Mrs. Iwalola Akin-Jimoh, a nutritionist and member, advisory board of the Ovie Brume Foundation speaks on the growing spate of child obesity in Nigeria and its health and psychological implications; even as she urges early preventive measures.
While it might be said that Obesity in children in Nigeria has not reached an alarming stage, it nevertheless calls for concern seeing that cases liter our exclusive private schools; can you give us a current statistics?
I cannot give you any statistics at this point in time, but to say that it is not yet at an alarming rate is something I won’t agree with. It’s quite alarming at this point in time, and the problem of obesity actually takes roots from the way you feed your infant, when the child is born right through the type of diet that the child is weaned on. I mean you can talk about private schools, where it seems to be obvious, but I really think the situation in which we’ve found ourselves needs urgent attention.
There are controversies on whether obesity is a disease in itself or a condition; could you please explain obesity in simple terms?
Obesity is a situation that predisposes somebody to certain other conditions, to certain diseases. For example, if you’re obese, you’re susceptible to high blood pressure, hypertension, cardiac diseases, and diabetes mellitus, particularly in adults. So it’s more like a dangerous condition that predisposes you to other diseases.
Some people take pride in having their children looking chubby, especially at the early stage. What have you got to say to this?
It’s good for a child to look healthy, but he doesn’t have to look overweight. When you have your infant, you should take him through a process called Growth Monitoring at a health centre, where they will measure his weight and height and let you know if he is thriving. If the child is overweight or prone to obesity, they would tell you.
Is there a specific measurement of weight for height for children or even adult?
Yes we do. For adult, you take your BMI and for a child, there is a standardised Growth Monitoring Chart, which is approved by the Federal Ministry of Health and which is actually used in all government health facilities, and approved private health facilities. The chart gives a range of what height is supposed to be for a particular weight. There is a range that tells you a child is healthy, malnourished, underweight and even overweight.
What’s the difference between being overweight and being obese?
When you’re overweight, your Basic Metabolic Index is probably over 25. The Basic Metabolic Index has a formula that you use to calculate it. Many people have questioned the authenticity of the BMI because if you’re familiar with the Nigerian population, you find out that almost everybody is overweight. And when you get to a certain range, you say somebody is obese; and when you get to another range, you say somebody is morbidly obese. The Basic Metabolic Index, which is a relationship between your height and your weight, actually tells if a person falls within any of these ranges. It is important to note here that there are certain tests that are also performed on individuals, because a person may be overweight and his biochemical parameters remain okay. Also, a person may be within the normal weight range, while already showing high cholesterol level. You might also be within the normal weight and already have high blood pressure. It’s just that when you’re obese, it predisposes you to some of these conditions. So once a person is above 40, 45; there is need to continuously check a lot of biochemical parameters in your blood, to see how you’re fairing health-wise.
Obesity also seems to be more common amongst children of the upper-class and middle-class? Why is this?
It’s actually related to diet. If you look at Lagos for example, you’d find that a lot of the upper-class parents are very busy. They don’t pay extra attention to diet and you find that their kids in the morning take cereal, sausage and chips, which is very high in calories diet. In the afternoon, they go for rice and maybe a quarter of a chicken, which is way too much. And in the evening, they go for maybe white bread, egg and sausage again. So the diet that a lot of kids in the upper-class take might actually contain a lot of fat, a lot of sugar and very high carbohydrate diet. Sometimes, it is also very high in protein, way beyond what you need. And when you take too much carbohydrate and protein, it is converted and stored under your skin. So your diet provides enough for you to meet your energy needs, it is excellent. Rather than consuming way more than you need and having it works against you.
Do you then subscribe to the opinion that obesity is more common amongst the rich and upper-class?
Being overweight has nothing to do with your economic class. It has to do with your diet. If you don’t eat right, you have a tendency to have malnutrition, irrespective of your economic class. Malnutrition can be over-nutrition or under-nutrition. Over-nutrition is a category in which we have the manifestation of obesity, which means you’re over-eating. And whether you’re living in Ajegunle or Mushin, if you fall in this category, you have the tendency to become obese. In children, it might not be very obvious, but in adult, it is quite evident. If you look at the Nigerian population; you’d find that people are overweight, irrespective of their economic class. I’m not saying that people are also not undernourished, but when you look at the trend in the last ten years and also project into the next ten to twenty years; you’d find that Nigeria could actually have a population in which a lot of people will actually be overweight, because they’re not just eating right.
The general opinion is that obesity is preventable. How so?
You can actually start preventing obesity right from infancy by breastfeeding your child exclusively for six months; all breast, no water. At least ensure that you do this for the first three months of your maternity leave. Even when you have to go to work, you can still manage by breast feeding them when you are at home; and by extracting and storing when you know you would be at work. Also, you can use weaning milk, peradventure you cannot give your child exclusive breast feeding, and stick to the instruction on the can. Do not give four level spoons, when the instruction says three, just because you can afford it. In any case, no health worker will encourage a mother to raise her child on infant milk, except in health cases such as when the mother is HIV positive etc.
How do you reverse obesity in a child?
To reverse obesity, you need to place the child on a diet, because the truth is your weight is almost 70 per cent of what you put in your mouth and 30 per cent of your physical activities. But you shouldn’t cut back too much on the protein because the child needs protein, but you’re reducing the fat. You shouldn’t cut back too much on the milk because the child needs calcium; you should not cut back on things like legumes, beans and all that, because the child is still growing. And then you want to increase the child’s physical activities. If you can afford it, swimming is actually a very good sport that engages the whole parts of the body and even strengthens the back. You might want to enroll the child in aerobics, dance class and generally increase his/her physical activities. So the child is exercising and also enjoying himself. Even simple exercises like brisk walking will go a long way. So you can use increased physical activities and diet modification to help a child lose weight. Another thing: if your child is used to ice cream, chicken and the likes, you don’t cut it out totally; simply reduce the portion size, otherwise when you turn your back, he goes back and binge on it. For a more effective approach, parents who can afford it should also see a dietician or nutritionist. Virtually all teaching hospitals has departments designated for them. The sooner the issue of a child showing signs of obesity is addressed, the better.
Aside the health implications, there are psychological issues, which seems to even assail obese children much earlier. Do you have experiences to share in this regard?
Of course it affects them psychologically and leads to issues of self-esteem because in a case where they are just one or two looking like that in a class, the tendency is for their mates to call them names such as orobo, facto and all of that. And it cuts through even the public schools, because we do a lot of work with public schools. It might even affect their studies in the long run, because they become too self-conscious. And then during sports there is the issue of performance, in which you might not be able to run as fast as your colleagues or compete generally in physical exercise. This does not necessarily apply academically though. Talking about the female gender, the image that is posted out there whether on the internet or on the television; is the idea that an attractive lady is one who is slim and shapely. And if you’re obese, you don’t tend to fit into this image and it affects the way you look at yourself. And so parents really need to pay a lot of attention to this, so that when their children are obese, they help them get through the difficult period of self worth. The fact that you have only one body and cannot get a spare one in the markets, means that you need to strive to keep it as healthy as possible. Obesity is a condition that you don’t even want to find yourself. You should also cultivate the habit of taking fruits and vegetables. It is bad enough that children don’t like vegetables and fruits; but to now let them perpetrate a diet that is devoid of them means that you’re setting them up for something that will not benefit them in the future. Besides, if you don’t bring them up to take fruits and vegetable, how do they in turn transfer this healthy health habit to their children? Exercise is also key. A lot of parents lay too much emphasis on academic success, such that the child hardly pays any attention to physical exercise of any sort. And that is extremely harmful to a child because a child has a lot of energy. They need to learn how to multi-task and manage their time effectively. An active sports life will also help them avoid sedentary life and help then burn up extra calories and energy even when they over-eat. It is important for a child to start laying the foundation for healthy muscles rather than fatty tissues.
