In this opinion piece, Nigerian public health physician Dr Chinedu Anthony Iwu considers some of the challenges to disseminating knowledge of obesity prevention and care in low-and middle-income countries, with a focus on specific cultural barriers in Nigeria, and suggests pathways to overcome these challenges.
Obesity is a pandemic silently creeping into societies that have been battling with the control of communicable diseases and undernutrition. This pandemic, although a public health concern, has not been the focus for many developing countries with poor resources; instead, attention has been significantly dedicated towards the control of communicable diseases including malaria, tuberculosis, diarrhoeal diseases and HIV/AIDS. The common denominator for these communicable diseases is “weight loss.” This perception of weight loss being associated with such diseases has always been a stigmatizing belief in an environment plagued by poverty coupled with poor healthcare services and out-of-pocket healthcare expenditure; and also, where relatively good healthcare is accessible only to those of higher socioeconomic standing in their communities.
The rich, unlike the poor when afflicted with these communicable diseases, are able to access treatment immediately, and therefore, the long-term effect characterised by weight loss is more obvious among the lower socioeconomic class. These sub-groups of the population are often unable to access treatment or receive inadequate treatment during the course of the disease. Over time, this results in a community perception linking weight loss to poverty and overweight to affluence. This perception has persisted in Nigeria, while the trend of obesity has been increasing due to relatively improved socioeconomic factors, rural-urban migration, changes in eating habits and lifestyle, and in general, changes in the overall epidemiological and demographic patterns of the country. The realities of this creeping obesity pandemic and its consequences are yet to take root in our communities as obesity is still considered to be cultural and socially acceptable.
Obesity or overweight, and the associated non-communicable disease consequences, are often taken for granted, particularly amongst the least educated and those of lower socioeconomic class. In Nigeria, and most definitely in other developing countries, these demographics are often more concerned about how society views them, which is usually based on their physical appearance. This outward appearance of a robust individual is translated by the society to mean “financial capability” which affords this individual a level of recognition that provides them easier access to opportunities that ordinarily would not be available.
Furthermore, in some parts of south eastern Nigeria, cultural practices are fuelling the pandemic of obesity where women before marriage are subjected to a process of body fattening which includes a cycle of confinement, force-feeding, recreation and sleeping to the delight and pride of the parents, fiancé and the community, as no eligible man dares marry a girl that is not fattened. In these communities, an overweight bride feels honoured and respected and she is considered healthy, beautiful, and presentable for marriage. It portrays her family as wealthy.
This is the challenging context that we face as obesity care practitioners attempting to forge a pathway in disseminating knowledge and the consequences of obesity. Obesity prevention and care in a society driven by pro-obesity cultural practices proves difficult. This is an environment where a robust individual is considered affluent with societal importance and respect, and where an individual feels comfortable with his or her physical appearance and therefore does not see overweight or obesity as a disease requiring medical attention. This attitude poses a significant challenge in the management of obesity in our country. So in tackling the issues of overweight and obesity, we can begin by taking advantage of the doctor-patient relationship and maximizing the strong bonding relationships that communities have with their healthcare providers, in addition to the counselling opportunities that exist during doctor-patient contacts.
In consideration of this doctor-patient strategy as one way of initiating positive change in pro-obesity cultural beliefs and attitude within our communities, it has become essential to improve the obesity knowledge, counselling, and management skills of doctors. I believe the most immediate and effective pathway for achieving this will be to introduce obesity prevention and management sensitization programs within medical residency training platforms, which would initiate a more impactful, sustainable discourse and practice in obesity management within our environment.
Views and opinions expressed in this article belong solely to the original author and do not necessarily represent the views of the World Obesity Federation.