Mon | Sep 25, 2017

FIXING HEALTH: Stopping the obesity tsunami before it stops us

Published:Wednesday | October 28, 2015 | 10:00 AMDr Alfred Dawes
Obese persons are as beautiful as anyone else, but they must treat their disease so they can live long, fulfilling lives.
Dr Alfred Dawes, immediate past president of Jamaica Medical Doctors' Association.
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The single biggest threat facing the Jamaican health sector is the obesity epidemic. Having effectively dealt with infectious diseases that wreak havoc in other developing countries, Jamaicans are more likely to die from chronic non-communicable diseases (CNCDs) than infections.

The leading causes of death in Jamaica are cardiovascular disease and cancers. We share this pattern of diseases with our First World neighbours, but we have only a fraction of the resources at their disposal.

Obesity is a disease that is linked to CNCDs and leads to more deaths annually than murders in our bloodiest year. Yet, despite recent enlightenment, we are still doing very little to combat one of the fastest rates of fattening of the population in the world that is found in our country. Already, about 25 per cent of Jamaicans are classified as obese.

Obesity is defined as a body mass index (BMI) of over 30. The BMI is a ratio of our weight to our height, accounting for the fact that taller persons will naturally weigh more than shorter persons. The higher your BMI, the greater your risk of developing CNCDs and dying at an earlier age.

Obese persons use more sick days and have more mental issues, respiratory complications, diabetic complications, hypertension, gastrointestinal problems, cardiac issues, obstetric and gynaecological complications. They are at increased risk of developing almost every common cancer. They have more complications after surgery and do worse following trauma.

In spite of what is said in the name of political correctness, once you are obese, you are unhealthy.

Obesity may not cause any immediate problems, but it is a ticking time bomb. As more and more persons become obese, the strain on the faltering health-care system could one day cause a total collapse.

Battling obesity involves changing prejudices and lifestyles on a national level. Obese persons face significant discrimination and fat shaming that does nothing to help them in their struggles. They reside in a world that is geared towards overconsumption of calories and sabotage of physical activity. This, for many persons living with obesity, results in their present unhealthy state, as they are rendered helpless by their genes.

 

NOT GREEDY

 

Contrary to what many people believe, obese persons are not greedy. In fact, many obese persons eat less than slimmer individuals and still pack on the weight. We know from research that genetics plays a big role. Obese persons store fat more efficiently than slim individuals. They may have a lower metabolic rate, meaning that they need less energy to carry out daily activities, such that the recommended daily allowances for regular individuals, provide too many calories that are stored as fat.

The excess weight leads to difficulty exercising and crash diets that lead to increased weight gain in a vicious cycle.

Once you get to a BMI of 40, you have a five to 10 per cent chance of losing weight and keeping it off at 10 years. This leads to a feeling of hopelessness in the obese individual and acceptance of their fate, playing it off publicly as confidence or through humour. But obesity is a disease that must be prevented and treated like any other ailment. Obese persons are as beautiful as anyone else, but they must treat their disease so they can live long, fulfilling lives. Prevention, on the other hand, is difficult to achieve.

Obesity is a public-health issue. Unfortunately, public health in Jamaica is corrupted by politics. There are clear policies that will reduce the rate of obesity, but require political will to implement.

For instance, sugary drinks are a basically fat in a bottle. Taxes on sugary drinks would decrease their consumption, as they are currently less expensive than healthier alternatives. Unfortunately, when this was attempted in New York and Mexico, there was tremendous backlash, and the politicians wilted under pressure. The banning of trans fats in some Scandinavian countries, however, found greater public support.

The Government must take the initiative as it did with the smoking laws and move to decrease the availability of unhealthy foods that are high in sugar and fat. Forcing restaurants to declare the caloric value of their meals would also allow customers to consider healthier meal options.

 

STOP CELEBRATING OBESITY

 

Public-education campaigns must counteract our cultural practice of celebrating obesity as a mark of financial success and something to be desired. This should be carefully done in a way to also combat the discrimination and ridicule faced by obese individuals.

We do not tease diabetics and cancer patients. Why, then, do we ridicule those suffering from obesity? Only a well-crafted public-education campaign can address these and other issues.

A major part of the treatment of obesity is increased physical activity. Greater emphasis should be placed on physical education in schools and children should be encouraged to play outside.

The lack of green spaces in metropolitan areas is a national disgrace. We need more jogging paths, public parks and public gyms. In Latin America, it is common to see inexpensive but effective exercise equipment placed in parks. These measures encourage exercise to be a part of their cultures, with the result being lower rates of obesity than in North America and the Caribbean.

Weight-loss surgery, although fairly new to Jamaica, is the most effective way of treating obesity, and is one of the fastest-growing fields in medicine. A weight-loss surgery programme must immediately be established in the public-health system, as it is the surest method of losing weight and keeping it off, as well as curing diabetes and other CNCDs.

These measures need a long-term vision and not just planning for an election cycle. The benefits of tackling obesity are not immediately seen, but will lead to a healthier society in the medium to long term. What we now experience with obesity and CNDCs is only the tremors. We must now brace for the coming tsunami.

 

RECOMMENDATIONS

 

- Public-education drive on the dangers of obesity and to combat discrimination against obese persons.

- Decrease the attractiveness of unhealthy foods through sin taxes.

- Increased number of parks and public gyms.

-Prioritise physical activity in schoolchildren.

- Develop weight-loss surgery programmes in the public service.

Send feedback to yourhealth@gleanerjm.com.