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By Dr. Colin Alert
For some time, obesity was considered a cosmetic problem, or sometimes just a case of someone whose lack of mental fortitude caused him/her to “let themselves go”. In Bajan lingo, obesity occurred in people who were the two Ls: lazy and lickrish. Sedentary activities, like screen watching, were in vogue – just sit back and relax – and high-calorie foods, including fast foods, runneth over on our meal tables.
When the HIV/AIDS epidemic scared large segments of the population, being “big and fat” was treasured as a sign that you did not have the virus, even though the HIV/AIDS campaign posters stressed that “you can’t tell by looking”. Then calypso singer Captain Sawyer suggested that “big, and fat, and thick” was at least lovable in our womenfolk.
In the early 2000s, even though a couple of international surveys placed Barbados in the top 15 countries of the world with the fattest people, little interest was shown, especially by the medical community. Certainly, it was not widely appreciated that obesity was linked to poorer quality and quantity of life, in particular non-communicable diseases (NCDs).
CARICOM heads of government and ministers of health met in Trinidad in September 2007: “Uniting to stop the epidemic of chronic NCDs”, and formulated the Declaration of Port of Spain. This was a “commitment to action in key areas including risk factor reduction and health promotion; improving quality of care, and the development of appropriate legislative frameworks to provide an all society response to NCD prevention and control efforts”. There was even a specified deadline: “Ministries of Health, in collaboration with other sectors, will establish by mid-2008, comprehensive plans for the screening and management of chronic diseases and risk factors so that by 2012, 80 per cent of people with NCDs would receive quality care and have access to preventive education based on regional guidelines.”
But shortly after this, another chronic disease appeared: Implementation Deficit Syndrome (there is still some debate as to when this actually started; some even suggest that this is not a ‘non-communicable disease’ since it seems to have spread to many government departments).
Prior to 2012, like cigarette smoking and consuming alcohol, obesity was known to be associated with a variety of illnesses, and even cancers. But if cigarette smoking and drinking rum, albeit potentially bad for you, were a personal choice, then obesity could similarly be considered. These aren’t diseases, just bad personal choices. The Ministry of Health put out a slogan: “Your health is your responsibility”, hoping large numbers of the population would heed the call. Despite this, the NCD pandemic expanded rapidly, and it became apparent that thousands of people were suffering and hundreds of people were dying from a broad variety of illnesses related to obesity. Millions of dollars were being spent to treat these diseases, generally in losing battles. We may not get more money for our health (and wellness), but we need more health and wellness for our money.
People were encouraged to “eat less and exercise more”; almost everyone who did this saw a few pounds drop off initially but then returned (many times with interest) a few months later. Multiple medical studies done around the world showed that the “eat less, exercise more” plan does not work for a vast majority of people.
In 2012, the American Medical Association (AMA) put obesity in the disease category. This stimulated more interest in obesity, including new obesity-focused courses in many university medical schools, new research into weight loss strategies and drugs, and even mandated US physicians to treat both the obesity-related complication and the obesity itself if the medical insurers were requested to reimburse the physician for the medical consultation.
The anti-smoking advocates realised that they were up against a billion-dollar industry that embraced a strong desire to hold on to their profits when efforts were made to discourage smoking. Similarly, the high-calorie processed food industries and the sedentary lifestyle industries, which included travel and entertainment, were willing to hold on to their profits and discouraged attempts to reduce obesity-promoting activities.
Even though we have had weight loss drugs around for many years, recent research has brought a new series of effective weight-loss drugs to the market, and, you guessed it, a new billion-dollar industry. These new weight loss drugs are generally so effective that they have been embraced by celebrities and billionaires who are willing to pay thousands of dollars out of pocket for these new medications to become and stay slim. Novo Nordisk, a Danish firm, has become one of Europe’s most valuable companies largely on the back of sales of one of these new anti-obesity medications.
The new anti-obesity medications, belonging to a category of drugs called the GLP-1 agonists, work by activating the receptors of hormones that are naturally released after eating. In turn, this makes you feel full quickly, so (hopefully) you stop eating; the reduced eating can lead to weight loss of up to 20 per cent for some people. A weight loss of 10 per cent or more in obese people is generally associated with health benefits. Drugs that were initially developed for treating diabetes, for example, are now increasingly being used to treat obesity. While rich individuals purchase these drugs to look good, national drug formularies, and even most individuals affected by these obesity-related illnesses, cannot afford them. So it is of little surprise that these drugs are of limited availability to those who really need them.
So while the alcohol manufacturers come up with new combinations and new advertising campaigns in efforts to sell more alcohol, the gap between supply and demand for mental health services grows. While we boast about Brand Barbados alcohol, our mental health officials tell us that four out of every ten people who seek help at our main psychiatric institution do so for an alcohol-related issue. At the same time as the head of our ambulance service publicly pleads for more resources, he notes that there is a surge in the number of motor vehicle accidents requesting ambulance help. [It seems that the implementation of the breathalyser has been affected by the Implementation Deficit Syndrome.]
While our finance officials lament our high national food import bill, our people flock to the supermarket to stock up on processed foods and, in many cases, despite sweetened beverage taxes, many of the same sugar-sweetened beverages. While fast-food delivery vehicles, a phenomenon that suddenly expanded during the COVID-19 lockdowns, crisscross our island delivering fried chicken, hamburgers, rotis and pizzas, among others, our major tertiary hospital, the QEH, pleads for non-life threatening cases to stay away because it is being overwhelmed. Our Ministry of Finance is being called on to provide more and more resources for health and wellness when it is clear that our health is not going well.
Obesity is (no pun intended) a big problem, and a variety of obesity-related illnesses like diabetes, hypertension, heart attacks, strokes, mental health issues and many cancers dominate our health landscape. While eating and exercise activities are part of our lifestyles, big business encourages us to eat more and exercise less, fuelling the obesity pandemic. Our Ministry of Health and Wellness lacks the resources needed to tackle obesity, either in terms of prevention or in terms of providing effective drug treatments. The complications of obesity-related illnesses saturate our Accident & Emergency Department, our hospital wards, and even our cemeteries.
The prevalence of obesity and obesity-related medical complications are both rising rapidly. At present, our manufacturers are committed to profit-making, producing a variety of products and services that fuel our obesity pandemic. We cannot build hospitals or emergency departments/clinics at a fast enough rate to keep pace with our actual medical needs, nor are we presently able to afford the new obesity medications –although as new products come on stream some prices may drop slightly.
When our hospitals ask people to stay away, then we are at some sort of crisis point. All available evidence suggests we need more resources to fight obesity-related issues because resources are being spent on generating obesity.
We need a Plan B. We need not only to do the right things, but we need to do things right.
Family physician Dr Colin Alert, founder-director of the Wellness Clinic, is a former researcher with the George Alleyne Chronic Disease Research Centre of the University of the West Indies.
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