Those of us who have been in the healthcare arena for some time have noticed that patients, their families and communities are getting more overweight or obese. The WHO Global Obesity rates (2016) reflect this trend, this with 39% of adults over age 18 being overweight (BMI: 25-29.9) and 13% being obese (>30). This translates to monumental numbers of 1.9 billion overweight people and 650 million obese people in the world today with continued increasing trends. Where once prevalent in high income countries, the overweight and obesity rates are rising 30% higher in low and middle income countries, especially in urban areas. Since 1975, the global obesity rate has tripled and childhood obesity has increased tenfold in forty years in children (5-19 years), now representing 74 million boys and 50 million girls (1).
The Lancet Commission Report (March 2019) has identified the Global Syndemic of Obesity, Undernutrition and Climate Change, where these three epidemics are simultaneously occurring and interacting to produce serious sequelae. The report states that obesity is increasing in every region and no country has successfully reversed it. The World Health Assembly has been addressing obesity unsuccessfully for 30 years due to opposition from the food industry.The health and economic burden of obesity has not swayed enough political will for action in countries. The fight to combat global obesity is in a dire state.
Is there a Syndemic of undernutrition and obesity in Myanmar? Undernutrition for children under five remains a serious concern, presenting with stunting (29%), wasting (7%) and underweight (19%). Stunting is more common in the rural areas (32%) and lower in the Yangon region (20%). Only 1% of children under five are overweight and obesity is not currently a problem for children under 5 (3). Even in 2014, the underweight prevalence in 5-19 year-old children was 39.8% in boys and 33.3% in girls (6). The overweight and obesity rates have more than doubled since 1999, at 13.4% and 2.3% for boys and 9.9% and 5.2% in girls (4,5,6). Although undernutrition is decreasing, our youth are still entering adulthood at higher BMI’s, predisposing them to the health risks of non-communicable diseases.
The newest Global Nutrition report (2018) best identifies the current prevalence and trend from 1999 to 2015. The prevalence of overweight in men increased from 17.72% to 27% and from 11.3% to 21.2% in women,reflecting a 65% increase in men and 53% in women. At the same time, obesity increased from 2.9% in men to 7.3% and from 1.1% to 4% in women, reflecting 39.7% and 27.5% increases. This translates to 7,155,000 overweight and 1,934,000 obese men and 5,591,500 overweight and 1,166,000 obese women; thus, the numbers have increased at an alarming rate.
Obesity trends have been termed “obesity time bombs” with rate increases happeningwith a vengeance over time. The Malaysian overweight rate and obesity rate was 16.6% and 4.4% in 1996 and increased to 30.0% overweight and obesity rate to 17.7 % in 19 years. In 1969, the US obesity rate was 10.7%,doubled to 20.5% in 28 year and doubled again to 38.3% in another 28 years. It may not take Myanmar that much time. In 2015, the World Obesity Federation stated that Myanmar had the fastest rate of adult obesity with a 29.3% increase from 2010-2014 (9).
What are some contributory obesogenic factors and trends which could accelerate overweight and obesity rates? Urbanization is burgeoning with migration from rural to urban areas; urban people tend to adopt sedentary lifestyles. The peoples of Myanmar are walking less, even in the villages and towns, and owning motorcycles and cars is considered a status symbol. Cell phone entertainment results in less active urban and rural communities.
The Myanmar diet is very high in carbohydrate (70% of total calories) with Myanmar people being the biggest consumers of rice (average household consumption of 155.14 kg/year (4, 5). Fat babies and children are considered healthy, cute and cuddly so overfeeding is common. Permissive parenting styles regarding food and the low level of health and nutrition knowledge in families promotes unhealthy food choices (fast food, processed foods/snacks, sweet drinks, candy etc.). Traditionally, being overweight has been a sign of wealth or high social status so being a “little fat” is acceptable.
The influx of expensive foreign fast food restaurants serving processed high sugar/high fat/high sodium foods has createda culture of eating fast food, widely regarded as a status symbol. Whereas our grandmother’s painstakingly prepared home-cooked foods, many families of today are eating convenience food like instant noodles. Our people are eating the “worst foods” with low nutrient quality and moving away from fresh natural foods.
The double burden of malnutrition in communities describes the coexistence of undernutrition, overweight and obesity. Malnutrition in utero and early life in children predisposes them to overweight and non-communicable diseases in adult life (7). Thus, this double burden could cruciallyimpact healthcare resources and costs in Myanmar.
Like other ASEAN countries, the statistics and changing landscape indicate that Myanmar is “on the course” of obesity being a problem. There should be a wake-up call for the government, authorities in education, healthcare institutions/professionals, regulatory bodies, private sector and communities. Alas, will anyone take notice, listen and take action. In other counties, obesity was like a sleeping snake which suddenly woke up to strike.What are we doing about our sleeping but quickly awakening “snake”?
References:
- https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
- Lancet. The global syndemic of obesity, undernutrition and climate change: the Lancet Commission Report. March 2019
- Myanmar Demographic Survey. 2017
- KoKoZaw, Tint SweLatt, et. al. The study of National and Regional levels of obesity in Myanmar. 2009
- Myint, Theingyi: Study on Per Capita Rice Consumption and Ratio of Household Expenditure in Myanmar. 2016
- TintSweLatt, KoKo,et.al. A summary of the Myanmar clinical practice guidelines for the management of obesity. Jour. ASEAN Fed.Stud.Vol 24.No.2, 2011.
- Myanmar Nutrition Global Report.2018
- WHO. Double burden of malnutrition. 2017
https://www.who.int/nutrition/double-burden-malnutrition/infographic_print.pdf?ua=1 - Lancet series.Personal view: obesity in transition. 2019
- DVB. People in Myanmar are getting fatter faster than any other place in the world. 2015
https://coconuts.co/yangon/news/people-myanmar-are-getting-fatter-faster-anywhere-else-world/ - Lum, M. Malaysia is Asia’s fattest country. Health.Aug.14, 2018
Thelma Tun-Thein
B.Sc (Foods and Nutrition), M.Sc (Maternal/Infant Nutrition), Registered Dietitian/Nutritionist, International Board Certified Lactation Consultant, Registered Lactation Consultant (USA)
