“God bless fat child.” (Bus windscreen message – Grenada 1980s, Barbados today)
The Healthy Caribbean Coalition (HCC, website www.healthycaribbean.org) has launched a campaign to reduce childhood obesity, now at alarming epidemic proportions in the region. The HCC is a civil society alliance established some ten years ago to combat non-communicable diseases (NCDs). The mission statement is:
“To harness the power of civil society, in collaboration with government, private enterprise, academia, and international partners, as appropriate, in the development and implementation of plans for the prevention and management of chronic diseases among Caribbean people.”
And the vision is to achieve a reduction in death and disability from chronic diseases among our people. Professor Sir Trevor Hassell, who chairs our own NCD Commission, is the President, and the HCC works closely with governments and academia, especially our Chronic Disease Research Centre and the ERU, UWI, the research of which is informing policy and planning. And studies of childhood overweight and obesity have revealed alarming statistics.
The first studies of obesity and the link with diabetes were carried out by the late Professor Rolf Richards in Jamaica. The first study in Barbados (Fraser and Dotson, 1978) showed dramatic figures for obesity in women attending the outpatients at the Queen Elizabeth Hospital for hypertension and diabetes. The National Nutrition Study (1981) organised by the late Frank Ramsey showed a higher figure for obesity in women than in men, while the Wildey study (Charles, Rotimi and Fraser) a few years later showed an increase in both genders but twice the prevalence of obesity in women compared with men.
What about the children? The ordinary “Eyeball-oscope” – the free diagnostic instrument that keen observers use – was noting many overweight and obese (OWOB) school children. This led Dr. Pamela Gaskin and colleagues to carry out a study of 400 secondary school children between ages 11 and 16 (classes 1 to 5) in four schools. A slightly later study by Dr. Gaskin and colleagues have shown a dramatic increase in overweight and obesity in middle school children between 1981 and 2010, from 8.5 per cent to 32.5 per cent. This work confirmed the widely observed impression using the “Eyeball-oscope”!
Dr. Gaskin set out to describe the prevalence of overweight and obesity and their association with physical activity and associations of weight status with the children’s perceptions of body size, health and diet.
The prevalence of overweight was high – 15per cent in boys and 17per cent in girls – and the gender difference for obesity was much greater – 7per cent in boys and 12per cent in girls. Mothers’ obesity strongly predicted weight status: reporting an obese mother increased the odds of being overweight five-fold!
Physical activity was disappointingly low and predicted higher weight status. It was interesting that overweight subjects tended to misclassify themselves as normal weight and those who misclassified perceived themselves to be of similar health status to children of normal weight.
Clearly there are several factors causing this dramatic increase in overweight and obesity in children. The increase in obesity related diabetes being seen in children is worrying but the implications for an even more massive epidemic of NCDs in adulthood than we presently have to deal with is frightening and the need for more education and creative intervention is urgent.
It’s worth noting that the surveys of the 1980s and ’90s across the Caribbean showed that obesity was closely correlated with the proportion of the population involved in tourism. It was highest in the Bahamas, then the BVI, then Barbados, then Jamaica and St. Lucia. This is not surprising, as tourism workers in general are less physically active and working in the hospitality industry may be associated with lower calorie expenditure and higher intake.
It’s also worth noting that obesity in Britain has increased dramatically in the last 30 years. In the 1980s it trailed the USA and the Caribbean by a long way, but it appears to have caught up. A Nuffield Trust report out this week shows British children to be top of the league in Europe for overweight and obesity (OWOB). The percentage for girls is 29.2 per cent, leading Greece and Portugal, with countries like Sweden at 19.3 per cent and Holland 16.1 per cent. The USA is top, at 29.7 per cent, but we beat them all at 32.5 per cent for boys and girls combined. For boys the figure is 26.1 per cent, somewhat lower, as in Barbados, while Greece, Italy and Portugal lead. The association between lower economic status and obesity is strong, and in a sense Britain has regressed to the health status of a middle income developing country, with health statistics similar to Barbados.
The quotation at top – a proclamation on the buses, which I first noticed in Grenada around 1980 but has recently appeared in Barbados – is ambiguous. It may have been based on a traditional African view that God blesses a fat child, as children were likely only to be fat if not suffering from neither malaria nor sickle cell disease, both endemic in West Africa. There, in some communities, a fat girl was so prized that fattening huts were common, for a bride to be fattened up for the wedding. Today the bus sign would be more appropriate as a prayer for the fat child, who is at such high risk of distressing NCDs.
The HCC initiative is therefore both timely and urgent, and we could set an example for the world. In the words of President Sir Trevor:
“My colleagues and I at the Healthy Caribbean Coalition (HCC) have the privilege to be part of a truly worthwhile and amazing campaign to reduce Childhood Obesity in the Caribbean. Currently, 1 in every 3 Caribbean children is obese or overweight, putting them at risk for diabetes and, in their adult life, for Non Communicable Diseases (NCDs) such as cancer and heart disease, These NCDs are now among the top ten leading causes of death in our region.
As part of our campaign, we have launched a Childhood Obesity Prevention E-petition which we are calling on EVERYONE to sign and to circulate widely via email, Facebook, twitter, whatsapp, et cetera over the next few months.
The HCC plans to present this petition at the upcoming CARICOM Heads of Governments Conference in Jamaica in July – four months away! So we need your support and your signatures!! Please see the link to the petition immediately below: http://www.healthycaribbean.org/yourvoicematters. Also, please send photos to Francine Charles, HCC Communications at Consultant firstname.lastname@example.org of you, your family, workmates or friends clicking on that petition button so that HCC can post them on our Facebook and Instagram pages.
Let’s tell the region’s leaders we want more to be done to protect and save our children! Let’s end Childhood Obesity! Your Voice Matters!”
To echo Sir Trevor’s call, we’re calling on EVERYONE to join this petition, by going on to the website http://www.healthycaribbean.org/yourvoicematters – it really does! A healthy, happy and prosperous future depends on it.
In memoriam: Wednesday April 4th is the 50th Anniversary of the death of Martin Luther King, who ranks alongside Nelson Mandela and Gandhi as the greatest genuine Global Heroes of the last century. It surprises me that he attracts so little attention or celebration in Barbados.
(Professor Fraser is Past Dean of Medical Sciences, UWI and Professor Emeritus of Medicine and Clinical Website: profhenryfraser.com)