TORONTO – This is a story of two U.S. doctors on a fellowship to Gabon and the patient who taught them of what’s sparking an obesity epidemic across the developing world.
At a tiny stall in a bustling intersection in Lambarene, Gabon, a woman sells sugar-coated, deep fried beignets.
Her name is Marie. She is 26 years old, heavy set, wearing braids in her hair, a colourful sarong and a wide smile across her face.
Marie cooks over a small kerosene gas tank, frying up the doughnut-like snacks for her steady stream of customers. She has dreams of expanding her shop – adding a fridge to serve cold soft drinks, working with a baker to make sandwiches and even owning her own sit-down restaurant.
But in 2011, Marie – which is not her real name – was plagued with searing pain in her chest, persistent headaches and constant fatigue.
Obesity among less severe in throng of illnesses
It was in hospital that she met medical and public health fellows, Laura Blinkhorn and Mascha Davis, who were in Gabon for three months helping with primary care and developing nutrition programs for malnourished children.
Blinkhorn was in her third year of medical school, while Davis was a registered dietician.
The pair of Albert Schweitzer fellows expected to look after the gravest of patients: locals delirious with malaria, some nearly skeletal from advanced HIV/AIDS and even dying with tuberculosis.
Next to these patients was Marie, plump and cheerful. Her mother forced her to get a check up with the doctor; she wanted to get back to her food stall.
But to the American fellows, Marie’s predicament hit home.
“From our perspective, she seemed very familiar. We have seen young people like this. We thought she is someone on the path of Type 2 diabetes, she’s really perfect for an intervention now than waiting years until she has very critical disease.”
Her chest pain was linked to gastric reflux, her headaches were attributed to high blood pressure.
At 5’6, Marie weighed 220 pounds and had a body mass index of 36. An overweight BMI ranges between 25 and 30. By those accounts, Marie was considered morbidly obese.
Nutrition transition phenomenon around developing countries
Marie’s story is not unique. She represents the obesity epidemic that’s gripping much of the developing world – regions like China, India, Mexico, Brazil, much of the Middle East and South Africa.
It’s called nutrition transition – this overwhelming shift in diet and physical activity. Global citizens are switching their physical labour for sedentary jobs. Meanwhile, fast food corporations are swiftly tapping into new markets, offering consumers a plethora of food they haven’t had access to before.
“Marie is in this middle income developing nation. She’s this young entrepreneur being faced with a barrage of very unhealthy, but very easily accessible foods and that’s what’s happening in much of the developing world right now,” Davis said.
“It’s the fact that people start working jobs that are less physically demanding. At the same time, there’s increasingly caloric dense foods, preprocessed foods, more cookies and snacks,” Blinkhorn said.
As a result, patients are trading in infectious diseases – malaria, respiratory illnesses, for example – for chronic conditions, such as diabetes and hypertension.
“It is happening in the same hospitals in various countries. I can’t quantify it but it’s a phenomenon,” Blinkhorn said.
Families’ dinner fare has turned from home cooked meals and cutlery to fast food served out of cardboard boxes and eaten with their hands.
Women cook in food stalls in Gabon. (Photo courtesy John Davis)
Lack of nutrition education
Unlike much of North America and first world countries, who are already dealing with their health crises, much of the developing world isn’t receiving the food education it needs to make sound consumer decisions.
“This was one of the most striking differences between Marie and patients in the United States,” Davis said.
“People have very basic knowledge of nutrition and even if they eat at McDonald’s, they know it’s not ideal. Marie didn’t have that.”
Her doctors handed her medications for her hypertension and acid reflux, along with ibruprofen for her headaches.
She also received a photocopy of a food pyramid without any explanation.
On a rainy afternoon, Blinkhorn and Davis met with Marie to talk about her diet.
She’d skip breakfast, eat half a baguette filled with spaghetti mixed with oil for lunch washed down with ice water. A plate of rice with chicken and ice water was her typical dinner.
Throughout the day, she’d snack on croquettes, beignets and a local grapefruit soda.
She couldn’t remember the last time she had fruit or vegetables. She hardly had any physical exercise in her daily routine.
“Making the actual connection between her diet and obesity was a big struggle for her,” Davis said.
“It seems very obvious for us and for many of us in the west who have good education and know a bit more about health but for many in the developing world, some have never of this. It’s a really novel idea,” she explained.
Corporations know these developing countries are their next emerging market, Davis said. They’re investing in advertising promoted to the masses.
While Marie went to school, issues such as nutrition weren’t taught. Unlike the western world, there weren’t any public health campaigns to counter the barrage of unhealthy food.
When the doctors asked Marie what she thought she could do to improve her eating habits, she suggested cutting back on iced water.
She was sure it was the cold water that was triggering her reflux.
Catching up on health awareness
Davis, who just completed seven months work in Ethiopia, said that the developing world needs to play catch up on raising awareness of healthy eating.
This is especially the case in developing countries with burgeoning economies and a growing middle class.
“The food industry is seizing upon this demographic,” Davis said.
For starters, governments need to shed light on balancing a healthy diet similar to programs that already exist in Canada and the United States.
Compared to snacks, healthier fare is also much more expensive in Gabon: an apple costs about 300 CFA (Gabonese Central African Franc) meanwhile a package of chocolate wafers is only about 50.
In some parts of South Africa, rebate programs are offered when households buy produce instead of junk food.
But like North America trying to fix bad eating habits, Davis suggests the developing world faces an uphill climb.
“It’ll take a long time, even convincing our governments to subsidize healthy food. People really need these incentives,” she told Global News.
Davis is heading to Sudan for the next two years to work on another nutritional program.
Meanwhile, Blinkhorn will begin her family medicine residency in Seattle in June.