KARACHI: A risk factor for multiple diseases, obesity is rapidly growing in some sections of Pakistani society and there is an immediate need for awareness campaigns to educate people, particularly those living in cities, about the hazards poor quality street food poses to their health.

This was stated by Prof Zulfiqar Bhutta, founding director, Centre of Excellence in Women and Child Health, Aga Khan University (AKU), on Thursday as he spoke to Dawn in the backdrop of a recently released study led by the World Health Organisation and Imperial College London.

The study, published in The Lancet ahead of World Obesity Day (Oct 11), shows that there has been tenfold increase in the number of obese children and adolescents (aged five to 19 years) in most regions and countries over the past four decades. It also warns that if current trends continue, more children and adolescents will be obese than moderately or severely underweight by 2022.

Local consumption of healthy food like vegetables and fruits has declined because of economic concerns

Despite this rise, the study notes, more children and adolescents are moderately or severely underweight than obese, with the burden of underweight increasingly concentrated in South Asia and Central, East and West Africa.

“The rise in the body mass index (BMI) of children and adolescents has plateaued, albeit at high levels, in many high-income countries, but has accelerated in parts of Asia. There is a need for bridging the disconnect between policies that address underweight and overweight children and adolescents to coherently address the large remaining underweight burden while curbing and reversing the rise in overweight and obesity,” the WHO study says.

Prof Bhutta, who also contributed to the study, replied in the affirmative when asked about how relevant the study is to a country like Pakistan with high poverty figures. He said: “In some sections of [Pakistani] society, especially adolescent girls and women as well as adults, being overweight is a rapidly emerging problem in urban contexts and obesity rate (the worrying type of overweight) is increasing.”

He said that in many settings the quality of processed junk food was very poor, but equally so was the risk posed by street food, as well as local foods which were fried and full of harmful fats.

“So it is not all just ‘foreign foods’. We need much more public awareness of this in cities and also among the population at large. Local consumption of vegetables and fruits has declined because of economic concerns as well,” he pointed out.

In this context, he also referred to a 2015 study which found large social and geographical inequalities in child and maternal nutrition in Pakistan, masked by national and provincial averages.

Titled ‘Geographical and socioeconomic inequalities in women and children’s nutritional status in Pakistan in 2011: an analysis of data from a nationally representative survey’, the study found more women of reproductive age overweight than underweight in 106 districts of the country whereas in 49 of these districts more women were obese than underweight.

The study had used the Pakistan National Nutrition Survey 2011.

It also found that children were better nourished if their mothers were taller or had higher weight, if they lived in wealthier households, and if their mothers had 10 or more years of education. Severe food insecurity was associated with worse nutritional outcomes for both children and women.

By contrast, the study’s findings showed, Punjab had less undernutrition among children than other regions, although it seems to have come at the cost of increased prevalence of overweight and obesity among adult women. A north-south gradient was evident, with the southern districts of Punjab resembling Sindh in socio-economic and malnutrition indicators.

The authors also noted high prevalence of maternal wasting in some of the poorest districts of Pakistan. Stunting prevalence ranged between 22 per cent and 76pc.

While the ill effects of undernourishment on foetal development and the mother herself are well documented, experts have found convincing evidence that being heavier at birth increases the odds that an individual will be overweight or obese as a child — as well as an adult. And the excess weight has been linked to a range of chronic conditions, including asthma, diabetes and metabolic syndrome (a group of metabolic risk factors).

Some researchers have also linked excess body mass index with the risk of a child being born with birth defects.

One of the lead authors of the WHO study, Professor Majid Ezzati of the School of Public Health at Imperial College London, says: “These worrying trends reflect the impact of food marketing and policies across the globe, with healthy nutritious foods too expensive for poor families and communities.

“The trend predicts a generation of children and adolescents growing up obese and at greater risk of diseases, like diabetes. We need ways to make healthy, nutritious food more available at home and school, especially in poor families and communities, and regulations and taxes to protect children from unhealthy foods.”

Published in Dawn, October 13th, 2017