In this second part of two articles on malnutrition in Nigeria, CHIKEZIE OMEJE reports that food choices and lifestyle changes are increasing obesity among children, with serious consequences such as hypertension, diabetes and heart disease. The first story covered the underlying causes of undernutrition, which has assumed a dark dimension in the northwest region.
While an estimated 11 million children under the age of five in Nigeria are stunted due to inadequate nutrition, the number of overweight and obese children is also increasing. The World Health Organisation has dubbed the simultaneous occurrence of these two extreme and opposite problems the “double burden of malnutrition” – a growing health problem that affects many developing countries.
“It’s a typical reflection of inequality in the country,” says Laz Eze, a public health specialist. “The poor face undernutrition, while rich people and the middle class have their own form of malnutrition in obesity.”
At the moment, undernutrition is the more widespread of the two problems. Two in every five children are not getting the right quantity of protein in their foods or not even eating enough to get the amount of energy they need. But there is this small but growing proportion of children – currently about 2 percent of the population – who have enough to eat but are not eating the right food.
For this second group, which eventually could outgrow the first, “the issue is not how much they eat but what kind of food they eat,” says Eze.
The main problem, he suggests, is that affluent people are increasingly eating processed food that has more carbohydrates, fats, and cholesterol than their bodies can use. When this happens, the bodies use what they need and deposit the rest as fat.
Both forms of malnutrition are a threat to the long-term socioeconomic development of the country. Undernourished children grow up with physical and mental deficiency, and are more likely to drop out of school and become less productive in adult life. But obese children are prone to lifestyle-related diseases such as hypertension, heart disease, diabetes, and kidney failure. Health workers say these diseases are already rising among young people. Over time, the result will be rising healthcare costs and reduced productivity and economic growth.
While the two forms of malnutrition most often occur in different population groups, some children experience both problems simultaneously. “You see children you are stuffing with fast food,” says Amaka Onyekwu, a nutritionist. “It will precipitate obesity because of carbohydrate and fat, but at the same time, the child isn’t getting enough micro-nutrients.”
“The child is undernourished and also obese,” she says, adding that such cases are particularly difficult to treat when children become ill and have to be admitted to hospitals.
She traces the rising cases of obesity in children to urbanisation, changes in dietary habits and change in lifestyles. Ironically, these problems are an unintended side effect of economic growth.
“People are trying to give an impression that they have arrived and they belong to the upper class,” says Onyekwu. “They have the tendency to abandon locally-available foods in favour of over-processed foods.”
While the extent of obesity in under-five children is still relatively low in Nigeria, public health experts warn that if current feeding practices for children continue, the problem will become an overwhelming public health challenge, like undernutrition, within the next 10 years.
Nigeria is not alone. While obesity was once considered a problem of western, developed countries, it is becoming more common in developing countries too. Of the 41 million overweight children in the world, 10 million live in Africa, according to the 2017 Global Nutrition Report. The number of overweight children under the age of five years in Africa has increased by 50 percent since the year 2000.
Toyin Adenaike, a primary healthcare physician who practised in the United Kingdom for 25 years before returning to Nigeria to establish the Niyot Medical Centre, Lekki, Lagos, blamed increasing childhood obesity on adoption of western diets and lifestyles.
A growing tendency to substitute processed and instant foods for fresh and natural foods has contributed to the increase in obesity in countries like Nigeria, according to public health experts. They say packaged foods, which the middle class tends to buy from supermarkets, are a particular problem because they are especially high in sugar, salt, and fat — all of which contribute to diseases once considered Western.
On top of consuming more energy-dense foods, children have less opportunity today to do physical activities to expend the energy. “Now the children of the upper class and middle class are driven to school,” Adenaike told the ICIR. “They don’t have access to physical activities, but they have access to corn flakes, pizzas and so on.
“Even when children come home, they are playing with the computers, playing with the mothers’ phones or playing games,” adds Ifeanyi Nsofor, the CEO of EpiAfric, a public health consulting firm based in Abuja, and Director of Policy and Advocacy at Nigeria Health Watch. “Children don’t get to go out a lot compared to when we were growing up. So we need to increase physical activities for children.”
Nsofor points out that many schools in Abuja do not have sporting facilities for the children, and there are little or no parks in residential areas for children to have outdoor activities.
THE NEW STAPLE FOODS FOR URBAN CHILDREN?
The ICIR visited two nursery schools in Abuja and found that lunchboxes for the children contained mostly instant noodles, pasta, pastries, biscuits, and juices.
“You will hardly see a child come to school with beans or normal food,” says Onyiye Ugwu, a teacher in one of the schools. She says children prefer to eat noodles or snacks, and their parents usually give them what they want.
Another teacher, who does not want to be named, says parents are too lazy to cook a proper meal for their children. “They are easy to prepare in few minutes,” she says, pointing to the noodles some of the children are eating during the break. “They give their children all these junk foods because they don’t want to wake up on time to cook good food for their children.”
Vivian Uche, also a teacher, attributes the kind of foods that children bring to school to peer pressure. “Kids like noodles, chips, juice, candies. When they go to school and see what other kids bring, they come back home and want to be like the other kids.”
This puts added pressure on parents to offset such influences. Chiyere Eze, a parent, told the ICIR that though her children prefer noodles, she makes sure they take healthy meals to school.
“All kids like snacks, candies,” says Eze. “To make sure they eat healthy food, I make sure they have fruits and vegetables among the foods they take to school. Most kids want sweet things, but I give my kids the food they need to eat. They go to school with beans and plantain. I make sure they have fruits, oranges, pineapples, and watermelon.”
In Nigeria, noodles are popularly known as Indomie, the name of an Indonesian company that first started producing noodles in the country in 1995. With aggressive marketing that often targets children and working mothers, Indomie has become a staple food for children.
“It is normal food for children,” Ademola Olarewaju, a parent, told the ICIR. “When they are going to school, you package Indomie and plantain and put juice by the side. It is good for them. If you don’t give them what they want, they will take it to school and bring it [home] the same way you gave it to them.”
Victoria Okafor, another parent, says “every child nowadays prefers Indomie to other foods. So you just have to garnish it with egg, tomatoes, and carrot to give it nutrients. It is a carbohydrate, and it is not good to be eating only carbohydrates.”
Some other parents aren’t so conscientious. They appear not to care about the nutritional value of what their children eat. Happiness Ameh told the ICIR that children love sweet foods and her concern is to make sure that they eat. “Let it be that there is something in the system to sustain life,” she says.
Olufemi Akogu, a parent, says urban residents resort to fast foods to feed their children because they have become too busy. “Parents are working. Children are left to fast food. Parents are no longer bothered about what the children even eat at home. Sometimes they don’t cook at home. They take them to eateries.”
ARE NOODLES ADDICTIVE?
Sarah Abagai, a dietician with the National Hospital and author of ‘Basic Concepts of Healthy Nutrition: The Secrets of Eating to Live’, told the ICIR that noodles are dangerous to children’s health because they come with seasoning that contains monosodium glutamate (MSG).
Although many nutritionists believe that MSG has addictive and other harmful effects, these claims have not been sufficiently proven since MSG phobia started with the controversial ‘Chinese restaurant syndrome’.
In an article in 1968 on the New England Journal of Medicine, a doctor described the symptoms he experienced after eating in a Chinese restaurant. But the first placebo-controlled trial to study the effects of different doses of MSG shows that it does not cause irregular heartbeat or shortness of breath as suggested by believers in the Chinese restaurant syndrome. The study was published in November on PubMed.
“Do you think it is just coincidence that people are eating instant noodles the way they are eating it?” Abagai asks. “We have always asked people if I should take away that sachet of seasoning contained in the pack and say cook these instant noodles, would you eat? They say no. That’s the attraction, and that is where the problem is.”
She notes that the substantial amount of sodium salt in MSG puts people at the risk of developing high blood pressure, diabetes and neurological problems. While such effects may only appear over time, she says some teenagers are coming down with high blood pressure because of the foundation that was laid in the early years.
Abagai also faults parents for feeding their children noodles too readily. “Now when people want to beautify instant noodles they add an egg in it but at the end of the day it doesn’t take away other additives that constitute a threat to the health of the consumer.”
Not everybody accepts Abagai’s arguments. Ngozi Nnam, a Professor of Community and Public Health Nutrition at the Department of Nutrition and Dietetics, University of Nigeria, Nsukka, and former President of the Nutrition Society of Nigeria, told the ICIR that eating noodles is not a problem by itself. The problem, she argues, arises when people serve their children just the noodles without adding other nutritious food items.
“The problem with noodles is that many a time, people eat it without adequate supplementation,” she says. “It’s like just boiling rice and eating it like that. It’s not good for the health of your child.”
Nnam insists that she does not want to discourage people from eating noodles. “You don’t tell people not to eat rice, rather you tell them when you’re eating rice, add protein source, and add vegetables so that it will be nutritionally adequate.”
She says processed foods like noodles lay the foundation for obesity because they mainly contain carbohydrates. She adds that children need vegetables and fruits in their meals to supply micronutrients like iron, zinc, and vitamins for healthy brain and body development.
POLICY CHANGES NEEDED
Obesity in children has not received as much attention as undernutrition in Nigeria. However, WHO points out that tackling the double burden of malnutrition requires integrated action on malnutrition in all its forms.
A report by the Malabo Montpellier Panel, a group of agriculture and food experts, urges African countries to recognise obesity as malnutrition and make necessary policies to address the problem.
“What is required are policies and interventions that go beyond just increasing agricultural production to making actual improvements in the provision and quality of diets,” says the report.
The report advises policymakers to learn from western and developed countries that have a long history of dealing with obesity-related problems.
Ignorance about what makes up healthy diet remains a major problem, as the rising childhood obesity is driven by excessive consumption of processed foods high in fat, salt and sugar.
Dieticians say individuals need to start ticking off packaged and canned foods on their shopping list and replacing them with fresh and natural foods. Parents also have to replace bottled and canned drinks in their refrigerators with fruits and vegetables.
Click here to read the first article on alarming undernutrition in the northwest region.
This report is supported by the International Centre for Journalists (ICFJ) under the Early Childhood Development Reporting Fellowship.