Key to addressing obesity in Africa lies in education, food systems

Across Africa, the number of men and women living with obesity is increasing annually. All African countries with available data are off track to meet global targets on adult obesity. The latest statistics show that 18.4% of women and 7.8% of men on the continent live with obesity — up from 12% and 4.1%, respectively, in 2000.

Despite this growth, health experts say obesity has failed to gain the attention and affirmative and intentional action needed to achieve control because the food crisis in Africa is usually viewed in the context of undernutrition, malnourishment, and famine.

“Obesity has just not really been understood as a health challenge,” said Johanna Ralston, chief executive officer at the World Obesity Federation.

But with obesity emerging as a critical factor in COVID-19 mortality, an increasing number of key stakeholders have signified interest in addressing the obesity epidemic on the continent.

Though nutrition activists say urgent action is needed, they have also warned that to deal with the crisis, governments must start by reimagining food systems and educating populations.

A lack of understanding

On World Obesity Day last month, a global coalition aiming to drive action on obesity was launched by the World Health Organization, UNICEF, and WOF.

The coalition plans to push for a WHO resolution on obesity and ensure that there is a greater understanding of obesity as a health challenge.

But local organizations in Africa say that this is easier said than done. Dr. Agbo Urudinachi, president at The Obesity Society of Nigeria, told Devex that her organization cannot do much to address obesity until the country has a well-informed population.

“We need to cure the ignorance of the populace for real change to happen,” she said.

Estimates show that by 2025, nearly 4 million Nigerian children ages 5-19 will be living with obesity. The country only has a 1% chance of meeting WHO’s 2025 target of halting the rise in childhood overweight and a “very poor chance” of meeting adult obesity targets for 2025.

Urudinachi said TOSN is currently providing training sessions on obesity for health care professionals, as it is often overlooked in patient management.

“When it comes to the hospital, we doctors in the hospital overlook obesity as a cause of the illness and then just start treating,” she said. “You could see someone who's diabetic and obese. When the person comes to the hospital, usually we don't even treat that obesity; we just give drugs for diabetes.”

She added that nutrition education should also be incorporated into the country’s academic curriculum so that “even if you give them [children] a packet of juice and they look at it and it doesn't have a food label, they will not want to take it,” she said. “They will [instead] say, ‘I want to know the amount of sugar I'm taking in.’”

Limited data and funding

In addition to a lack of understanding, there is also limited nutrition data on the continent. According to the “Global Nutrition Report,” 28 African countries “have insufficient data to comprehensively assess their progress” on nutrition targets. As of 2020, the Food and Agriculture Organization said only seven countries in Africa reported having dietary guidelines.

Body mass index and other key metrics that could provide a clearer picture of overweight and obesity rates across sub-Saharan Africa are often unavailable, WOF’s Ralston said, as a lot of systems that have been set up have been focused on communicable diseases.

Urudinachi added that obesity programs have insufficient funding. Food industry players whose products are driving the obesity epidemic are more influential and better structured, connected, and funded than institutions and local organizations expected to address obesity and bring about desired policy changes, she said.

Even though more than half the countries in Africa have an operational policy, strategy, or action plan to reduce unhealthy diets related to noncommunicable diseases — according to WHO’s Global database on the Implementation of Nutrition Action — they are backed with little action.

Dr. Samuel Oti, senior program specialist in the global health program division at the International Development Research Centre’s regional office for eastern and southern Africa, said African governments need to start playing a more active role in empowering small players with viable and healthy food offerings to survive in highly competitive markets dominated by corporations with unlimited resources.

“We need to incentivize them to focus on healthy and sustainable food, because if we don't do that, eventually they're going to be consumed by the big brands that have a lot of money and a lot of resources and tend to focus on unhealthy, ultraprocessed foods,” he said.

Because nutritious foods are often highly perishable, their prices are largely determined by local productivity and value chain efficiency. According to “The State of Food Security and Nutrition in the World 2020,” the cost of healthy foods is substantially higher in lower-income countries, and low-income countries and lower-middle-income countries — in Asia and Africa in particular — “face relatively higher premiums to move from a nutrient adequate diet to a healthy diet” when compared with other countries.

The time is now to reimagine food systems in Africa and to invest in local ones, Oti said.

“Africa cannot continue with the business-as-usual approach. We should become more proactive, generate evidence, and advocate for the transformation of our food systems,” he said.

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