Addressing the Escalating Issue of Obesity among Nigerian Children

It is not unusual to see plus-sized children waddle alongside their parents in a mart or at a cinema.

Medical experts say childhood obesity is now one of the most serious challenges of public health in the 21st century, particularly in urban areas.

The World Health Organisation defines the condition as abnormal or excessive fat accumulation that presents a risk to health.

A Body Mass Index (BMI) of over 25 is considered overweight, while over 30 is obese. This may differ in relation to the age, sex and height of an individual.

The issue has grown to epidemic proportions, with over four million people dying each year as a result of being overweight or obese, a 2017 report by the Global Burden of Disease showed.

The WHO notes that the rate of overweight and obesity continue to grow among adults and children.

From 1975 to 2016, the prevalence of overweight or obese children and adolescents aged five to 19 years increased more than four-fold from four per cent to 18 per cent globally.

“Obesity is one side of the double burden of malnutrition and today, more people are obese than underweight in every region, except sub-Saharan Africa and Asia.

“Once considered a problem only in high-income countries, overweight and obesity are now dramatically on the rise in low and middle-income countries, particularly in urban settings. The vast majority of overweight or obese children live in developing countries, where the rate of increase has been more than 30 per cent higher than that of developed countries,” the WHO report adds.

Three researchers, Drs Oluwafunmilayo Adeniyi, Gabriel Fagbenro and Foluke Olatona, in a 2020 report, noted that the rate of childhood obesity in some developing countries was as high as that of developed countries.

They added that children in low and middle-income countries were exposed to high-fat, high-sugar, high-salt, energy-dense, and micronutrient-poor foods, which were lower in cost but also, lower in nutrient quality.

For the medics, these dietary patterns, in conjunction with lower levels of physical activity, result in a sharp increase in obesity in children.

In 2013, for instance, the prevalence of overweight and obesity among children in developing countries was documented as 12.9 per cent for boys and 13.4 per cent for girls.

Around this period, an obesity prevalence of 7.5 per cent was reported in schoolchildren aged six to 12 years in the Tamale Metropolis of Ghana, while in Tanzania, a prevalence of 22.6 per cent for obesity and overweight was reported.

In Nigeria, a prevalence of 3.7 per cent was documented in 2007 among school-aged children in Lagos.

However, by 2014, the prevalence of obesity among schoolchildren aged six to 11 years residing in the Lagos Island area had increased to 11.5 per cent.

Adeniyi, Fagbenro and Olatona conducted a cross-sectional study of schoolchildren aged six to 13 years and mothers from two local government areas in Lagos State, using a multi-stage sampling technique.

In all, 440 children, comprising 232 boys (52.7 per cent) and 208 girls (42.3 per cent) were studied. Of these, 29 of the participants (6.6 per cent) were overweight, while 39 of them (8.9 per cent) were obese.

Most of the children (71.2 per cent) consumed root/tubers and processed cereals, while nine (0.02 per cent) and (17) 0.04 per cent consumed fruits and vegetables.

BMI was only significantly related to child age and sex.

In all, 243 mothers (55.2 per cent) had good practices against childhood obesity. Levels of maternal preventive practices were not significantly associated with child BMI.

Watching television and staying idle indoors were the prevalent sedentary activities among the children. These were identified as trigger factors for overweight, and if not controlled, might lead to obesity.

Children, who walked to or from school, were classified into a higher physical activity category than those who used transport to travel to school.

“In this study, the majority of the children were consuming pastries, processed cereals, roots and tubers, while only a few were eating fruits and vegetables.

“The predominant sedentary activities identified in the majority of the children were watching television and staying idle indoors.

“Additionally, the mothers found it difficult to quantify the amount of food their children were actually eating.

“The dietary pattern observed may be related to the socioeconomic status of the children as most of the mothers were in the low-income earning group and a significant proportion were unemployed and had less than secondary school education.

“Low socioeconomic status is known to influence dietary choices such that children from such families are given foods that are cheaper, irrespective of their nutritive values,” the researchers noted.

A public health researcher, Tomiwa Oba, believes that excessive weight gain during childhood can result from several factors, adding that parental influence on the feeding habits of children and dietary intake are important, among others.

“Previous studies have documented a relationship between child Body Mass Index and maternal behaviours, namely restrictive feeding practices, pressure to eat and concern for weight.

“However, there is still a paucity of such studies in school-aged children and their mothers within the Nigerian context.

“Feeding children with calorie-dense foods/fast foods and rewarding good behaviour with food are known to contribute significantly to childhood obesity,” she adds.

Two medical researchers, I.O. Senbanjo and E.A. Adejuyigbe, in an article titled, ‘Prevalence of overweight and obesity in Nigerian preschool children’ submit that in developing countries like Nigeria, a lot of attention is paid to nutrition and assessment of nutritional status in children under the age of five. However, nutrition in school-aged children has received less attention and scrutiny.

According to them, the awareness of obesity, its negative impacts and prevention among mothers are low.

Also, there is a misperception that heavyweight status is possibly a sign of successful parenting.

“Parents play a crucial role in the formation of dietary habits and patterns of physical activity in children, thus failure of parents to recognise obesity constitutes a significant barrier to its prevention.

“There is a need for continuous education and advocacy concerning healthy diet and other preventive strategies against childhood obesity in Lagos, and potentially other parts of the developing world,” the researchers say.

A senior lecturer at the Department of Public Health, Federal University of Technology, Owerri, Imo State, Dr E.T. Oparaocha, says while it is expected that childhood obesity affects only developed, affluent countries, the current trend shows a gradual shift in dimension towards low income and developing countries like Nigeria.

“Although causes of obesity differ intrinsically among nations, the health outcomes appear to be similar, which include renal, cardiovascular, musculoskeletal, respiratory and neurological disorders, as well as psychological and emotional problems. Identified causes in Nigeria include among others, shifts in lifestyle and behaviour, medication, cultural beliefs, taboos, food habits and choices as well as the genetic makeup of individuals.

“Suggested approaches towards control would include timely intervention, health education, lifestyle modification; a shift in bogus beliefs and taboos, as well as change in food habit and food preferences. The role of parents and the media in the control of childhood obesity will also be highlighted,” he added.

Another medical doctor, Dr Jennifer Chudi-Emokai, believes that obesity is more prevalent now due to ‘environmental and lifestyle preferences’.

She says, “In Nigeria, there has been significant progress in improving childhood nutrition. This is due to the intake of our traditional diets with a high intake of cereals and vegetables and a low intake of animal foods as compared to the Western pattern of nutrition, which comprise high intake of animal foods and high energy dent food.

“When the BMI of a child is greater than the average for a child’s age and weight in relation to height, then it is a widely accepted measure to check for overweight and obesity clinically. Other ways to detect obesity include larger than average body size, breathing and sleeping problems and some skin problems.”

Speaking of the risk factors, Emokai says a child’s diet is a ‘very big risk factor’.

She notes that regular intake of high calorie-like fast foods, snacks, sugary drinks and juice, contribute to weight gain and obesity in children.

“Lack of exercise is a contributory factor too, especially in children who spend their time watching TV and playing video games. They’re likely to become obese. This is due to the sedentary activity or lifestyle. There’s the family factor as well. If a child comes from a family of overweight people, they’re more likely to put on weight.

“There’s the socio-economic factor where there’s lack of access to fresh and healthy foods. This can contribute to obesity in children. There are a few cases where some medical illnesses contribute to this,” she adds.

The medical doctor explains that obesity in children is hereditary and about five per cent of childhood obesity is caused by hereditary or defective genes.

She says “One of the best strategies to reduce childhood obesity is to improve the eating and exercise habits of the entire family.”

Another medical doctor, Oluwakemi Olaseinde-Olaitan, on her part, says obesity is on the rise among kids because of increased exposure to Western diets and sedentary lifestyles.

According to her, children now spend lots of time playing games and other indoor activities, adding that childhood obesity can be diagnosed “when a child’s weight-to-height ratio is at or above the 95th percentile of the CDC sex-specific BMI-for-age growth charts.”

She recommends some lifestyle modifications, which include a healthy intake of fruits and vegetables.

“WHO recommends a reduced intake of free sugar. Children should reduce fast food and should eat appropriate portions.

“An energy-restricted balanced diet, in association with patient and parent education, behavioural modification, and exercise can limit weight gain in many pediatric patients who have mild or moderate obesity,” she adds.