•Why excessive body fat is harmful during pregnancy and for children
VINCENT KURAUN examines the intricate effects of obesity on people and society in Nigeria, as specialists express concern over the rising occurrence of this health problem in the nation.
For many years, medical practitioners in Sub-Saharan Africa have mainly concentrated on infectious diseases as the main health risks and primary causes of death. However, in the last three decades, this perspective has changed considerably, with more people being identified with long-term, non-communicable conditions.
This phenomenon is primarily due to the increasing impact of Western influences on eating patterns and lifestyle decisions, leading to what is known as the "double burden of disease." This term describes the simultaneous presence of both infectious (contagious) and non-communicable illnesses in the population.
Professionals caution that ailments like obesity, diabetes mellitus, high blood pressure, and several types of cancer, which were previously considered to mainly impact adults, are now emerging as significant issues for children and teenagers.
Once seen as an issue limited to Western countries, obesity is now increasing in cities, towns, and even rural areas throughout Nigeria. This growing trend is fueled by fast urbanization, a decrease in exercise, and the rising intake of high-calorie, processed foods that have become a key part of the contemporary Nigerian diet.
The gravity of the issue is emphasized by statements from a pediatrician and pediatric cardiologist, Dr. Emmanuel Eyo-Ita, who recently spoke with Sunday Tribune, citing a study featured in The Lancet that revealed a remarkable 67.1 percent rise in the number of overweight children between the ages of 5 and 14 in Africa from 1990 to 2021. Shockingly, the obesity rate increased by an astonishing 215.8 percent over the same time frame.
In the future, predictions indicate that these numbers could keep increasing, with forecasts showing an additional 33.3 per cent rise in the number of overweight children and a 140.3 per cent increase in obesity rates by 2050.
A medical professional and champion for public health, Dr Charles Adedamola Adeogun, shared these worries, highlighting the significant health consequences of obesity. "Obesity is not just about physical appearance; it is a condition on its own, strongly linked to hypertension, type 2 diabetes, heart disease, infertility, arthritis, stroke, and certain types of cancer. The most concerning aspect is the increasing rate of obesity among children and teenagers," he mentioned.
He linked this increase to inactive ways of living, long hours spent in front of screens, and unhealthy eating habits, which are putting young people at risk of long-term health issues that were previously common in adults.
In 2024, the World Health Organisation (WHO) emphasized the growing global obesity problem, pointing out that the numbers keep increasing, especially among children, and it has become a major public health issue.
The WHO also mentioned that more than 35 million children under the age of five were projected to be overweight in 2024, with obesity emerging as an issue in low- and middle-income countries too. The WHO highlighted the intricate aspects of obesity, which is associated with noncommunicable diseases, and remains committed to advancing its Acceleration Plan to combat obesity by implementing broad, lifelong, and cross-sectoral policies.
Dr. Adeogun added that the financial impact of this health issue is also immense. Nigerian households allocate millions of naira annually to deal with obesity-related problems, while the country faces the consequences of reduced productivity and rising medical costs. If not addressed, this hidden epidemic will place additional pressure on the already weak healthcare system.
The increasing prevalence of obesity among children
In an interview with the Sunday Tribune, Dr. Eyo-Ita discussed the impact of the Lancet study, stating: “Given the severe effects of obesity, I can describe it as a terrifying entity that is expanding quickly, and we are not ready to deal with it.”
He emphasized that the main reasons for childhood obesity are genetics and lifestyle decisions, while noting the growing recognition of a third influencing factor, the onset of adult diseases during fetal development.
Many genetic conditions can make people more likely to be overweight and obese," he said. "These genetic factors exist irrespective of where someone lives and are only slightly influenced by lifestyle choices. Although they contribute to obesity, they don't fully account for the sharp increase in obesity rates seen over the past few decades.
Dr. Eyo-Ita expanded on the idea of fetal onset of adult disease, explaining that fetuses subjected to starvation or poor nutrition might acquire a metabolic pattern that increases their risk for long-term health issues like obesity, high blood pressure, and diabetes.
He mentioned that this issue has been especially widespread in Nigeria and still presents difficulties for public health at present.
He also highlighted diet and exercise as the two main lifestyle elements that play a significant role in childhood obesity.
Nutrition is the most important factor," he said. "Including unhealthy food or what we call empty calories in a child's daily meals is a certain way to lead to obesity. Moreover, if daily routines involve mostly inactive behavior, this increases the likelihood of gaining excess weight.
He outlined the physical effects of these lifestyle decisions: "If I eat the same quantity of food but burn fewer calories, my body will automatically save the extra energy as fat, in anticipation of a potential 'rainy day.' When these additional calories come from processed foods that the body struggles to use effectively, they are more prone to be stored as fat. If this 'rainy day' never arrives, these fat stores grow, becoming noticeable both in appearance and on the scale."
In reference to childhood obesity, he emphasized the need for parents to be attentive to certain important signs that could indicate possible dangers.
One significant indicator is a child's degree of physical activity," he mentioned. "Children who steer clear of outdoor games, biking, dancing, or any type of active entertainment and instead spend their time watching TV, playing video games, or using tablets may be leading a sedentary life, increasing their chances of becoming obese.
He recommended that parents carefully monitor clothing sizes. He stated, "If parents notice they are buying clothes that are two sizes bigger than what is normally suitable for their child's age, this might be a concerning sign of a tendency towards being overweight or obese."
Emphasizing the importance of active involvement in physical exercises, Dr Eyo-Ita stated: “It is essential for parents to take part in physical activities alongside their children. If a child shows no interest in walking, playing, or other types of exercise, or if they become tired quickly, this might indicate a higher risk of obesity.”
He emphasized the influence of family background on the likelihood of obesity. "A documented family history of obesity should raise awareness. As lifestyle factors are commonly shared among family members, it makes sense that children growing up in similar settings might have a higher chance of encountering obesity-related health issues."
Additionally, when discussing the immediate and lasting health issues related to childhood obesity, Dr. Eyo-Ita pointed out various important worries that parents need to know about.
He said, 'Health is described as a condition of full physical, mental, and social wellness.' 'Obesity significantly influences all these aspects and negatively impacts every organ system in the body.'
He pointed out that the cardiovascular system is especially susceptible, facing substantial risks like hypertension, heart failure, and hyperlipidemia. Furthermore, the endocrine system may also be impacted, resulting in issues such as diabetes, thyroid problems, and challenges associated with puberty and menstruation in females.
The respiratory system faces increased risk as overweight children are more prone to develop obstructive sleep apnea. Additionally, a range of musculoskeletal issues can occur because of added weight, alongside possible deficiencies in essential nutrients. Disturbingly, the incidence of stroke in children is rising, especially when linked with obesity and high levels of lipids.
Regarding psychosocial impacts, Dr. Eyo-Ita highlighted that overweight children are more likely to experience body image issues, face bullying, and encounter negative influences on their school achievements.
"Ultimately, we are raising people who might experience depression, anger, and social isolation," he warned.
He ended with a strong warning regarding the financial consequences of this escalating problem. "As the number of overweight and obese people continues to grow, we can expect an increase in long-term health issues, which will add more pressure to an already overwhelmed healthcare system. This pattern also threatens to keep young individuals out of the workforce because of chronic illnesses like joint difficulties, strokes, and kidney diseases," he stated.
He also promoted the idea that families should take action to stop childhood obesity from an early stage through participation in exercise.
"It is crucial to get children active," he said. "Urge them to go outside and participate in physical activities, similar to how previous generations spent time playing outdoors," Dr. Eyo-Ita mentioned.
He stressed the significance of restricting screen time when outdoor activities are not possible. "Parents need to set clear boundaries on the amount of time children spend watching TV, playing video games, or even reading books. As my teacher once suggested, allow children to feel bored. It's good not to occupy every moment with organized activities; this helps kids develop their own forms of play, which usually include a lot of physical movement," he stated, also pointing out the importance of making thoughtful food decisions.
Dr. Eyo-Ita emphasized that it is not beneficial for parents to consume junk food while hoping their children will adopt healthy eating practices, noting that "This effort must be a family-wide commitment. It's not practical to expect one child to stick to a different meal plan while the rest of the family eats however they want. Everyone in the family needs to be involved in the same program for it to work."
Although I don't object to occasional pleasures, it's important to maintain balance and make sure these indulgences don't turn into a regular part of your eating habits.
In terms of final guidance for parents on preventing obesity and promoting healthy habits for their kids, Eyo-Ita recommended that families "look for information to grasp how much harm is being inflicted on children. Awareness can drive essential changes."
Secondly, recognize that addressing or managing overweight and obesity is a slow and shared process that requires the involvement of the whole family.
Difficulties associated with obesity during pregnancy
To grasp the complexities and impacts of obesity during pregnancy, the Sunday Tribune interviewed a resident doctor from the Department of Obstetrics and Gynaecology at Lagos University Teaching Hospital in Idi-Araba, Lagos, Dr. Margaret Obienu, who stated, "An individual is considered obese if their calculated body mass index (BMI) is 30 kg/m² or higher."
She mentioned that "determining BMI during pregnancy might not accurately reflect morbidity because of higher body water levels. Nonetheless, BMI is still widely used as a method for screening and tracking obesity in pregnant people."
She observed that the effects of obesity during pregnancy are substantial and complex, explaining, "Obesity during pregnancy is a major issue for obstetricians due to the related difficulties and potential complications. Typically, women who are obese have other existing health conditions that may become more severe during pregnancy."
Dr. Obienu highlighted the particular dangers of obesity for both expectant mothers and their infants, stating, “In pregnant women, obesity raises the likelihood of miscarriage, gestational diabetes, gestational hypertension, pre-eclampsia, venous thromboembolism, and early labor. For the baby, there is a higher chance of birth defects, fetal macrosomia along with its associated issues, and early birth.”
She also addressed the difficulties of offering prenatal care to individuals who are obese. "Complications may occur, such as issues with measuring blood pressure because of an absence of properly sized cuffs, problems in conducting obstetric exams to evaluate fetal health, and challenges in carrying out ultrasound scans."
The attending doctor also cautioned about possible issues during labor, saying, “Evaluating the health of both the mother and the baby can be difficult, with a higher chance of prolonged labor, problems in delivering the baby, the necessity for assisted delivery, injuries to the mother and/or child, lack of oxygen around birth, urgent C-sections, heavy blood loss after birth, and suboptimal healing of wounds.”
Dr. Obienu pointed out further difficulties encountered during Caesarean sections, such as issues with moving the patient to the operating room, giving anesthesia, and extended surgical durations.
To handle weight management before becoming pregnant, Dr. Obienu recommended, "Overweight women who want to get pregnant should obtain preconception care to evaluate their health condition and take appropriate actions. These could involve changes in lifestyle such as losing weight, physical activity, and adjustments in diet."
She highlighted the significance of taking folic acid supplements and managing any existing health issues before becoming pregnant, pointing out that proper preconception care can reduce risks during pregnancy.
In reference to prenatal care for women with obesity, Dr. Obienu mentioned, "It is important for obese pregnant individuals to enroll in antenatal care at an early stage. Their treatment should be handled by a team of specialists, including obstetricians, dietitians, physicians, neonatologists, midwives, anesthetists, and other medical experts."
She stated, “For women who are overweight during pregnancy, the ideal weight gain should not exceed 5-9 kg, while those with a normal weight should aim for a gain of 11.5-16 kg.” Dr. Obienu also highlighted the importance of dietary management during pregnancy, suggesting a daily calorie intake of around 1900-2000 kcal.
In conclusion, she addressed the possible long-term health effects on children whose mothers were overweight during pregnancy, emphasizing that these children face a higher likelihood of becoming obese as kids, which could result in diabetes mellitus in the future.
Dietary recommendations
A certified nutritionist, Toluwalope Phoebe Farodoye, also shared insights with Sunday Tribune regarding dietary guidelines for pregnant people facing obesity.
She mentioned, “For this group, nutritional care aims at attaining suitable weight gain during pregnancy, preferably within the advised range of 5 to 9 kg (11 to 20 lb). A well-rounded, controlled-calorie diet is crucial, emphasizing the addition of fruits, vegetables, whole grains, lean proteins, and low-fat dairy items.”
Important approaches involve managing serving sizes, reducing the consumption of extra sugars and saturated fats, and maintaining sufficient intake of vital micronutrients like folate, iron, and calcium.
In her guidance for women who are planning to become pregnant, Farodoye highlighted the significance of following a diet rich in nutrients that ensures adequate levels of essential vitamins. She recommended that women start taking a daily dose of 400 µg of folic acid at least one month before trying to conceive, to help lower the chances of neural tube defects.
Additionally, consuming adequate amounts of iron, zinc, vitamin B12, and essential fatty acids, such as omega-3 and omega-6, is essential for enhancing reproductive health and aiding fetal growth. Farodoye also emphasizes the importance of keeping a healthy body mass index (BMI), refraining from alcohol and tobacco use, and properly managing stress as key elements of thorough preconception care.
When examining the link between diet and obesity, Farodoye highlighted the essential impact of nutrition on this significant public health concern, pointing out that obesity frequently stems from overconsumption of calories, a large intake of sugary drinks and high-energy foods, and a lack of fruits, vegetables, and whole grains.
In response to this trend among children, she suggested various dietary adjustments, promoting well-balanced meals that feature suitable serving sizes, a higher consumption of fruits and vegetables, and a focus on whole grains. Additionally, she encouraged reducing the intake of sweet snacks and drinks and emphasized the importance of regular family meals to promote better eating practices.
Emphasizing the need to cut down on ultra-processed foods and promote healthy eating habits from an early age, Farodoye noted that the first five years play a crucial role in forming dietary patterns. She added that caregivers should not only concentrate on feeding children to make them full but also consider the nutritional value and developmental advantages of every meal.
Regarding the obesity crisis impacting both children and adults, Farodoye highlighted the major influence of processed and fast foods, stating that these choices significantly lead to increased calorie consumption and poor nutrition.
"Marked by elevated amounts of saturated fats, refined sugars, and salt, yet deficient in vital nutrients, processed foods encourage a surplus of energy intake, resulting in weight increase among various groups," she stated.
In response to this rising issue, she suggested a number of family-focused methods to decrease the consumption of these harmful foods, pointing out that the main strategies involve preparing more meals at home, restricting the use of sugary drinks, carefully checking nutritional information, and improving availability of fresh fruits and vegetables.
Regarding nutritious replacements for typical snacks and dishes, Farodoye highlighted that careful swaps can significantly improve family dietary health.
To reduce the intake of sugary drinks, Farodoye recommended water, unsweetened fruit-infused water, smoothies, or low-fat milk as better alternatives. In addition, she advised parents to swap pastries and sweets for fresh fruits, yogurt, or roasted nuts.
These simple and family-friendly alternatives, as she explains, not only enhance feelings of fullness but also boost nutritional value and assist in lowering the chances of obesity.
When discussing how parents can gain a better understanding of suitable portion sizes for children to avoid overeating, Farodoye highlighted the significance of following age-based nutritional guidelines, including the World Health Organization (WHO) growth standards and the My Plate framework. Since children's stomachs are still growing and have limited capacity, it is advised that parents offer small, regular meals that are rich in nutrients, instead of sticking to the conventional three large meals each day.
Farodoye also called on families to focus on nutritious food choices and efficient weight control by implementing thoughtful meal organization.
She highlighted that effective meal planning begins with preparation, especially in choosing healthy food options and creating well-balanced meals ahead of time, noting that families are advised to create weekly menus that include a wide range of fruits, vegetables, whole grains, lean proteins, and beneficial fats. Making a shopping list is essential as it aids in reducing unplanned buys of processed foods.
Moreover, activities like preparing large quantities of food at once and dividing meals into specific servings help maintain regularity and aid in managing serving sizes.
She mentioned that including the whole family in this process, such as establishing consistent meal times and involving kids in cooking, can encourage better habits and support lasting commitment to a well-rounded diet.
When questioned about dietary supplements or functional foods she might suggest for adults facing obesity, Farodoye highlighted that a proper, calorie-regulated diet along with consistent exercise continues to be the fundamental approach for successful weight management.
She explained that although dietary supplements and functional foods can provide supportive advantages, they should not take the place of a well-rounded diet. She further mentioned that supplement use should be customized to target particular nutrient deficiencies instead of being used on a regular basis. In situations where there is a medical need, nutrients like vitamin D, iron, or omega-3 fatty acids can offer substantial benefits.
Furthermore, functional foods containing soluble fiber, plant-based proteins, and probiotics may help increase feelings of fullness and support metabolic well-being; nevertheless, their use should be tailored to individual needs and monitored by a certified registered dietitian or licensed expert to guarantee both safety and effectiveness.
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