Prevention and Control of Obesity: Approaches and Challenges
CHAPTER ONE
PREAMBLE TO THE STUDY
Introduction
Obesity has reached epidemic proportions globally, with the prevalence more than tripling since 1975 (WHO, 2022). In Africa, overweight and obesity rates have witnessed a steep incline in recent decades as countries have undergone nutrition transition from traditional diets to increased consumption of cheap processed foods high in fat, salt and sugar (Abrahams et al., 2011; Ettarh & Ogunniyi, 2015). This rapid nutrition transition, coupled with reduced physical activity, sedentary lifestyles, urbanization and other factors have contributed to escalating obesity in Africa (Ettarh & Ogunniyi, 2015; Ofori Asenso et al., 2016).
The public health implications of rising obesity in Africa are profound. Obesity is a major risk factor for various non-communicable diseases (NCDs) like cardiovascular disease, diabetes, cancer, and musculoskeletal disorders, contributing to morbidity and mortality (Kengne et al., 2012). The social and economic costs are also considerable, from reduced productivity to higher healthcare spending (Kirunda et al., 2015). Tackling obesity is thus an urgent priority in Africa, necessitating comprehensive prevention and control strategies adapted for this context.
LITERATURE REVIEW
Adult Obesity Prevention and Management
Contributing Factors to Obesity
Prevention strategies, which include interventions, can help individuals who are at risk for obesity or already obese. Engaging in physical activity and modifying dietary choices can improve health and severity of chronic disease. Engaging the obese population in exercise can be a challenge, but necessary to improve health outcomes. Educating obese individuals who have chronic illness or are at risk for chronic illness is essential to prevent the progression of disease. Adults belonging to some ethnic groups are at higher risk of obesity than others. The studies reviewed the Latino and African American ethnic groups because these two groups of people are at high risk of obesity and need support. Healthy dietary options for these individuals can be a challenge as these individuals may have limited access to healthy foods and places to exercise. Providing educational opportunities on portion control and healthy eating as well as referrals to available resources to assist with increasing physical activity can be a benefit to these populations in order to prevent obesity (CDC, 2011, Hoelscher et al., 2015, Kisling & Das, 2019).
Managing Obesity Affiliated Chronic Diseases
A self-management exercise program can help people with pre-hypertension and obesity (Tongyichean et al., 2019). There were thirty-two participants in this quasi-experimental study, who were diagnosed with pre-hypertension. Sixteen of the participants were part of the experimental group (self-managed exercise program), and the other sixteen were placed in the control group (conventional treatment). The results of the study showed that the experimental group had improved physical fitness compared to the control group and was able to improve in the following areas: cardiorespiratory fitness, muscular endurance, and flexibility. The study by Tongyichean et al. (2019) supports obesity management in adults and provides evidence for overweight individuals with pre-hypertension who participate in a self-managed exercise program.
Using a commercial weight loss program can help individuals with pre-diabetes lose weight (Marrero et al., 2016). There were 225 people recruited to participate in this randomized control trial, who were diagnosed with pre-diabetes. One hundred and twelve participants followed a “Weight Watchers” plan com- pared to the 113 participants who followed the “Your Game Plan to Prevent Type 2 Diabetes” plan. The results showed that the “Weight Watchers” group lost a significantly larger amount of weight when compared to the “Your Game Plan to Prevent Type 2 Diabetes” group. The study by Marrero et al. (2016), provides evidence supporting the use of “Weight Watchers” to help individuals with pre-diabetes lose weight and manage obesity.
Increasing physical activity and promoting self-regulation, which includes self-monitoring, goal setting, and time management can improve the behavioral effects of obese adults with type 2 diabetes (Silfee et al., 2016). This interventional study with randomization recruited participants by a few methods, including: researchmatch.com, flyers, or newsletters. A total of 23 participants enrolled for the pilot study and were older than 18 years of age.
Approaches for Obesity Prevention and Control
National policies and strategies
Developing national policies and strategies is vital for a coordinated response and accountability. South Africa adopted its first obesity strategy in 2015 focusing on health promotion, improving food environments, treatment access and monitoring (Department of Health, 2015). Mauritius implemented a multipronged plan in 2009 encompassing educational campaigns, nutrition programs, physical activity promotion and engagement with the food industry (Magni et al., 2017). More countries need to formulate comprehensive national strategies aligned with WHO recommendations and local contexts.
Community-based interventions
Community-centered interventions that engage local groups and utilize existing resources have shown effectiveness for health promotion in Africa (Lopez et al., 2016). For obesity prevention, this can encompass communal vegetable gardens and physical activity groups, involvement of village chiefs/elders, culturally adapted education using drama or stories, tapping into social norms of healthy lifestyles, and partnerships with shops/food suppliers to improve nutrition (Lopez et al., 2016).
Leveraging schools and worksites
Schools provide access to large numbers of children and potentially their families, making them an important platform for nutrition education, obesity screening, physical activity programs and modifying food environments cost-effectively (Draper et al., 2010). Worksite wellness initiatives also enable targeted interventions for adults given the amount of time spent at workplaces, an approach applied successfully in South Africa (Puoane et al., 2013).
Conclusion
Obesity is an escalating but under-recognized public health crisis in Africa that necessitates comprehensive preventive strategies adapted for the regional context. Progress will require systematic, coordinated and sustained efforts engaging all sectors of society with strong political commitment and leadership. Tackling obesity offers immense benefits for African countries by averting a looming epidemic of NCDs and associated social and economic costs. Investing in evidence-based, multi-pronged interventions with robust monitoring and evaluation must become an urgent priority across Africa.
References
- Abraham, C., & Nordsieck, M. (1960). Relationship of excess weight in children and adults. Public Health Reports (1896-1970), 75(3), 263–273.
- Abrahams, Z., McHiza, Z., & Steyn, N. P. (2011). Diet and mortality rates in Sub-Saharan Africa: Stages in the nutrition transition. BMC Public Health, 11, 801. https://doi.org/10.1186/1471-2458-11-801
- Abroms, L. C., & Maibach, E. W. (2008). The effectiveness of mass communication to change public behavior. Annual Review of Public Health, 29, 219–234. https://doi.org/10.1146/annurev.publhealth.29.020907.090824
- American College of Obstetricians and Gynecologists. (2020). ACOG Practice Bulletin No. 211 Summary: Critical Care in Pregnancy. Obstetrics & Gynecology, 135(6), 1432–1435. https://doi.org/10.1097/AOG.0000000000003893
- Atun, R., Davies, J. I., Gale, E. A. M., Bärnighausen, T., Beran, D., Kengne, A. P., Levitt, N. S., Mangugu, F. W., Nyirenda, M. J., Ogle, G. D., Ramaiya, K., Sewankambo, N. K., Sturke, R., Vallabhaneni, S., Vollmer, S., & Yudkin, J. S. (2017). Diabetes in sub-Saharan Africa: From clinical care to health policy. The Lancet Diabetes and Endocrinology, 5(8), 622–667. https://doi.org/10.1016/S2213-8587(17)30181-X
- Department of Health Republic of South Africa. (2015). Strategy for the Prevention and Control of Obesity in South Africa 2015-2020. https://www.health-e.org.za/wp-content/uploads/2015/12/National-Strategy-for-prevention-and-Control-of-Obesity-4-August-latest.pdf
- Draper, C. E., de Villiers, A., Lambert, E. V., Fourie, J., Hill, J., Dalais, L., Abrahams, Z., & Steyn, N. P. (2010). HealthKick: A nutrition and physical activity intervention for primary schools in low-income settings. BMC Public Health, 10, 398. https://doi.org/10.1186/1471-2458-10-398
