (Moore and Diez 2006). Prevention strategies There are a number of ways child obesity can be fully prevented. It should be ensured that advertising of unhealthy foods is regulated. This is one of the biggest contributors to child obesity in the world today. Regulation can be done by increasing the rates and imposing fines on the advertisements to reduce the frequency. To ensure that the population has access to enough food that is not processed, governments should reform agricultural policies. At the same time, support can be provided to people to farm to ensure there is constant supply of food, fruits and vegetables. The policies drafted should be implemented to once in relation to this subject matter (Gortmaker, et al, 2011). Evaluation The various child obesity intervention and prevention strategies can be effective if they are done appropriately. However, the school, parent and community levels may not very effective. Despite their consistent advocacy for healthy eating, the food related advertisements may derail the children. Of course advertisements are eye catching and most children would want to try them out. Government intervention can really work. Governments have the resources and power to impact on any given industry including the food and agricultural industry. All that would be done is drafting various policies and implementing them, and letting all the affected industries know. This would be the most cost effective way of reducing prevalence to obesity in children. Conclusion The low income countries are experiencing a lot of changes as a result of globalization. These changes have come with increased prevalence to obesity for children and adults. This is associated with the availability of processed foods, change in lifestyle, low physical activity and the availability of convenient stores. Prevalence in obesity is changing among the poor and the wealthy in these countries, but the trend is going towards the prevalence disparities in the developed and high income countries. Prevention strategies from school, parental, societal and governmental level can really assist in reducing prevalence to obesity among the children. Monitoring and evaluation of the various policies and strategies should be followed up keenly to ensure the objectives are met. References Astrup, A, et al., 2008. Nutrition transition and its relationship to the development of obesity and related chronic diseases. Obesity Review, 9 (1), pp.48–52. Black, E.R. et al., 2013. 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