Gene Expression

Africa’s urban poor becoming obese

Yeah, you read that right. Overweight and obesity in urban Africa: A problem of the rich or the poor?:

Descriptive results showed that the prevalence of urban overweight/obesity increased by nearly 35% during the period covered. The increase was higher among the poorest (+50%) than among the richest (+7%). Importantly, there was an increase of 45-50% among the non-educated and primary-educated women, compared to a drop of 10% among women with secondary education or higher. In the multivariate analysis, the odds ratio of the variable time lapse was 1.05 (p<0.01), indicating that the prevalence of overweight/obesity increased by about 5% per year on average in the countries in the study. While the rate of change in urban overweight/obesity did not significantly differ between the poor and the rich, it was substantially higher among the non-educated women than among their educated counterparts.

Here’s a chart showing the urban/rural difference by nation:

i-040f625cd5b72f207c7331eca7e1a9ad-obeseafrican.png

This is a problem in a specific sense; obesity tends to increase morbidity. But it also points to a bigger general positive development, the nutritional plentitude of the modern era.

Citation: BMC Public Health 2009, 9:465doi:10.1186/1471-2458-9-465

Comments

  1. #1 proximo
    December 31, 2009

    Maybe they’ll stop showing so many isolated, unrepresentative and disturbing images of starving Africans.

  2. #2 diana
    January 1, 2010

    Nutritional plenitude? No way. Refined carb plenitude, dude.

    Not good at all. Watch for diabetes rates to go up. There’s even a new term for it: “diabesity.”

    http://www.google.com/search?q=diabesity&ie=utf-8&oe=utf-8&aq=t&rls=org.mozilla:en-US:official&client=firefox-a

    When diabetes rates go up, all sort of horrible health consequences. I doubt they have a surfeit of prosthetic limbs in Africa.

    Nothing new about this. Gary Taubes writes about the phenom. of obesity in the poor in GOOD CALORIES BAD CALORIES.

  3. #3 razib
    January 1, 2010

    diana, these are never people who ate a lot of steak and meat in the first place. so this is a better than starvation. first tackle mortality. then morbidity.

  4. #4 diana
    January 1, 2010

    Razib,

    I agree. They weren’t living on steak and broccoli before now. My impression is that the traditional African diet was a high carb staple diet. But that the calories were adequate before the current pop’n and chaos explosion.

    After reading GCBC I did read a lot of low-carb websites, and many of them are on an anti-carb jihad. I’m not. I think “it’s more complicated.” Or maybe more simple: sugar kills.

  5. #5 razib
    January 1, 2010

    I think “it’s more complicated.” Or maybe more simple: sugar kills.

    i think the emphasis on sugar is probably right. re: carbs in general, it’s pretty clear to me that different people have different nutritional “optimums.” so anti-anything is probably overdoing it in the reductio ad absurdum. i.e., sugar kills for south asians more than it kills for europeans.

  6. #6 diana
    January 1, 2010

    “it in the reductio ad absurdum. i.e., sugar kills for south asians more than it kills for europeans.”

    I don’t understand this.

    BTW I wrote to Gary Taubes and explained my perplexity about the issue of carbs/obesity. For example in the book he spoke about the Pima Indians, the most obese people on earth. Yet a bit of research tells us that the Pima were bean-eaters before the advent of European diet. So they were healthy on carbs from beans….but got sick and diabetic on carbs from refined flour & sugar.

    He wrote me back and essentially agreed that refined carbs are worse than unrefined but punted on the subject of carbs as unhealthy. He’s become quite a carb-o-phobe.

    I do think that refined sugar and flour derange the metabolism, and once the metabolism is deranged and you are insulin insensitive you have to give them all up to be lean.

    Boring!

  7. #7 razib
    January 2, 2010

    I don’t understand this.

    south asians become insulin insensitive much more easily than europeans.

  8. #8 Matt
    January 2, 2010

    With regards to sugar, apparently Europeans have a higher sensitivity to sugar (taste it as more strongly) than other populations including South Asians (East Asians, especially Africans, &c.), despite having a low frequency of the bitter tasting “supertasting” allele. Increasing the sugar in products apparently begins to taste more unpleasant more rapidly for Europeans.

    http://www.cell.com/current-biology/abstract/S0960-9822(09)01254-8

    http://www.newscientist.com/article/dn17382-europeans-sweet-tooth-may-have-been-survival-trait.html

    However, I’m not sure what the real effect of this is on dietary preferences, since sugar intake is probably also moderated by psychological desire and by the addictive effect of the “sugar rush” of energy becoming available.

  9. #9 Peter
    January 2, 2010

    I don’t want to oversimplify this discussion but i would like to add that Diabetes in Africa is mostly caused by lifestyle changes and that’s why it is being seen more in the urban and peri-urban population where the rapidly growing middle class and the rich are consuming more processed foods as opposed to the rural population that continues to grow their own food and prepare it in more traditional ways. I really don’t see the relevance of all the above talk of taste buds etc. It’s more a ‘people living on steak (hold the broccoli) and kids on constant sugar-highs’ issue than anything else.
    Finally, Razib, are you kidding me with the “deal with mortality first then morbidity” thing? And not everybody in Africa is standing on the road from the airport empty bowl in hand waiting on USAID posing for foreign journos!!

  10. #10 razib
    January 2, 2010

    And not everybody in Africa is standing on the road from the airport empty bowl in hand waiting on USAID posing for foreign journos!!

    no doubt. all one needs is a malnourished minority. 20% obesity is preferable to 20% malnourishment.

  11. #11 diana
    January 2, 2010

    Razib,

    I think you are positing a false choice. Sure, better to have people eating something, even bad things, than nothing at all.

    But I am saying that traditional Africans did not starve. They starved where there was political instability (Biafra, Ethiopia), but that’s usually the case. Europeans, Asians, everyone starves when there is war. Ask the Dutch.

    Maybe it’s easy for me to say, never having starved, but the public health costs of obesity will far outstrip those of slight malnourishment. People are very good about squeezing calories out of their environment, but dealing with this surfeit of refined carb/sugar calories is something new entirely.

    “However, I’m not sure what the real effect of this is on dietary preferences, since sugar intake is probably also moderated by psychological desire and by the addictive effect of the “sugar rush” of energy becoming available.”

    I think it can go in any direction. Frex, I am extremely sugar sensitive. I can taste sugar in the minutest amounts in salad dressings, canned foods, mayonnaises, cole slaws, etc., and I hate it. In foods that are “supposed” to be savory, I just hate the taste of sugar and I won’t eat it. I make my own mayo now because Hellman’s ruined its old good formula with sugar.

    But – I love sugar in dessert type foods, to my detriment. To me, a meal is an excuse to get to dessert. My father with the same sugar sensitive taste, was indifferent to desserts (mostly).

    Regarding sugar rush, I thought that was out the window and now the model is that sugar calms you down.

  12. #12 razib
    January 2, 2010

    malnourishment can leave permanent effects. it also probably turns kids into tards. fatitude can be reversed. public health costs are never an issue in a society where malnourishment is prevalent in any frequency. if you’re letting people get malnourished you don’t care. period. (in those societies people are also riddled with all sorts of endemic diseases, in addition to being malnourished)

  13. #13 diana
    January 2, 2010

    Razib,

    Where in this article (or anywhere) does it say that the obese Africans were malnourished prior to becoming obese? I am not saying that malnourishment is good- clearly it isn’t.

    I am questioning the dichotomy you offered. The African diet was not characterized by malnourishment, that’s all I am saying. It was quite adequate. Where did Africans starve? Only in areas where there was war.

    Malnourishment has permanent effects but so does obesity. Read up about the effects of “diabesity”. And it’s not at all easily reversed. The obese as a class aren’t going to lose weight, they are going to (as a class) get diabetes, sicken (in some pretty awful ways) and die early. (And get more cancers, and other metabolic disorders.)

    Read up on all the possible medical consequences of diabesity and perhaps the old endemic diseases won’t seem so uniquely horrifying.

    “if you’re letting people get malnourished you don’t care. period.”

    I do care. I care about them eating their proper, traditional diets, and not western shit that will kill them slowly.

    This isn’t a question of “letting” people get malnourished. I believe in political stability and freedom. People usually do a good job of feeding themselves in such conditions.

  14. #14 razib
    January 2, 2010

    most humans have been malnourished since the rise of agriculture. my model isn’t as simple as you presume. i have no idea what you’re getting at. my point is an ‘obesity epidemic’ is generally a sign of increased affluence in many societies. so what’s your point? what should africans do? (my father’s family is full of type ii diabetics, i know the issues)

  15. #15 diana
    January 3, 2010

    I thought I made my two points repeatedly.

    1. You were offering a false dichotomy: modern plenitude as opposed to traditional malnourishment. I got that idea from this:

    “But it also points to a bigger general positive development, the nutritional plentitude of the modern era.”

    2. I also disagree that obesity has anything to do with “nutritional plenitude.” Obesity doesn’t come from eating too much of a good thing. It comes from eating refined carbohydrates and sugar, which deranges the metabolism. I have already said several times that this is better than nothing – but again, Africans weren’t eating “nothing” when they were living pre-modern lives. They were eating an adequate healthy diet. Maybe they could have done with a few more calories, but not a different kind. And a few more good calories doesn’t make folks obese.

    http://li14-183.members.linode.com/traditional_diets/out_of_africa.html

    “Dr. Weston Price visited Africa in 1935. His journey into the interior began in Mombasa on the east coast of Africa, inland through Kenya to the Belgian Congo, then northward through Uganda and the Sudan.

    Throughout his studies of isolated populations on native diets, Price was continually struck by the contrast of native sturdiness and good health with the degeneration found in the local white populace, living off the “displacing foods of modern commerce” such as sugar, white flour, canned foods and condensed milk. Nowhere was the contrast more evident than in Africa….”

    Etc.

    Price wasn’t the only one to observe this. Every anthropologist has noted the degeneration in health of people who have shifted from traditional to modern diets.

    Nutritional plenitude? I’d call it nutritional genocide.

  16. #16 razib
    January 3, 2010

    Obesity doesn’t come from eating too much of a good thing. It comes from eating refined carbohydrates and sugar, which deranges the metabolism

    you’re wrong. it does come from eating too much of a good thing, especially sugar. in pre-modern times the things making people into fatties were luxuries, sweets and refined & processed foods. this is why there is now a fatitude epidemic among well off south asians in india. it may be a bad thing even in small quantities, i don’t know. but it wasn’t enough to make people fat. sweets have been part of the traditional cuisine of south asia for a long time, but until recently they were consumed on special occasions.

    Throughout his studies of isolated populations on native diets, Price was continually struck by the contrast of native sturdiness and good health with the degeneration found in the local white populace, living off the “displacing foods of modern commerce” such as sugar, white flour, canned foods and condensed milk. Nowhere was the contrast more evident than in Africa….”

    life expectancy was low. in africa in particular populations were less malnourished than in asia because it seems that mortality rates due to endemic disease kept bumping the population below the malthusian limit. this is obviously true in congo during the time you’re alluding too, there’d just been a massive die off around 1900 thanks to king leopold. also, white people in africa don’t do too well because they’re less robust in the face of tropical disease, so there are other causal factors.

    pre-modern populations did have good teeth, etc., (excepting those who had too much grit in their grain from milling). they didn’t suffer from the ailments of modernity. but they lived shorter lives and had less choice in their diet.

  17. #17 diana
    January 4, 2010

    No, you’re wrong. Wrong about everything, including how to define what’s “good.”

    You are wrong about how to define nutritional plenitude.

    It’s ludicrous to equate nutritional plenitude with caloric plenitude. How can you call eating lots of sugar nutritional plenitude when it doesn’t nourish?

    “it does come from eating too much of a good thing, especially sugar.

    Razib, sugar isn’t a good thing. When I said, you don’t get fat eating too much of a good thing, I meant eating the vegetables, pulses, grains, legumes, meats, and fruits that are part of a traditional diet. Blood sugars are normal and for the most part people don’t overeat.

    “in pre-modern times the things making people into fatties were luxuries, sweets and refined & processed food….”

    Yes, that’s exactly what I’m saying. That’s what makes people fat. This is not too much of a good thing: this is any amount of a bad thing. Some people can eat very little sugar and it will still make them fat.

    “there’d just been a massive die off around 1900 thanks to king leopold.”

    What does this have to do with my point about Africans and their traditonal diet?

    Again, you pointed to a study about obese urban Africans as if it was some kind of weird thing – as if Africans traditionally starved.

    You’re wrong. They did not. Absent political conflict, they grew, gathered and hunted quite adequately.

    What exactly is YOUR point? That absent political conflict Africans were incompetent food-gatherers, hunters and growers?

  18. #18 slamram
    January 4, 2010

    I thought most West Africans have subsistence farmers for several thousand years, farming tubers like yams and consuming rice–this would be precolonial. East Africans, particularly Ethiopians farmed in their highlands.

    Famous differences in both regions respectively would be the Fulani and the Maasi engaged in pastoralism.

    Groups that were primarily hunter gatherer like the bushmen generally continued their traditions, while groups that were farmers before Europeans the Ashanti or Yoruba just adopted new foreign crops like cocoa and maize.