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July 2014
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Isn’t anyone freaking out? He was discernibly disturbed by the figures. He was not the first medic I had heard complain about complacent responses to the numerous studies showing that obesity hasplonked itself down as a Caribbean characteristic and is playing havoc with our lives. At a function celebrating Sir Frank Worrell recently, another doctor was venting about the media’s preference for sensationalism and unwillingness to give prominence to medical issues that were of public importance. He was talking about the range of chronic non-communicable diseases—hypertension, diabetes, asthma, cancer, obesity, cardiovascular ailments leading to heart attacks—licking up the region in numbers higher than anywhere else in the world. We’re doing the research, we’re putting the results out there, he said, gesturing impatiently into the night sky, but nobody is taking it on. What do we have to do to make people realize this is a very real crisis? I’d seen the headlines announcing the news, the study findings, the Ministry of Health’s responses; they were not gripping, and not one had made the front page or topped the television news headline acts. Figures alone are just too bland, and every other day a new study contradicts the last. Yet this story is a dramatic one, with massive dire implications for the future of the region—as massive as the crime bonanza that still runs neck and neck with politics for first place—and at best it can only warrantan also-mentioned space in the news line-ups. Make no mistake, the crime situation, as bad as it is, has become the most topical news because of the public space it is unwisely afforded. What would it take to raise the public profile of the real serial killers among us? Well, for one thing, there was a distinct buzz when Minister of Health,DrFuad Khan, took it upon himself to lead the way in promoting healthier lifestyles among the populace. Taking up office in June 2011, by November he was launching his Fight the Fat campaign as he tried to persuade the public that our obesity figures would be the death of us all. Still, no matter how he preached, citing figures from the National Risk Factor Survey in 2011 that locally, more than 60% of all deaths are due to four major CNCDs: cardiovascular diseases, cancer, diabetes and strokes and that T&T tops the region for CNCD deaths, nobody seemed to be taking it to heart. Undaunted, he pledged to start a project to dissuade people from over-eating MSG, salt and sugar. In March 2012, a report in the Trinidad Guardian referred to the Ministry of Health’s fight against obesity and said it would “involve working with fast-food companies to have more vegetables on their menu and to decrease salt in the foods they sell.” Minister Khan was quoted as saying that “Burger King has worked with us along these lines,” as he described how “they now have more salads and water on their menu,” and that they had been identifying the calorie count for each item. “The Ministry is developing cartoons and videos where healthy foods are heroes and bad foods are the villains. Freddy French Fries will be the villains,” the Minister said. But there has been little done by way of State intervention to impose controls in the food and beverage industry. Who regulates the amount of sugar in those insidious soft drinks? Who is to staunch the torrent of highly processed meats and snacks? What can be done to shift the culture away from the refined carbohydrates such as white flour and white rice? What about controlling the fare in schools—eliminating the junk, expanding the school feeding programme, putting in lunchroom facilities—instilling a different culinary culture? It is true that culture shifts are slow and face much resistance. More than 50 years ago, Dr Theo Poon-King and a research team conducted a year-long survey that ended in July 1962, screening 23,900 people and finding 448 diabetics in T&T. He noted then that diabetes was more common in Trinidad than in North America and Great Britain. Today, the mortality rates from diabetes and cardiovascular disease are higher than in North America (the US and Canada). Dr Poon-King had gone further; past the theory that it was simply a diet high in fats that contributed to the large number of diabetics. He found that it was refined carbohydrates that were the real culprit. “Roti is the root of all evil,” he’d said, stressing that white flour and white rice were the biggest contributors to type 2 diabetes. Identifying obesity and its root was a ground-breaking revelation then, but despite many public education initiatives, little has been done to dent the local desire for roti,bread, bakes, dumplings and all the other white flour treats. There have been some Government initiatives, but they do not appear to have been linked to the health aspect; for example, the National Food Production Action Plan 2012-2015, put out by the Ministry of Food Production(under a previous Minister) has a list of “staples” selected under the food security programme. These were rice, dasheen, cassava, eddoes, sweet potatoes and breadfruit—a list that would have pleased Dr Poon-King—but they were selected on the basis of a goal to reduce imported staples. The Government website in 2013 noted that with the “food import bill hovering at over US$2b, the consumption of root and tuber crops is assuming greater importance in the diet of all Caribbean peoples, as imported carbohydrates, such as flour and rice continue to escalate.” And even that same year when the The Trinidad and Tobago Agribusiness Association (TTABA) gave out 38 contracts to farmers to give them 120,000 lbs of cassava to produce the TTABA Farmers Bread brand, all the talk was about boosting food security. Nothing was said about how consumers were going to be wooed to a new taste, or educated about why it would be a healthier choice. Has the cassava bread taken off? In early June,the Guardian reported that, “Between 2005 to 2009, T&T’s imports of staples averaged 236,700 tonnes at a value of almost $700 million annually.” These were the staples whose import cost was supposed to drop in ranges from 25% to 100% if all went according to the 2012-2015 Action Plan. Saying that this figure was 29% of the total food import bill, the Food Production Minister Devant Maharaj said it led to an unacceptable level of vulnerability. “Our food consumption patterns are based on dishes that encourage high consumption of wheat and value added products such as bread, roti and pastry,” he said. Maharaj said his Ministry, through a Staples Commodity Team led by Nigel Grimes, is developing a Strategic Industry Development Plan for the cassava industry. The report did not quote anyone here, but explained the plan’s intent: “This plan will focus strategic promotion of cassava to increase markets and demand for that staple given its historically low consumption and the insignificant trade in cassava related products in T&T.” The Ministry acknowledges the “historically low consumption” and “insignificant trade” in cassava related products, but nowhere have I seen any effort to raise public awareness about the value of these staples in health-related terms. Will people really get turned on to these staples in order to reduce the food import bill? The problem is that nobody sees the big picture. It is one thing for the man in the street to be preoccupied with his little corner of hell. But our planners ought to be the ones grasping the full basketful of factors and making strategic plans that connect the dots.
In November 2012, the Health Minister was urging citizens to avoid food additives such as monosodium glutamate (MSG), commonly labeled as Ve-tsin or glutamic acid, and very present in fast foods, because of its link to childhood obesity. In November 2012, aNewsday report quoted him as saying, “It goes into the system, goes into the brain and stops what they call the satiety centre. The satiety centre tells you when to stop eating, okay. It (MSG) is an addictive type of compound that makes you eat more…“That is why we have a whole set of young children obese, want more of the junk food, with empty calories.” While obesity is the most common factor in all of the lifestyle diseases, it doesn’t mean that a person of normal weight is not susceptible—a range of contributing factors exist, and regular exercise and sensible eating choices are the best preventative medicine. The Health Minister has been vocal in the cause of better lifestyle choices in terms of exercise and diet.Yet, there is little evidence to show that the Ministry is exerting itself to follow through on these pronouncements. Another consistent voice has been that of Dr David Bratt, the pediatrician who uses his column to dispense advice. His column of June 3, 2014, “Fast food the new cigarettes” makes a compelling case for State interventions in areas where industries are making a killing despite the ill-effects of their products. “Fast food is the new cigarettes, and sugar the new tobacco,” he writes, saying that the Chief Medical Officer of the UK has warned that sugar is an addictive substance, likely to be as addictive as heroin, cocaine, nicotine and alcohol. “The food industry knows this,” he ends grimly. As a medical doctor, he brings a credible measure of first-hand knowledge when he describes the impacts, the symptoms and the costs of this large range of CNCDs. Still, there is a surprising amount of ignorance about them and their relatives. Take for instance, Metabolic Syndrome, the name given to cluster of factors thatsignificantly increase the risk for CNCDs. People with Metabolic Syndrome are twice as likely to die from, and three times as likely to have a heart attack or stroke compared with others. It’s a bit like those Lotto and Play Whe cages with the balls inside. One ball might be a large waistline. Another, a high LDL level (what we call high bad cholesterol), or it might be low HDL (the good one). Then there’s the high blood pressure ball bouncing dangerously close to the high fasting blood sugar ball. Throw in a smoking ball, a snoring ball, and if you put in your hand and pull out three of those balls then you might as well say No. 4 (Dead Man) call. The growing figures for obesity, the growing numbers of sufferers, the growing cost of health care, all of it has not come overnight. The increase in childhood obesity is not confined to the Caribbean, it is global; we’ve just taken it to the extreme as usual. What it means is that yet another generation is starting with yet another disadvantage. We have failed them in education, damaging their minds; we’ve neglected and abused them, scarring their souls; and we’re failing them in health, mashing up their bodies. Isn’t it time we do something right? |
One of our local doctors returned from the CARPHA conference in Aruba in April, nonplussed by the low level of concern over the rise of childhood obesity in the Caribbean. 
No campaign aligns the two elements in marketing these staples. No one seems to be willing or able to grapple with the formidable task of shifting the mindset of a people already industrially steeped in oil and sugar. If there could be one massive project of public education, the piecemeal efforts would not fall so readily by the wayside.