Suzanne Soares-Wynter | Obesity-prevention efforts by no means diluted
Jamaica, like many other countries, has finally taken action to fight the war on obesity. This is necessary if we are to have any hope of controlling the social and financial burdens of related morbidity and mortality.
The fact that the severe forms of childhood malnutrition seen in former years have all but disappeared is testament to Jamaica being adept in solving its own nutritional problems. This was the result of local research into the understanding and treatment of severe malnutrition, as well as education, training, and improved food and health policies.
The recent closure of the malnutrition ward at The University of the West Indies’ Caribbean Institute for Health Research highlights the significance of this achievement.
However, since the early ’80’s, we have slowly transitioned to the other extreme of mal- or ‘bad’ nutrition – obesity.
Across the gamut of well-designed randomised controlled trials and clinic-, epidemiology- and population-based studies, there is overwhelming global evidence about obesity. Sweetened ‘sugary’ beverages, low fruit and vegetable intake, and inactivity remain consistent in negatively influencing obesity and chronic non-communicable diseases.
High salt and sodium intake must also be included. Contrary to popular belief, the effects of other diet variables (for example, portion size, total fat) are not as consistent. Local surveys of Jamaican children and adults show similar trends, and no one seems risk-free. The impact of these unhealthy foods and lifestyles often remains even after controlling for differences in socioeconomic, environment, health or genetic status.
Overwhelmingly, the evidence also shows reduced levels of obesity and malnutrition when children have healthier school environments. These promote increased access to healthier foods while limiting unhealthy foods.
A collaborative and multi-pronged approach is being taken to provide Jamaican schools with more health-promoting environments. Improvements cover both nutrition and wellness and go beyond just curbing access to overly sweetened drinks. Other areas being targeted include nutrition and physical education; standards for the types and portion sizes of meals and snacks that can be sold, provided and marketed to children; as and provisions to secure protection for more vulnerable children.
However, implementation will only be successful when there is wider multisector intervention. Parents, community organisations, and school administrators are key informants, and initial results suggest they are fully in support. It is imperative that the ministry of agriculture and related community organisations are also engaged, as they, too, play an integral role in securing healthy foods.
FOOD SUPPLY AND INDUSTRY
Even the food industry is reactive. As always, hats off to those street vendors who continue to find novel ways to sell fruits and water. (The only caution being that they must comply with safe food-handling requirements.) Given the unhealthy amounts of sugar, salt (sodium) and trans-fats in many packaged foods, kudos may also be given to those manufacturers and distributors who have begun experimenting with healthy reformulations and new products.
As expected, there will always be food industry players who are vehemently opposed. After all, their concerns for public health versus company profits are not equivalent line items. But we must press on. There is no argument strong enough to counter the damages of unhealthy food. It will be unfortunate for those who fail to recognise the global shift by consumers who increasingly demand and require healthier alternatives.
For clarification, the Heart Foundation of Jamaica’s (HFJ) ‘sugary drink’ campaign simultaneously targets the reduction of sweetened beverages and the promotion of the consumption of whole fruits and water. The chosen targets are clearly evidence-based, yet many naysayers have claimed that the messages are “too simple”, that “the problem is not sugar”, or that it is “not stringent enough”.
However, public perception of food and eating behaviours is complex and will always be challenging. Successful weight management requires simple and familiar messages while adopting gradual changes that derive the most benefits.
The HFJ and the government ministries responsible for education and health have certainly increased the public’s awareness of obesity and its causative factors. Other nutrition-related initiatives exist, but these have figured prominently in the media. The efforts are complementary and should augur well for weight management. Undoubtedly, many of us have become mindful of our sugar intake and sedentary behaviours.
There are multiple benefits to reducing sugary drinks and replacing them with whole fruit and water. These include reduced intake of unhealthy excesses such as dietary sugars, ‘empty’ calories, and non-nutritive ingredients (for example, artificial sweeteners, food colouring and preservatives). In contrast, whole fruits and water provide many essential nutrients (for example, fibre, vitamins and minerals), plant-based foods, and appropriate rehydration fluids. They also contribute to feeling fuller, which may help those concerned about eating those ‘too large’ portions.
Promoting physical activity is more challenging, as we are attempting to modify widespread inactivity. Current efforts are designed to increase the public’s awareness of the importance of physical activity and to encourage participation. Potentially, the long-term benefits are increased caloric expenditure, improved functional capacity, and healthier body composition.
These strategies are in keeping with current global, regional and national recommendations. Efforts are taken to craft messages that can be aptly communicated and are adaptable and understood by a variety of audiences. These provide for a wider reach at the population level.
Registered nutritionists and dietitians can be found in all government hospitals and public clinics and in many private clinics islandwide. Several others work in research, policy and education, and there are professional bodies, such as the Jamaica Association of Professionals in Nutrition and Dietetics, where they can be contacted.
As educators, many will assist with presentations, provide guidance, and offer consultation services. The media, other health professionals, social, community and corporate groups and organisations are encouraged to engage these professionals.
The list of potential strategies is by no means exhaustive, and many other facets of nutrition and public health remain to be addressed. However, as “diluted” as these messages seem to appear, we must, as a nation, continue to fight obesity. Our survival depends on it.
Suzanne Soares-Wynter, PhD, is clinical nutritionist at the Caribbean Institute for Health Research. Email feedback to firstname.lastname@example.org.