Overweight And Obesity As A Leading Cause Of Diabetes And NCDs. What Needs To Be Done?

Zachariah N. MuriukiNational Diabetes Prevention and Control ProgramDivision of Non-Communicable DiseasesMinistry of Health

Presentation outline

Introduction Causes of overweight and Obesity Approaches to prevent obesity in Kenya

and successes Policy Environment & legal Framework What the private sector can do to prevent

obesity Challenges Way forward

Introduction

Diabetes is a major public health concern in Kenya

Prevalence range between 2.2% in rural areas to 12.2% in urban areas

The prevalence of impaired glucose tolerance is equally high 8.6% in the rural population, and 13.2% in the urban population

Dirk L. Christensen et al, Prevalence of glucose intolerance and associated risk factors in rural and urban populations of different ethnic groups in Kenya. Diabetes Research and Clinical Practice 2009; 8 4: 3 0 3– 3 1 0

Introduction - Obesity

Obesity is defined as an adult having a Body Mass Index (BMI) greater to or equal to 30kg/M2

25% of women of reproductive age (15-49 years old) are either overweight or obese.

The prevalence is even higher in urban areas where 40 percent of women are either overweight or obese

Over a third of women aged 18 years old and older in urban slums are also either overweight or obese

(Global Nutrition report, 2015)

Factors and determinants of overweight & Obesity

•URBANIZATION• Decreased physical activity at work and at home• Less time for food preparation• Affordability of fresh foods in urban environments

• Industrialization of the food production: agriculture to processing• More processed foods: long shelf-life• Rapid growth of supermarkets and fast food outlets•More sophisticated and aggressive marketing and promotion, particularly to children

• Agricultural policies and subsidies • Price and taxation measures• Transportation policies• Urban planning policies (i.e., places for physical activity)

Consumption of unhealthy diets

Consumption of unhealthy diets

Physical inactivity outcomes Countless studies have shown a correlation between physical inactivity

and the following outcomes:

•Depression •Type 2 diabetes •Heart disease •Stroke •Hypertension

•Colon and breast cancer •Osteoporosis •Obesity•Arthritis•Premature death

Approaches to Prevent Obesity - What Needs To Be Done

Approaches to prevent childhood

obesity Promote Exclusive breastfeeding for six months and

continued breastfeeding up to 2 years. Promote Appropriate complementary feeding from

six months. Promotion of growth monitoring and screening for

children less than five years. Promotion of appropriate weight gain in pregnancy

and consumption of healthy meals/physical activity. Nutrition counselling and close monitoring of

expectant mothers to maintain good control during pregnancy. Mothers with GDM have a high probability of giving birth to overweight babies who have a probability of being obese later in life-.

Approaches to prevent obesity

Conduct Social marketing campaigns/media campaigns

Promote healthy Diets and Physical activity policies

Develop Policies influencing the food environment Develop Policies to deter marketing of unhealthy

foods and non-alcoholic beverages to children Promote food labelling Introduce Food taxes and subsidies Promote consumption of fruits an vegetables at

the community.

Analysis of approaches – What the MOH is doing

Social marketing campaigns/media campaigns

Diet and Physical activity policies

Ad hoc mainly media triggered have been going on,

Lobbying supermarkets through the food fortification project to support displays that promote healthy eating

Healthy diets and physical activity guidelines finalised awaiting printing

PROPOSED ACTION CURRENT SITUATION

Analysis of approaches cont.....

Policies influencing food environment

Policies influencing marketing of unhealthy foods and non-alcoholic beverages to children

Fruits an vegetables initiatives

Trans fats regulation – Almost finalised. To follow are salt and fat reduction standards

The food composition table is out dated.

Not in place but there is an urgent need

Incorporated in the guidelines for healthy diets and physical activity.

PROPOSED ACTION CURRENT SITUATION

Analysis of approaches cont......

Food taxes and subsidies

Standards for food

Nutrition labelling

KEBS using codex and in country recommendations

-

Incorporated in the foods and drugs and chemical substances act – needs improvement

PROPOSED ACTION CURRENT SITUATION

Process 2: Policy Environment & legal Framework -

Constitution of Kenya (2010), article 43 - every person has the right to be free from hunger and article 53 - every child has the right to basic nutrition.

National Non-communniclable diseases strategic Plan 2015 – 2020, National Food and Nutrition Security Policy - A multi sectoral policy October

2012 National Nutrition Plan of Action 2012 – 2017, Has Strategic Objective – To

improve prevention and management of diet related non – communicable diseases

Breast Milk Substitutes (Regulation and Control) Act (2012)

Mandatory fortification of cereals and oils passed (June 2012)

Various Policy Statements, Guidelines and Detailed work plans for given nutrition areas developed

Process 2: Policy Environment & legal Framework -

Nutrition sensitive policies, strategies and plans:Vision 2030

National Development and Poverty Reduction (Kenya VISION 2030; and Economic Recovery Strategy for wealth and employment creation 2003),

Agriculture (Agriculture Sector Development Strategy 2010-2015),

Education & Health (National School Health Policy 2009),

Health (Kenya Health Policy 2012-2030)

Comprehensive

national health policy framework

Strategic objective 2: to halt and reverse the rising trends of non communicable diseases.

By;1. Development of National action plan and

strategic plan to prevent and control NCDs2. Conducting nation wide house hold survey on

the risk factors of NCDs and come up with recommendations to address the risk factors

3. Strengthening advocacy for health promoting activities aimed at preventing increased burden of non communicable diseases

National Guidelines for Healthy Diets and Physical Activity

The guidelines have key components including, Healthy diet – The different food groups, healthy

eating plate, food pyramid, packed meals. Food processing and storage – cooking methods, Food and nutrition in institutions – school feeding,

and nutrition education in schools Physical activity for different age cohorts –

younger children, older children and adolescents, adults, elderly and pregnancy.

Healthy body weight – including Body Mass Index, Waist/hip ratio, waist circumference,

What the private sector can do

Regulation of food and beverage production and marketing (Trade, health, industry, communication, justice)

Produce price friendly healthy foods Provide healthy diet friendly work place so that

people make healthy choices of diet. Stock and support display of produce that

promote healthy diets in easy to see areas. Discourage display of foods high in sugars, salt

and highly processed in high movement isles. Support information displays to clients.

Challenges

In the past, very little efforts to promote healthy eating for children above five years. (6 – 18 years)

No population based approaches to prevent childhood obesity.

Lack of multi sectoral approach in prevention of obestity efforts.

Weak linkages with stakeholders in nutrition sensitive interventions.

Inadequate nutrition staff Inadequate government budget to nutrition while

external budgetary support is skewed to the Arid and Semi Arid Lands where only 20-30% of population live, the rest of country having no additional resources for nutrition interventions

Next steps

Contributing to the school curriculum that is currently under review.

Establishing/strengthening multi sectoral efforts to forge a common agenda for reduction of obesity.

Leveraging on strengths of other sectors like gender, education, sports and planning.

Strengthening Advocacy and nutrition profiling for scaling up nutrition – within and across sectors and networks

Developing nutrition financial tracking tool and M&E tools.

Roll out of Nutrition Action Plan in all counties.

GeneticsEnvironment

Unhealthy DietSedentary Lifestyle

Lack of Physical Activity

Factors Contributing to Obesity

Nutrition is Key “Take up your role and act

now”