The Fat of the Land

In Uncategorized on January 13, 2010 at 4:48 pm

The WHO Joins the Fight Against Obesity

Neda Shahriari, Staff Writer

There is a bit of irony in thinking about obesity in developing countries: it was only recently that health advocates were raising awareness about malnutrition in middle-income to low-income nations. Unfortunately, rapid industrialization has created a burgeoning population afflicted with obesity in these countries, forcing their healthcare systems to deal with alarming increases in non-communicable diseases—from cardiovascular diseases to diabetes and cancer. Taking cognizance of this, the World Health Organization (WHO) has created an antiobesity strategy that is now starting to take effect.

The correlation between obesity and morbidity is quite apparent in Egypt, a developing country where cardiovascular disease-related mortalities have increased from 5% of deaths to 39.1% in males and 2.9% of deaths to 27.2% in females between 1961 and 1985.[1] In an effort to bring this emergent issue to light the WHO developed the Global Strategy on Diet, Physical Activity, and Health (DPAS) in 2004. As its name suggests, DPAS seeks to address two risk factors—diet and physical activity—that play a hand in promulgating obesity.[2]

DPAS was designed upon the request of several developing countries in the WHO that were alarmed by their rising rates of obesity. Dr. Timothy Armstrong, of the WHO’s Department of Chronic Diseases and Health Promotion in Geneva, informed HCGHR that, “In the 2002 World Health Assembly the secretariat was asked to develop DPAS, in order to reduce the risk factors that were contributing to the increase in cardiovascular diseases, diabetes, and cancers that were not just being observed in the developed world, but particularly in developing countries.”

In Dr. Armstrong’s view, DPAS is to be utilized as a set of “health tools” that can assist member states in addressing the risk factors for non-communicable diseases in the context of their own country.

Egypt has observed a sudden shift in dietary lifestyles in the past 50 years, brought on by rapid urbanization and industrialization. As more people abandoned agriculture to settle in the cities, Egypt lost its self-sufficiency in food production, resulting in an increase in food imports. This led to the introduction of new foods that were not originally a component of the traditional cuisine.[3] This dietary shift—compounded by the relative physical inactivity of a more urban lifestyle—has contributed to the county’s rise in obesity.

Under the WHO’s guidance, Egypt has now made use of DPAS and implemented policies to tackle obesity. According to Dr. Armstrong, “The primary thing that Egypt has done most recently is look at the issue of marketing food to children. It has put in regulatory responses to ensure that ‘fast foods’ are being restricted in the way that they are being advertised to children.” The promotion of physical activity in Egypt is more challenging, as a result of the country’s fragile infrastructure and highly urbanized population. Nevertheless, Dr. Armstrong asserts that Egypt is moving in the right direction as “one of the leaders [in tackling obesity] in the Mediterranean region.”

Despite the standardized nature of DPAS, any effort to tackle obesity must deal with conditions specific to particular countries. In Egypt, it has been found that women are more prominently affected by obesity. This has been attributed to their greater inactivity as a result of urbanization, greater illiteracy, and the fact that obesity lets women be seen as symbols of “beauty, fertility, and prosperity.” [4]

In an interview with HCGHR, Dr. Frank Hu, Professor of Nutrition and Epidemiology at the Harvard School of Public Health, pointed out that looking at such unique local factors helps bring context to the policies, initiatives, and programs that are implemented. Dr. Armstrong agrees: “When you get down to working with a particular country, it’s really taking some of the key messages in the Global Strategy document and adapting those for the particular geopolitical, cultural country. When we turn our strategies into policies, we want the programs that come from those policies to be relevant to that particular population.”

Egypt does not stand alone in its fight against obesity. Dr. Hu notes that in Asia’s developing economies “increasing globalization and East-West exchanges have been accompanied by increasing population movements, changes in food supply and dietary patterns, technology transfer, and cultural admixtures,” that have created obesity epidemics similar to what we observe in Egypt.

It will take several years before one observes a reversal in obesity and the rate of non-communicable diseases in developing countries, but to Dr. Armstrong, success at this point represents the growing number of countries that have joined Egypt in implementing DPAS and adopting policies to counter obesity: “It’s really through all of us taking appropriate action that we can reverse this trend.”


1 Galal, Osman. “The Nutrition Transition in Egypt: Obesity, Undernutrition and the Food Consumption Context,” Public Health Nutrition. 2002, pg. 145.
2 World Health Organization. “World Health Organization Process for a Global Strategy on Diet, Physical Activity and Health,” Publications of the WHO. February 2003, pg. 1.
3 Galal, Osman. “The Nutrition Transition in Egypt: Obesity, Undernutrition and the Food Consumption Context,” Public Health Nutrition. 2002, pg. 142-143.

4 Mokhtar, Najat et al. “Diet Culture and Obesity in Northern Africa.” JN: The Journal of Nutrition. 2001, pg. 888.


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