I recently visited family friends I had not seen for a while. I was eagerly greeted at the door with warm hugs and lavish compliments about how many extra pounds I had managed to gain since my last visit. Auntie Vida shouted for her husband to “Come see for yourself” as she motherly mentioned that it was imperative for an African woman to maintain her ‘natural curves’ and not succumb to all “the diet craze.” But I secretly made a mental note to immediately cut down on my daily milkshake treats as I caught a glimpse of my portly behind in the mirror. It was a sad realization that for many communities, the battle against such health issues as obesity begins with a transformation of cultural perceptions about weight and status. But why the concern over a few extra pounds?
Disease burden of obesity
There has been a shift from traditional health problems such as infectious and diarrheal diseases to coronary heart disease (CHD), stroke and diabetes as countries industrialize. This transition occurred decades ago in many developed countries as affluence, lifestyle, increased consumption of processed foods and decreased physical activity became the norm.
Despite the amount of health care dollars spent to keep up with the results of these lifestyle choices, CHD continues to be the number one cause of death in developed countries and accounts for over 17 million deaths annually worldwide, according to the World Health Organization (WHO). Unfortunately, as many developing countries industrialize and adopt more western lifestyles, CHD, stroke and diabetes have begun to occur at increasing rates. Studies have shown that one of the most important risk factors for CHD is being overweight or obese. Obesity is a major concern because it is known to significantly increase one’s risk of the following diseases:
- Hypertension (high blood pressure)
- Osteoarthritis (wear and tear of bones and joints leading to pain and limited mobility)
- high cholesterol levels
- Type 2 diabetes (which leads to blindness, kidney failure, limb amputations due to non-healing ulcers, nervous-system diseases and premature death)
- Stroke
- Gallbladder disease
- Respiratory problems and sleep apnea (difficulty breathing while asleep)
- Cancers such as endometrial (lining of the womb), breast, and colon (part of the large intestine)
What does it mean to be obese?
To help standardize definitions of obesity and control for global cultural differences, health providers use a measurement known as the Body Mass Index (BMI). It is a simple calculation that takes into account a person’s weight and height in estimating how much body fat you have compared to the general public. The equation used is:
BMI = (Weight in Pounds) x 703
(Height in inches) x (Height in inches)
Or BMI (using metric) = Weight in Kilograms
(Height in Meters) x (Height in Meters)
Each score obtained is placed into one of the following categories:
Underweight = <18.5
Normal weight = 18.5-24.9
Overweight = 25-29.9
Obesity = BMI of 30 or greater (An easier way to calculate your BMI is to type in your height and weight into this webpage: http://www.nhlbisupport.com/bmi/ )
Obesity trends in women of African descent
Now that we know the basics of BMI calculation, let us turn our focus back to the obesity discussion and try to understand how this relates to us individually but also as women globally. The WHO estimates that over 75% of women worldwide are overweight which includes women in both developed and developing countries. The numbers are similar when you look at the distribution among men.
The WHO also estimates that BMI increases in Africa over the next 10-20 years will account for over 25% increase in heart and stroke-related deaths if no action is taken to reverse obesity trends 1. Ten percent of the population in West Africa is currently believed to be obese! Patterns within each country reveal that women in urban areas are roughly three times more likely to be obese compared to men; women in rural areas on the other hand, are almost five times more obese than their men.
However, when urban women were compared to rural women, the former were twice as obese as the latter2. Several studies have shown a doubling of the number of obese individuals in West Africa over a short period of time and each attributes the rise mainly to women! Here in the US, African-American women have the highest rates of obesity compared to other ethnic groups with four out of every five women being obese. This makes one wonder whether obesity is a genetically linked disease among black women globally or whether it can easily be explained by shared environmental factors.
Causes of obesity
I would like to suggest that gender, genetics and one’s social environment play important roles in obesity patterns amongst women of African descent. The list of possible factors below tries to draw on experiences of women in African countries and the Diaspora.
1. Predisposition of fat deposit around the waistline and hips (fat here is associated with greater risk for CHD than fat deposited in other parts of the body) is a trigger.
2. Women have more body fat than men due to hormonal differences and effects of menstrual cycles.
3. Women experiencing menopause or taking oral contraceptive pills are also more likely to gain weight.
4. Cultural perceptions of wealth, beauty or femininity being viewed as plump, round figures, large hips and breasts – ideas perpetuated by the males in the community who seek women with ‘extra flesh on their bodies.’
5. Cultural perceptions of food and diets. For example, my grandmother always insisted that soup or stew be cooked with ample amounts of oil to taste better. Another erroneous perception was that salad leaves were only edible occasionally and had to be drenched in mayonnaise and salad dressings.
6. Lack of access to regular health care, screening or treatment
7. Lack of money to purchase healthier food options
8. Limited access to a variety of food stores in certain neighborhoods based on social-economic status
9. Limited access to safe areas to exercise or play (an effect of urbanization with busy roads replacing playgrounds or neighborhoods with increased violence)
10. Limited education on obesity, related complications and ways to maintain healthy lifestyles
Shedding those extra pounds
Given WHO’s obesity projections for Africa, steps need to be taken immediately to slow down to facilitate a reverse in trends. Anyone who has ever tried dieting knows how tough it can be to loose weight. But the key is determination – starting with small attainable goals and keeping the big picture rewards in plain sight. For many, the big picture means not having a heart attack or developing diabetes 10 years down the road. It might mean being able to keep up with your children, grandchildren or even spouse during family activities. Or it simply means being able to fit in those nice pair of jeans or dress that you love. Listed below are a couple of simple strategies that might help:
Increase physical activity
Consider walking up your stairs instead of using the elevator each time; park your car further away from the entrance to the mall, shopping center or workplace and walk the extra distance; try to have 30 minutes of cardiovascular exercise everyday.
Change diet
Avoid fast foods or processed dishes; reduce amount of salt, fats and oils in meals; eat smaller food portions; replace sugary drinks with water and fresh fruits; reduce quantity of starchy foods such as rice, bread, pasta, yams, cassava or corn-based foods and increase servings of fruits and vegetables. A quick way to make sure you are getting the right portions is to use the following divided plate suggestion:
Consider keeping a weight diary in which you track your daily weight, meal choices, exercise routines and mood. Note any patterns that might be present such as eating more when you are depressed and try to find other avenues for improving your mood without depending on food.
Try to avoid sliming pills that promise immediate results—most of these have significant side effects, are expensive to use over a long period and you tend to gain all the weight right back once you stop taking the pills.
Finally, I will recommend that you check out the 50 Million Pound Challenge and consider becoming a member for free at http://www.50millionpounds.com/. It is a program started by Dr. Ian Smith, author of the book The Fat Smash Diet, out of his concern for the alarming rates of obesity amongst African-Americans in the US. The goal is to have America as a whole lose 50 million pounds and the website provides diet tips, encouragement, resources, a free challenge kit to help guide and track your progress and the support of other people also taking a stand against obesity.
Do not allow obesity to steal the best years of your life…or that of your loved one!
References
1. WHO: warning on obesity http://www.who.int/mediacentre/news/releases/2005/pr44/en/index.html
2. Abubakari, et al., Prevalence and time trends in obesity among adult West African populations: a meta-analysis Obesity Reviews, Volume 9 Issue 4, Jan 2008. Pg 297 – 311
3. CDC: Overweight and Obesity Facts. http://www.cdc.gov/nccdphp/dnpa/obesity/