The Practical Side of Preventing & Managing Obesity

As a global epidemic, obesity claims at least 2.8 million lives every year.

As many Health Care Practitioners (HCPs) may have noticed, obesity was previously associated with high-income countries, yet, is now also prevalent in low- and middle-income countries. This prevalence is especially noted in rapidly urbanising environments.

Yet, obesity can be prevented and managed, with various strategies from HCPs, governments, civil society, non-governmental organisations and the private sector.

To empower patients in their own obesity prevention, management or reversal efforts, this article looks at each stage of human development, from conception to senior years. HCPs can present this article’s tips and recommendations to their patients to support their efforts.

1) Foetus (pregnancy)

As an HCP, you can remind your pregnant patients that obesity risk is heightened for the foetus when the mother is overweight/obese, as the child tends to have accelerated growth. The same is often recognised when the child is not exclusively breastfed for the first 6 months after birth.

TIPS for your patients:

Good maternal mental & physical health (before & during pregnancy)
Control of weight during pregnancy (avoid poor nutrition & stress as these can lead to obesity)
- Consult a registered dietitian to support good eating habits during pregnancy
Avoid excessive infant weight gain during the first months of life by breastfeeding (as traditional formulas have a higher level of protein)
- Again, a dietetic referral can support the mom to continue breastfeeding for as long as possible

2) Infancy

Parents need to be aware that high protein consumption in infancy is associated with accelerated weight gain during this period, which is a strong predictor of childhood and adult obesity.

TIPS for your patients:

Promote exclusive breastfeeding up to 6 months & beyond (this prevents excessive weight gain during infancy)
Avoid high protein intake:
- Use a formula with reduced protein (if infant is not fully breastfed)
- Avoid feeding cow’s milk before 2 years

3) Toddler

As toddlers have high nutritional requirements relative to their size, they need more nutrients than an adult (per kg body), to support their rapid growth and development.

You, as an HCP, can recommend the following tips to parents, to help ensure that toddlers get all the nutrients they need.

TIPS for your patients:

Aim for a diverse & nutrient-rich diet (regular meals, fruits and vegetables, small portions)
Establish healthy eating habits early:
- Ensure exposure to a variety of food options
- Practice responsive feeding

4) Childhood

Childhood obesity is currently one of the most serious public health challenges as overweight children are likely to become obese adults.

TIPS for your patients:

Parents are recommended to enforce a healthy lifestyle at home
- What children learn at home about eating healthy, exercising & making the right nutritional choices reflect in other life aspects
Parents shouldn’t use food as a reward or punishment
Offering a combined diet & physical activity intervention within a community (using a school component) is more effective at preventing obesity/overweight

5) Puberty

Sedentary behaviours show a sharp increase during the onset of puberty (ages: 11-13 years).

From 2000 to 2015, the prevalence of obesity in the children (aged 5-19 years), went from 1.4 to 3.6% in boys and 1.9 to 4.6% in girls. Yet, nutrition has a fundamental role in the timing and tempo of pubertal development.

TIPS for your patients:

Limit screen time & encourage physical activity
Encourage children to eat only when hungry & to eat slowly
Keep the refrigerator stocked with fresh fruit & vegetables (replacing soft drinks & snacks that are high in sugar & fat)
Provide at least 5 servings of fruits & vegetables daily
Encourage children to drink water rather than beverages with added sugar

6) Young Adulthood/Adolescence

Young adulthood is a vulnerable period for weight gain as unhealthy dietary habits are typical of young adults in many developed nations.

These habits all increase the risk of overweight/obesity: high sugar-sweetened beverage consumption, lower vegetable intake and greater consumption of foods prepared outside the home (fast foods).

TIPS for your patients:

Individuals can increase daily intake of vegetables & fruits
Colleges/varsities can:
- Make healthy choices available (in vending machines & food halls)
- Create awareness/educational campaigns to show how healthy eating can be inexpensive
- Refer your patients to a registered dietitian if they are not achieving their nutritional goals

7) Adulthood

Many of the causes of overweight and obesity are preventable and reversable. Yet, no country has been able to reverse the growth of this epidemic.

Africa’s adult population faces both a malnutrition burden and high levels of obesity, where 18.4% of women and 7.8% of men live with obesity.

Although there are many other factors involved, the fundamental cause of obesity is an imbalance of calories consumed and calories expended.

TIPS for your patients:

Reduce the number of calories consumed from fats & sugars (white sugar, flour, high-fructose corn syrup - especially sugar sweetened beverages - & saturated fat)
Increase daily intake of:
- Fruit
- Vegetables
- Legumes
- Whole grains & nuts
Engage in regular physical activity (150 minutes per week)
Learn to read nutrition labels and keep in mind the number of portions you are eating

8) Middle Age

Again, it is important to recognise that many of the causes of overweight and obesity are preventable and reversable.

Although many middle-age individuals are still of working age, some are moving into a more sedentary lifestyle.

TIPS for your patients:

Eat 5 to 9 servings of fruits and vegetables daily
- A vegetable serving:
  - 1 cup of raw vegetables or
  - 1/2 cup of cooked vegetables/vegetable juice.
- A fruit serving:
  - 1 piece of small to medium fresh fruit or
  - 1/2 cup of canned or fresh fruit/fruit juice or
  - 1/4 cup of dried fruit
Don't eat foods that are high in "energy density" or have a lot of calories in a small amount of food

9) Senior Years

Causes and health risks associated with obesity in young people have been extensively documented, yet, elderly obesity is less understood, particularly in sub-Saharan Africa.

Elderly that are overweight/obese have been shown to have a higher risk of developing hypertension and arthritis and report that they severely struggle with daily living activities.

TIPS for your patients:

Increase physical activity (as this could potentially mediate the effects of obesity on health risks among the elderly)
- 150 minutes of moderate-intensity aerobic activity a week
  - For example, 30 minutes a day, 5 days a week
As with other adulthood stages, increase daily intake of fruit & vegetables, legumes whole grains & nuts.
Recommended daily calorie intake for those over 70 years:
- Males:
  - Sedentary – 2,000
  - Active – 2,600
- Females:
  - Sedentary – 1,600
  - Active – 2,000
As obesity is a public health concern, this can be addressed through policies, educational campaigns, and interventions

Conclusion:

You can recommend various tips and strategies to reduce the risk of obesity at every stage in the human life. Although some common threads across age groups include the basics of healthy living: reducing consumption of fast foods, sugars and energy-dense foods, increasing consumption of vegetables and fruits, as well as physical activity.

When you feel concerned that your patient’s nutritional goals are not being met or are being over-achieved, it is advised that you recommend a nutrition consult for that patient.

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