April - May 2008


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Generation Overweight

Are we getting fatter as a nation?

Researcher, lecturer and trustee of the Helen Bhagwansingh Diabetes Education, Research and Prevention Institute at UWI, Professor Dan Ramdath, is well known for his invaluable research in health and nutrition. He has published numerous articles on the subject and is collaborating with local and international Universities and institutions to address the issues of health facing the region.

Q. Are we getting fatter as a nation? Is there a growing trend of obesity in our children?
A. Yes to both questions. We are following international patterns and we are seeing an increase in the number of children that are obese and overweight. In 1999 Dr Martin Guilford and the late Dr Deepak Mahabir measured weights and heights in more than 5000 school children and found that the overall prevalence of overweight was 8.4% and 2.5% of children were obese. More recently we have looked at Trinidadian school children, aged 6-12 years in a national health survey in 2003 and found that 11% were overweight and 6% were obese. This of course is lower than in other Caribbean countries and in America, but it is still cause for concern.

Q. How else can we measure obesity?
A. We use a body mass index…and this gives you an idea of what your weight should be in relation to your height. Your weight in kilograms is divided twice by your height in meters. This can be calculated using an online calculator: www.nhlbisupport.com/bmi/  Normal BMI is between 18-25; if your BMI is more than 25 but less than 30 then you’re overweight and if your BMI is more than 30 then you are considered to be obese. For our population (18-64 yrs) approximately 48% have a BMI greater than 25 (ie. overweight); This is high, but still lower than other Caribbean countries and certainly lower than the U.S. where it is over 60%. We also found that the overall prevalence of obesity (BMI more than 30) was 23% of persons aged 18-64 years old; the gender distribution was 23 % of the women and 12% of the men were obese. Another, more simple, way of measuring obesity is waist circumference and 26 % of the persons in Trinidad and Tobago aged 18-64 years had high waist circumferences. Basically, in men this is a waist or belt size of more than 40 inches and women greater than 35 inches. The frequency of [a wide] waist circumference is quite high and work by UWI graduate students have shown that this is associated with insulin resistance, a precursor to diabetes.

Q. What are the health risks associated with having an increasing waistline?
A. The implication of that is that as your waist circumference increases your risk for diabetes and high blood pressure also increases.

Q. What about things like sugary drinks? And what work is being done to help our kids make the right food and drink choices?
A. I was reading a study this week where they replaced soft drinks in high schools with water and fruit drinks and they found the prevalence of obesity decreased. My collaborators at the University of Saskatchewan were able to successfully implement a province wide programme in which soft drinks were replaced by water, fruit juices and milk. I’m working with the Ministry of Education and the University of Saskatchewan to implement similar programmes in local primary schools. We recently received a research grant from the Pan America Health Education Foundation grant for US $50,000 to look at how health promotion could be implemented in primary schools. What we are going to do with this grant is infuse the primary school curriculum by integrating healthy lifestyles into the curriculum …instead of isolated courses…and conduct workshops to train in the delivery of the educational material followed by an assessment of the impact of these changes to the curriculum…The other aspect is we need to promote a healthy environment to support these changes and that is where the issue of replacing the vending machines etc comes into place. So in the school cafeteria we need to change what is offered to students… One of my graduate students is feeding rats sugar in their drinking water and just by giving one group of rats sucrose, cane sugar, they display symptoms of diabetes.

Q. If a person has a history of diabetes in the family – grandmother, father, brother, aunt – is it inevitable that they too will become diabetic.
A. This is a good question. As a country, as a people, we do not have an overall increased disposition to diabetes. I have looked at the genetic make-up of our population, in particular the deleterious types of genes that are associated with diabetes, and it is not higher than in other populations. Therefore we do not have a higher than normal risk for being afflicted with diabetes or heart disease. I think that the answer to your question is that there is an interaction between what you are and what you eat; that is an interaction between your genetic make-up and your environment….you may have a genetic disposition but until you eat badly or if you do not exercise, then you increase your risk for diabetes. Even in diabetics if you exercise your body is better able to handle sugar. Exercise is not only a major modifiable factor in preventing the disease, but it is also important in reducing complications. And then there is diet of course…You can make informed choices and read labels- for example a serving of curried duck has 600 calories as opposed to 150 in baked chicken. It’s the same thing with shrimp and chicken. Shrimp has a lot more cholesterol and fat compared to chicken, but you do not eat a pound of shrimp whereas you might eat a pound of chicken.

Q. How does our diet compare to other countries?
A. Although as a country we eat a fair amount of fruit and vegetables compared to other countries, we still do not eat enough fruit and vegetables. We tend to have more fried, high fat foods (fast foods) in our diet; this combined with sedentary lifestyles and a decrease in physical activity make one predisposed to putting on weight. We have a culture here where we socialise with food, which is normal; so if a child passes Common Entrance we go out and celebrate …at a wedding… religious function we celebrate with food…We need to make informed choices about healthy eating and one can be guided by the definition of healthy eating which in my opinion, is eating a small amount of a variety of foods. So there is no good food and bad food. A food becomes a bad food when it is eaten in excess (except for fruits and vegetables, of course). For example, olive oil is regarded as having health benefits as part of a Mediterranean diet, so we proceed to fry everything in olive oil. The problem with this is that olive as used in the Mediterranean diet is never heated and is never used for frying. Frying changes the health benefit of olive oil and adds fat and calories to your diet. Remember …..Healthy eating is defined as eating small amounts of a variety of foods.