The ‘double burden’ of undernourishment and obesity in Africa

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Extract from the article: Almost one billion people worldwide are affected by obesity. These are the findings of a study published in the British medical journal ‘The Lancet’ and carried out in collaboration with the World Health Organisation (WHO) to mark World Obesity Day o

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Almost one billion people worldwide are affected by obesity. These are the findings of a study published in the British medical journal ‘The Lancet’ and carried out in collaboration with the World Health Organisation (WHO) to mark World Obesity Day on 04 March 2024.

The epidemic has progressed ‘faster than anticipated’, according to Prof. Francesco Branca, Director of the WHO's Department of Nutrition for Health and Development, at a press conference at the end of February. According to Prof. Majid Ezzati of Imperial College London, one of the main authors of the study carried out by the British medical journal ‘The Lancet’ in collaboration with the WHO, the number of people affected by obesity was initially expected to pass the one billion mark around 2030.

According to this vast study, between 1990 and 2022, the rate of obesity in the population quadrupled among children and adolescents, and doubled among adults. This rate has almost tripled among men and doubled among women. What is even more worrying is that in 2022, this disease will affect almost 160 million children and teenagers (94 million boys and 65 million girls). Some 30 years earlier, the figure was 31 million.

‘Double burden

According to this study, some low- and middle-income countries now have higher obesity rates than many industrialised countries, particularly in Europe. Not eating enough, but also eating badly: many low- and middle-income countries are experiencing the ‘double burden’ of undernourishment and obesity, particularly in Africa. While some of their populations still do not have access to a sufficient number of calories, others no longer have this problem, but their diet is of poor quality.

In 2022, a WHO study, which warned of this ‘time bomb’ for public health, pointed to ten countries particularly affected, most of them in southern Africa: Botswana, Eswatini, Lesotho, Mauritius, Namibia, Seychelles and South Africa. But also, further north: Gabon, Mauritania and Algeria, which holds the record for the highest number of obese people on the continent.

In Togo, 6.2% of the population is obese, according to a study by the Ministry of Health's Department of Non-Communicable Diseases, carried out in collaboration with the World Health Organisation. The World Health Organisation (WHO) has noted that obesity among children under the age of 5 is reaching ‘alarming’ levels in developing countries, particularly in Africa.According to survey data collected from infirmaries in Togo's two public universities, 8% of registered students are reported to be obese and 12% overweight, out of a total enrolment of 50,000.For Dr Raymond Kossi Barruet, Diabetologist (Lomé), obesity is influenced by cultural factors. As long as you're not handicapped in your daily life by your weight, you don't notice it. Obesity is due to stress, a sedentary lifestyle and what Dr Barruet paradoxically calls an improvement in diet. We're eating more and more sweets and starchy foods.Yam-based fufu, maize-based dishes and rice are all taking up a lot of space in our diets these days. All these foods eaten without physical activity tend to make us put on weight.

Specialists are very concerned about the prevalence of obesity in schools, particularly in large cities, where severe, morbid obesity is found in very young children.

Westernised lifestyles

A complex, multifactorial chronic disease, obesity is accompanied by an increase in mortality due to other pathologies, cardiovascular disease, diabetes and certain cancers. The Covid-19 pandemic, in which overweight was a risk factor, is a case in point.Obesity is going to be a risk factor for a number of diseases, in particular arterial hypertension, which is a crucial problem in Africa, says Colette Azandjeme. With the attendant risk of stroke, myocardial fracture and all the other cardiovascular diseases.Obesity, with all its attendant endocrine disruption, is also a major risk factor for cancer.The prevalence of cancer is rising. It's a phenomenon that wasn't very well known a few years ago, but more and more cases of cancer are appearing, particularly female cancers, breast cancers, uterine cancers, male cancers such as prostate cancer and other types of cancer such as childhood cancers.Obesity is also a major risk factor for diabetes. And there are countries with higher prevalence rates, particularly in North Africa and South Africa’.

Obesity primarily affects people living in urban areas, although rural areas are also affected. The finger is pointed at junk food and a sedentary lifestyle. Colette Azandjeme, professor of public health and nutritionist at the Mother and Child Hospital in Cotonou, Benin, believes that one of the causes of obesity is ‘the nutritional transition that has seen our lifestyles change and become more westernised’, she explains.We're moving from a much more traditional diet to a Europeanised, energy-dense diet.We're exposed to increasingly processed and ultra-processed foods’.At the same time, our lifestyles have become more sedentary: ‘there is very little physical activity to compensate for this,’ comments the professor.Over time, we've lost the habit of walking a lot.There are more motorbikes, more cars.We sit in front of the television for longer.We adopt activities that are more bureaucratic: in sales, in commerce, where we sit for longer periods of time’. Add to this a lack of sleep and increased stress. A cocktail that favours an increase in obesity.

Taxing sugary drinks, subsidising healthy foods, limiting the marketing of unhealthy foods to children, encouraging physical activity... According to the WHO, these measures, which are rarely used, could help to slow the spread of this scourge.

William O.