The Obesity PandemicStrategies to Mitigate its Impact
on the Ghanaian Individual and
the Economy
Delali Hevi, MD
CULTURES BEAUTY AND WELLNESS CENTER
• Board Certified- Obesity Medicine
• Board Certified- Internal Medicine
• Member- American Society of Bariatric
Physicians
• Member- International Association of
Physicians in Aesthetic Medicine
• Member- Obesity Action Coalition
OBJECTIVES
Define Obesity
Outline the scope of the problem
Outline the causes
Zero in on the Ghanaian situation
Offer some suggestions/ solutions for the Ghanaian
situation
True/False Trivia
Disclosures
Definition
Obesity refers to any situation in which you have excess
formation of fat to the extent that it negatively affects
health
Health consequences are;
Metabolic
Biomechanical
Psychosocial
1. Based on BMI
BMI= weight (kg)/ height2 (m)
[weight(lb)/ height2 (in)] X 703
BMI 20-25= normal
BMI 25-30= overweight
BMI > 30= obese
The WHO formally recognized obesity as a global epidemic in
1997
The worldwide prevalence of obesity has more than doubled
between 1980 and 2014
In 2014 more than 1.9 Billion adults were overweight
Impact on Society
Obesity has long overtaken smoking as the #1 cause
of preventable death in America
Obesity costs America about $190 billion a year in
DIRECT health costs.
$139 billion in Indirect health costs
$73 billion a year in lost productivity
Obese individuals spend about
$1,500 more every year on
healthcare
It is estimated that about 1,200
enlisted members have to leave the
military every year because of their
weight
Medical Problems Related To
Being Overweight
Heart Disease; Heart Attacks,
Congestive Heart Failure
Stroke
Diabetes
Hypertension
High cholesterol
Alzheimers Dementia
Medical Problems Related To
Being Overweight
Arthritis
Cancers
Sleep Apnea/ Breathing Difficulties
Fatty Liver
Blood Clots
Depression
Acid Reflux/ GERD
Fat was initially thought to be an inert substance that
just stored energy and kept people warm.
We now know that fat is the largest endocrine organ in
the body- producing more than 100 active substances
of which only 2 are beneficial!!!
Over 100 of these
substances have been
isolated and out of
these only 2 are good
for us!!!!!
What is the general attitude?
If we continue down the current
path, todays generation of children
will be the FIRST generation in
American history to have a life
expectancy that is LOWER than
that of their parents!!!!
THE CAUSES OF
OBESITY
It is much more complicated than
the popular ‘calorie intake vs calorie
output’ theory
To say;
OBESITY= Imbalance of Energy intake vs Energy output
is like saying
CONSTIPATION =Imbalance of food intake and stool
output
What do you think about when
you see an overweight/ obese
person?
LAZY
LACKING SELF CONTROL
DIRTY
SICK
DEPRESSED/ PSYCHOLOGICALLY UNSTABLE
LACKING VISION/ AIM/ DRIVE
WRONG!
WE ARE PROGRAMMED TO
STORE FAT
Several years ago we hunted and
scavenged for food
This was energy expensive
Because of droughts, famines,
weather changes and fluctuation in
availability of food, our bodies
evolved to store as much as possible
in periods of plenty so that the stored
food could be used in the lean
seasons
What happens today?
Over the last about 50 years there has been a rapid change in
quantity/quality of food, as well as quantity of physical
activity
Addictive chemicals are added to our food
Our brains begin to crave this bad food to the point of virtual
addiction!
The Hevi Schema of Weight
Regulation
BRAIN
FOOD
BODY
This illustrates in diagrammatic form the 3 CORE players in the
regulation of our weight.
Each modality influences the other through complex pathways,
and each is affected by outside influences
Some examples of outside influences are;
Advertising, artificial scents, medication (affecting BRAIN)
Weather, altitude, surgery (BODY)
Artificial additives/preservatives (FOOD)
The point is;
REGULATION OF WEIGHT
OCCURS AT A SUBCONSCIOUS
LEVEL
Drugs that cause weight gain
Insulin
Antipsychotics
Beta Blockers
Steroids
Paxil/ SSRI’s
Sulfonylureas
Depakote
Birth control
Lithium
Antihistamines
Statins
The Ghanaian Dilemma
Rapidly adopting the Western diet-seen
as a ‘status symbol’
Viewing the ‘Pot Belly’ as a sign of good
health/success
Cultural practices that encourage women
to gain weight
Ingrained beliefs/ ignorance about
what constitutes a healthy diet
Perception that African men are more
attracted to ‘plump’ or ‘shapely’
women
R B Biritwum et al September 2005Ghana Medical Journal
Data drawn from 2003 World Health Survey on health
status and health system responsiveness.
Weight and height measurements (hence BMI) from a
nationwide random sample of 4231 respondents aged
18 years and older.
Prevalence of obesity in Ghana= 5.5%
Females=7.4%
Males=2.8%
Highest in Greater Accra (16.1%)
Virtually not present in Upper East or
Upper West regions.
By tribe
Ga Adangbe= 14.6%
Ewes= 6.6%
Akans=6.0%
Guan= 2.9%
Nil= 3.1%
Education
Primary completed= 5.5%
Second. Completed= 12.6%
College completed= 11.7%
Post graduate degree= 8.8%
Highest among ages 31-40 (8%)
Lowest among ages 21-30 (2.7%)
Never Married= 1.6%
Currently married= 5.9%
Divorced/Widowed= 7.6%
Prevalence of Overweight and Obesity and
Perception of Healthy and Desirable Body Size in
Urban Ghanaian Women
Benkeser, Biritwum, and Hill
2008/2009 Womens Health Study of Accra Wave 2
2,814 women in Accra > 18 years
Utilized BMI,Waist Circumference, WHR
BMI
Pertinent Findings
3.6% Underweight
31.5% Normal Weight
27.8% Overweight
31.7% Obese
WC >88cm
78.7 % Obese
WHR> 0.8
78.9 % Obese
Age, being married, relative wealth, urban
living, parity>2 correlated with greater
risk of being overweight or obese
Education was not associated with risk of
being overweight
72.2% were dissatisfied with their current body size
41.8% desired a smaller figure
30.4% desired a larger figure
Only 17.7% had actually tried to lose weight before
Controlling for BMI, none of the other parameters measured
had any influence on a womans desire to change her weight
Women growing up in the urban areas were less likely to desire
a heavier body image than their rural peers
SOLUTIONS
SOLUTIONS
1.
Assessment of Current Situation
2.
Political Engagement
3.
Education
4.
Provision of tools necessary to facilitate individual weight
loss efforts
1.
Assessment of Current Situation
 Surveys/statistical analysis
Scope of the problem
Impact on the individual
Impact on the economy
We may be able to extrapolate the impact from data from
developed countries but it would be great to have our own data
2. Political Engagement is necessary for everything to happen
Change requires;
Financial support
Legislation
Regulation
Coal tar and petroleum food coloring
Carageenan
Atrazine
Hormone infused beef and milk
Arsenic laced chicken
Ractopamine in pigs and cows
Bromine in bread and energy drinks
Azodicarbonamide to bleach flour
Olestra in fat free foods
Antibiotic infused meat
Butylated hydroxyanisole/ hydroxytoluene
Antibiotic infused/irradiated meat
Phosphates
All of the above have 3 things in common;
Toxic chemicals used as additives and preservatives in food
Banned in most European Countries
Used legally in (most of) the USA
3. Education
 Healthcare workers through;
CME/ Conferences
Workplace meetings
Curriculum in Medical/Nursing School
1.
Provision of tools necessary to facilitate
individual weight loss efforts
 General Public
Media: TV, Radio, Newspapers
Schools
Provision of tools necessary to
facilitate individual weight loss
efforts
 Education as above
 Make the following available, affordable, and easily
accessible to all;
Healthy food
Weight loss medications/ dietary supplements
Physical activity
Support groups
We must let people know that it is ok to seek
medical advice for weight loss and it is ok to take
medication/ supplements for weight loss if
needed (many people feel it is a sign of weakness
if they do so)
We must remove the stigma!!
Delali Hevi
[email protected]
www.cultureswellness.com
Question
1 calorie of carbohydrate = 1 calorie of fat = 1 calorie of
protein
TRUE or FALSE?
NOT all calories are
created equal !!!
The way our bodies handle calories is
very different
Which is better?
120 calories of bread
120 calories of orange juice
Breakdown
Bread  Glucose + Glucose
Juice  Glucose + Fructose
Juice has over 8 X
more potential to get
converted to fat and
cholesterol than
bread!!
Which is better?
120 calories of pop
120 calories of alcohol
Which is worse?
8 ounces of pop
8 ounces of orange juice
Orange juice is more calorie
dense than pop!
8 oz Coke= 97 calories
8 oz OJ = 110 calories!!
Which is better?
120 calories of fried pork
120 calories of orange juice
Protein and fat do NOT have
any
effect on blood sugar levels and
therefore do not produce an
insulin response
True OR False
Exercise is a
key factor in
losing weight
True OR False
Egg yolk
is bad for
your
health
True OR False
Foods labelled “Low Fat” are the
best for any diet