Behind The Medical Headlines

Obesity in the Caribbean (update)

• Dr R Wright-Pascoe, Consultant, Department of Medicine, University of the West Indies, Kingston, Jamaica

Summary

Obesity in the Caribbean has increased at an alarming rate over the past few decades, far exceeding that among, for example, Black Americans in the United States. Dr Rosemary Wright-Pascoe reports on how medical efforts to reduce obesity have been compounded by a culture in which being overweight and obese are perceived as desirable traits.

Declaration of interests: No conflict of interests declared

‘We remember the fish, which we did eat in Egypt freely, the cucumbers, and the melons, and the leeks, and the onions, and the garlic.’ The Bible, Book of Numbers, Chapter 11 Verse 5.

Introduction

The above recipe for good health was written more than 2,000 years ago, yet today humankind is grappling with an epidemic of obesity. There are now approximately 350 million obese and more than 1 billion overweight people in the world,¹ living in both developed and developing nations. Previously, underdeveloped nations grappled with undernutrition. Now many of these countries are in a transitional state and are dealing with the twin evils of under- and overnutrition. In the Caribbean nations between the 1970s and 1990s, the prevalence of overweight/obesity increased from 7% in men and 20% in women in the 1970s to 22% in men and 58% in women.²

The magnitude of the problem in the Caribbean is expected to increase as weight gain in this population is higher than that seen in Black Americans in the US. For example, the unadjusted weight gained per year by Jamaicans is 1.26 kg for men and 1.28 kg for women. This is four times the rate in Nigeria and the US (0.34 kg per year for men in Nigeria and the US and 0.43 kg per year for Nigerian women and 0.40 kg per year for Black American women).³

Age, gender and obesity

While obesity in Jamaica is seen in all age groups, it is highest in 40–54-year-olds, with the highest mean body mass index (BMI) of 27.7 in the 40–44 years age group.⁴ Abdominal obesity is seen in 36.2% of Jamaicans⁵ and 41% and 45% respectively of women in St Lucia and Barbados.⁶

Future generations are at a high risk of obesity. It has been clearly demonstrated in St Kitts and Nevis, Trinidad and Tobago, and Belize that obese adolescents become obese adults.⁷ Obesity/overweight affects 11% of Jamaican teenagers between the ages of 10–15 years and 35% of those between the ages of 15–18 years.⁸ Whereas previously the obesity rate in children remained steady, since 2000 the proportion of obesity/overweight in children has been increasing.⁸ In Barbados, 3.9% of children are obese.⁷

More Caribbean women are obese/overweight than men. This is evident as early as adolescence, with the disparity in obesity between teenage boys and girls being as high as 76% in Guyana and 47% in St Vincent and the Grenadines. The disparity appears to be related to the cultural preference for a carbohydrate-rich diet for pre-pubescent Caribbean girls.⁷

Development and diet

While in the 1960s there were still insufficient calories available for the Caribbean population, since the 1970s availability has rapidly increased. Today the average fat intake for individuals is 160% of the suggested daily requirement and for sugars, 250%.⁷ The average calorie consumption across the region is 2,800 kcals.² The epidemic has been aided and abetted by the fast food industry, with a proliferation of fast food restaurants throughout the Caribbean. Nine per cent of all food eaten is consumed outside the home.⁸

The transition of agriculturally based societies to service-based ones has taken its toll. In 1994, 30% of Caribbean workers were professionals, clerks or engaged in other service-industry jobs; this figure has now increased to 42%.⁹ Sedentary behaviour is highest among professionals and clerical staff. Thirty-four per cent of adults in Trinidad and Tobago are sedentary, 35% in Jamaica and 56% in Guyana. Leisure-time physical activity in the region is lowest in Trinidad and Tobago.

With development has come increasing mechanisation, a decline in manual labour and improvements in transportation. The number of cars in Jamaica in 1984 was 30,000 and in 2001 it was 160,000 and more.⁹

Risk factors

The increase in obesity is threatening the health and economy of the region. Generalised obesity is a risk factor for diabetes mellitus, and abdominal obesity is an even stronger risk factor for this disease,¹⁰⁵ with 90% of diabetic women having this form of obesity.¹¹ The prevalence of diabetes mellitus in Jamaica has increased from 6.1% in the 1980s to 17.9% in the 1990s. Obesity also predicts blood pressure: the region has a high prevalence of hypertension.¹²

The leading causes of death in the Caribbean are from chronic non-communicable diseases.¹³ It is estimated that the total cost of treating diabetes and hypertension is 10% of the gross domestic product (GDP) of the Bahamas, 5% of GDP for Barbados and 8% for Trinidad and Tobago.¹⁴

Changing policy and practice

In recognition of the significance of chronic non-communicable diseases to the stability of the region (and following the Nassau declaration in 2001 that ‘the health of the region is the wealth of the region’¹⁵), the heads of government of the Caribbean Community and Common Market, which has a combined population of approximately 6 million people, commissioned a task force to propose solutions to the problem.¹⁵ The Caribbean Commission on Health and Development has articulated the needs for compulsory physical education in schools, healthy school meals, a media blitz on the tenets of healthy eating, food security, the elimination of transfat from foods, promoting the indigenous foods of the Caribbean and increasing physical activity across the region.

Each country will have to change its cultural norms. In Jamaica, for instance, more than 25% of obese men and women feel that their weight is acceptable while more than 60% of overweight men and women feel that there are no health risks associated with being obese or overweight.¹⁶ In fact, across the region, obesity/overweight is acceptable and the preference is for babies and females to be plump.

Already some nations have made significant changes. Trinidad and Tobago, for example, has mandatory physical education in schools and now regulates food advertising to children.⁹ Jamaica, meanwhile, has a project aimed at promoting healthy lifestyle changes amongst young people.¹⁷

It behoves us to listen to the prescription for healthy living in the Bible, quoted at the beginning of this article, and ensure these and other measures are taken up for the health of all Caribbeans.

References

1. World Health Organization. Jamaica: Most recent national survey(s) for chronic, noncommunicable disease risk factors.
2. G Alleyne. Social determinants of health.Caribbean Commission on Health and Development; 2005.
3. Durazo-Arvizu RA, Luke A, Cooper RS et al. Rapid increases in obesity in Jamaica, compared to Nigeria and the United States.BMC Public Health 2008; 8:133.
4. Cooper R, Rotimi C, Ataman S et al. The prevalence of hypertension in seven populations of West African origin.Am J Public Health 1997; 87(2):160–8.
5. Ragoobirsingh D, Morrison E, Johnson P et al. Obesity in the Caribbean: the Jamaican experience. Diabetes, Obesity & Metabolism 2004; 6(1):23–7.
6. International Diabetes Federation. Diabetes atlas – prevalence of obesity.
7. Henry FJ. The obesity epidemic – a major threat to Caribbean development: the case for public policies.Cajanus 2004; 37(1): 3–21.
8. Food and Agriculture Organization of the United Nations (FAO). Nutrition country profiles: Jamaica.FAO; 2003.
9. Alleyne G. In his own words: the Caribbean community uses evidence to influence policy.Disease Control Priorities Project; 2007.
10. Sargeant LA, Bennett FI, Forrester TE et al. Predicting incident diabetes in Jamaica: the role of anthropometry.Obes Res 2002; 10792–8.
11. Wright-Pascoe R, Lindo JF. The age-prevalence profile of abdominal obesity among patients in a diabetes referral clinic in Jamaica. West Indian Medical Journal 1997; 46(3):72–5.
12. Forrester T, Wilks R, Bennett F et al. Obesity in the Caribbean.Ciba Found Symp 1996; 201:17–26.
13. Disease Control Priorities Project. 3. The burden of disease and mortality by condition: data, methods, and results for 2001. Table 3.10. The 10 leading causes of death in low-and middle-income countries, by regions, 2001.
14. CARICOM Heads of Government Summit on Chronic Diseases. Presentation of Dr Denzil Douglas, Prime Minister of St Kitts and Nevis.CARICOM; 2007.
15. CARICOM. The Nassau Declaration on Health 2001.CARICOM; 2001.
16. Ichinohe M, Mita R, Kazuko S et al. The prevalence of obesity and its relationship with lifestyle factors in Jamaica.The Tohoku Journal of Experimental Medicine 2005; 207(1):21–32.
17. Jamaican Ministry of Health. National strategic plan for the promotion of healthy lifestyles in Jamaica 2004–2008.Jamaica: Ministry of Health; 2004.