Pre­vent­ing early death from obe­sity

The UB Post - - Editorial - By JILL STREETEN

Obe­sity has hit al­most ev­ery coun­try world­wide. Even in Mon­go­lia there are many mor­bidly obese peo­ple who will die young if the sit­u­a­tion is not reme­died.

One ex­pects to add a bit of weight over the years, but take a look at the large num­ber of young chil­dren whose weight is al­ready way above nor­mal. They will be bul­lied at school, left out of sport­ing events as too obese to com­pete. They will fall be­hind scholas­ti­cally, be shunned by peers and even­tu­ally will not be ca­pa­ble of ad­her­ing com­fort­ably to adult life. Do par­ents re­ally want to make them mis­fits in so­ci­ety and even­tu­ally risk killing them by over­feed­ing them un­healthy food?

Here is a shock­ing ex­am­ple of what can oc­cur. Two years ago I read alarm­ing statistics show­ing life ex­pectancy for Fi­jians is a mere 55. So I de­cided to work for an NGO which had set up a nu­tri­tional project on the is­land. A les­son should be learnt from this in Mon­go­lia be­fore it is too late and life ex­pectancy is short­ened here too.

It is un­for­tu­nate that the harsh cli­mate of Mon­go­lia dif­fers vastly from that in Fiji, and so does the Mon­go­lian diet. Lit­tle can be done to al­ter that but much can be done to avoid the “bad” food that has crept onto su­per­mar­ket shelves. In par­tic­u­lar, high sugar con­tain­ing food, fizzy drinks and coke should be to­tally avoided.

Sim­ply cut­ting these out, re­duc­ing the size of meals, eat­ing only three reg­u­lar meals a day and re­duc­ing por­tions of food with­out yield­ing to the temp­ta­tion to eat snacks will do much to pre­vent over­weight. How­ever, reg­u­lar ex­er­cise is vi­tally im­por­tant too. Tak­ing a brisk walk ev­ery day, walk­ing in­stead of go­ing by bus, walk­ing up stairs in­stead of tak­ing the lift, and if pos­si­ble, tak­ing up some sport­ing ac­tiv­ity. Two decades ago, in Fiji there was lit­tle obe­sity, but as the coun­try badly needed peo­ple to set up and work in sugar re­finer­ies many were re­cruited from In­dia. The out­come of this was that many who came set up small su­per­mar­kets, where junk food was read­ily avail­able and ea­gerly pur­chased. With an abun­dance of dis­pos­able in­come sent from the younger gen­er­a­tion who had cho­sen to em­i­grate to Aus­tralia or New Zealand, the cus­tom of grow­ing their own crops ceased to be a pri­or­ity. Why bother when there is an abun­dance of ready­made food avail­able in su­per­mar­kets? Fiji peo­ple love to cel­e­brate, sim­i­lar to Mon­go­lians. They will cel­e­brate ev­ery­thing pos­si­ble and a fu­neral wake can last three days. Cel­e­bra­tions are total vil­lage events, with each house­hold mak­ing sure there is no lack of food. No won­der there is a ten­dency to gain weight over the years.

Obe­sity starts to be a prob­lem by the age of forty, and then grad­u­ally dis­eases be­gin to ap­pear. The strain on the heart hav­ing to carry the ex­cess weight can lead to heart at­tacks and death, or strokes, and with the in­creased con­sump­tion of high amounts of sugar, mainly coke and cakes, this leads to an alarm­ing num­ber who suf­fer from type two di­a­betes. A com­pli­ca­tion of this can be lower limb am­pu­ta­tion as a re­sult of poor cir­cu­la­tion caus­ing gan­grene. The suf­ferer is then con­fined to the house, to­tally de­pen­dent on fam­ily for all needs. There is very lit­tle chance of ob­tain­ing a wheel­chair and equally lit­tle or no avail­abil­ity of limb pros­the­sis. By the age of fifty, weight among many has in­creased to around a hun­dred ki­los. Walk­ing be­comes dif­fi­cult due to breath­less­ness and painful joints, made worse by be­com­ing stiff due to pro­longed in­ac­tiv­ity. Sleep be­comes dif­fi­cult, li­bido is low and many suf­fer from de­pres­sion. What then is there left to do other than eat and drink co­pi­ous amounts of fizzy drinks? Small won­der there is no in­cen­tive to go on liv­ing be­yond the age of fifty five! An em­bar­rass­ing prob­lem is in­con­ti­nence due to the ex­ces­sive pres­sure on the blad­der. This, added to the other prob­lems is one more rea­son for not want­ing to ven­ture out­side the house. It is no sur­prise that mar­i­tal har­mony is more than strained. Men openly told me they no longer fancy their obese wives and as a re­sult it is the chil­dren who be­come vic­tims of sex­ual abuse which has be­come an enor­mous prob­lem on the is­land.

The aim of this Nu­tri­tion Project is to of­fer a healthy eat­ing plan to any­one will­ing to par­tic­i­pate. We pre­pared posters show­ing "bad" food and "good" food, em­pha­siz­ing avoid­ing the amount of sugar found in coke and other fizzy drinks. The next step was for a group of six vol­un­teers to visit the vil­lages on the is­land and present ob­jec­tives of the pro­gram. Our aim was not to en­force a diet, but to tai­lor an eat­ing plan suit­able for each in­di­vid­ual. We found all those who were obese were ea­ger to par­tic­i­pate. Our next stage was to bring our team of vol­un­teers to in­ter­view each per­son, to take case his­to­ries and to doc­u­ment de­tails of weight, blood pres­sure, blood sugar lev­els mea­sure­ment of waist, and to record de­tails of life­style and diet. We did not give them ex­act items re­quired to eat but stressed meals should be lim­ited to three a day, that each meal must con­tain protein a small amount of car­bo­hy­drate and an even smaller amount of fat, and that a por­tion should fit in the palm of the hand, not fill the en­tire plate. Lit­tle did I re­al­ize, Fi­jians have very large hands! Suit­able meal times were sug­gested to each in­di­vid­ual, with a small por­tion of fruit to be con­sumed mid­way be­tween each meal, and noth­ing to eat after eight in the evening. We also stressed that ex­er­cise must be in­cluded and to take a walk ev­ery day. To re­lieve the de­pres­sion, we sug­gested vis­it­ing neigh­bors. We also em­pha­sized the need for the whole fam­ily to be in­volved in giv­ing sup­port. We then ar­ranged for the vol­un­teers to visit a cou­ple of weeks later to see if they were man­ag­ing to fol­low the plan or if there were any dif­fi­cul­ties. Two weeks fol­low­ing that visit we would weigh them, check blood pres­sure, blood sugar lev­els and waist di­men­sions. We were de­lighted to find a large num­ber had man­aged to re­duce their weight, but sadly, many re­mained the same. It has also been noted that chil­dren are four cen­time­ters shorter to­day than they were in the pre­vi­ous gen­er­a­tion, so an ef­fort is be­ing made to give talks to school chil­dren, en­cour­age reg­u­lar ex­er­cise pro­grams and to ask them to make their par­ents aware of the need to lead a healthy life­style. We gave out a hun­dred forms to the chil­dren to give to their par­ents hope­fully ob­tain­ing their agree­ment to pro­mot­ing a health­ier diet for their chil­dren. As this is a long term project, it will be some years be­fore we can see if life ex­pectancy in­creases.

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