A nation struggling to carry its own weight: The obesity crisis

The few older Kenyans who rarely saw a car while growing up in the countryside must be amused at how for some townspeople walking a few kilometres is flaunted as an extraordinary achievement.

For an increasing number of young people with smartphones that have a special feature of tracking the steps they take, covering more than 10 kilometres in a day is a feat worth hanging on their social media pages like a trophy.

Yet, for the oldies who grew up in the countryside spending the whole day in the field hunting, grazing cows, tilling the land or fetching water from the river, walking was just as natural as their heartbeat.

But attracted by an explosion of economic growth and urbanisation, Kenyans have moved to big cities like Nairobi which have big opportunities. Here, they have strived to keep up with its fast-paced life. A lot of them have gotten richer, lived on the fast lane, driven fast cars, and eaten fast foods.

Suddenly, for some, their bodies have got bigger and bigger. And unlike their parents who were afraid of succumbing to underweight, an increasing number of Kenyans today are afraid of dying of complications related to overweight and obesity including heart diseases, Diabetes, Hepatitis-2 and some types of cancer.

The fear is real.

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A 2015 joint survey by the Ministry of Health, Kenya National Bureau of Statistics (KNBS) and the World Health Organisation (WHO) indicates that close to a third of the adult population is overweight or obese. This means that they have a body to mass index (BMI)- a measure of how thin or how thick your body is in relation to your height- of over 25.

A majority of those who are overweight, 38.5 per cent, are women while 17.5 per cent are men.

In the last five years to 2020 when KNBS, the national statistician, began publishing overweight cases reported by various hospitals across the 47 counties, the number has risen nearly three-fold to 169,812 from 60,878 in 2016. But these are diagnosed cases. Tens of thousands of other cases go unreported.

Betty Okere, a nutritionist, cites diabetes cases which have been on the rise but have not been recorded.

“So, if we have 50 people in a room who have been diagnosed, there are another 50 who do not know their status,” says Okere.

The common underlying cause of diabetes- a metabolic disease that causes high blood sugar- is being overweight and leading a sedentary life.

An increase in overweight cases is correlated with an increase in lifestyle diseases, such as hypertension. Official data shows that there were 1.5 million cases of hypertension (a condition in which the force of the blood against the artery walls is too high) among people aged five and above in 2020.

This means that for every 100,000 Kenyans, 3,598 have high blood pressure compared with 740 in 2011.

WHO links 23 per cent of the global cases of high blood pressure to obesity, 44 per cent for diabetes and 41 per cent for cancer.

High blood pressure is commonly described as a silent killer, with deaths from the disease rising to touch a high of 5,799 in 2015 from 4,605 in 2010.

This figure then dropped to 5,353 in 2016- the last period when data is publicly available.

For long people thought of lifestyle diseases as a curse of rich countries such as in the United States of America where obesity was declared a national crisis.

The few cases that emerged from poor countries were often restricted to rich households. And of course, the rich still bear the brunt of lifestyle diseases than the poor in Kenya with data showing that they spend more on medication for diabetes and hypertension than the poor.

Changes in the structure of the economy that has seen a lot of people leave the ‘strenuous’ life of crop growing and livestock rearing for a sedentary lifestyle in major towns where virtually everyone is driven to work and can order for cholesterol-laden French fries and sugar-full soda, even the poor are being ravaged by obesity.

“Everybody is driving around. Nobody is going to the gym, everything has been automated. If you need to watch TV, you pull the remote and you are good,” explains Okere.

Even more critical is how increased urbanisation and the growth of the middle class has spawned “nutritional challenge” in which there consumption of “highly processed food” in most African cities, according to a 2020 status report by the Alliance for a Green Revolution in Africa (Agra).

This, says Agra, a non-governmental organisation affiliated to Bill and Melinda Gates, has led to serious public challenges in the form of overweight and obesity.

Besides eating tonnes of processed food, there has also been increased intake of red meat as people get richer. In the last 10 years to 2020, consumption of meat and meat products has generally been going up, touching a high of 19kg per person in 2018 before it started trending downwards.

However, intake of beef has been declining as more household knock it off their menus with its per capita consumption falling from a high of 14kg per person in 2018 to five kilogrammes in 2020.

“A lot of people do not prefer red meat saying that it makes them sick,” says Hannah Atieno, who has been selling meat since 1994 at Shauri Moyo (Burma) market, Nairobi.

Instead, the rich and some middle class, a 2019 study on meat consumption by the Kenya Markets Trust Society (KMTS) indicates, prefer consuming chicken due to their increased sensitivity to health as well as safety.

Consumption of goat meat, a popular dish at parties especially when roasted, has been on the rise over the last decade. In 2020, a typical Kenyan ate on average, 3.1 kilogrammes of goat meat, an increase of 55 per cent from two kilogrammes in the previous year, official data shows.

Kenyans who find themselves in the fast-paced urban settings tend to be busy to cook traditional dishes such as ugali. Thus, a lot of them have shifted to non-maize processed foods especially those made of wheat.

For example, while the per capita consumption of maize stagnated at 69kg in 10 years, that of wheat and wheat products more than doubled from 16.3kg in 2008 to 41.8kg in 2019. Increased wheat consumption means Kenyans are wolfing down tonnes of sugar-laden cakes, cookies, biscuits, white bread, and pizza.

Kenyans are also drinking a lot of soda which is high in concentrated sugar.

Official data shows that consumption of soft drinks jumped by 62 per cent to 588.5 million litres in 2019 from 363.2 million in 2011.

This means that, compared to 2011 when every Kenyan drank an average of 9.2 litres of soda, this jumped to 12.4 litres three years ago.

Generally, sales of street food, urban snack foods, and franchises selling fried chicken, pizza and other fast foods are growing rapidly in many African cities, notes the AGRA report.

In the less than a decade, Nairobi has been a magnet for American fast food franchises including Kentucky Fries and Chicken (KFC), Burger King, and Domino’s Pizza where residents can order prepared meals in the comfort of their homes or offices via food delivery apps.

Besides bingeing on junk food-foods that have no nutritional value other than giving you a lot of calories which when unused are converted into fat- urbanites are also just too relaxed spending their weekdays in front of the computer while in the office and television or mobile phone while at home.

Over the weekends, a lot of them will be in pubs imbibing alcohol-another agent of overweight.

With the comfort now causing some discomfort, many residents of Nairobi are towards some ‘exhaustion,’ desperate to shed some extra fat.

Some six years ago, there was a reality TV, SlimPossible, in which over-sized contestants were taken through a rigorous 12-week exercise of diet.

Nutritionist Lina Njoroge, one of the creators of the show, told an American website that when they started the programme there was little interest with a lot of people not keen to talk about their weight on national television.

Interestingly, when in 2016 Citizen TV posted on Facebook a story of the winner of Slimpossible’s first season in which a contestant known as Triza walked away with a cash prize of Sh1 million after losing 16 kilograms, not everyone was impressed.

One irate person suggested that the Sh1 million would have been better used to buy relief food.

And therein lies the dilemma for Kenya and many other low and middle-income countries.

It almost appears as though being overweight is a personal choice that needs self-discipline as opposed to deliberate policy decisions.

Ms Okere does not think that being overweight is a personal choice, noting that anyone, including those who live in slums, can be a victim.

Indeed, for the slum dwellers, things tend to change towards the end of the month when they get paid. Vegetables, critical for keeping overweight and obesity at bay, disappear from their dining tables with families only eating beef and chapati. People move around in boda-boda. No one wants the hassle of walking.

As a result, reports have shown that obesity has also emerged in slums.