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The Obesity and Malnutrition Paradox: Why A Country Can Have Both Health Problems?

by Julian Martin Dollente, RN

Fact-checked and Edited by Christopher M. Cirino, DO MPH

THE PHILIPPINES, as a developing country, suffers from unemployment and the poor education of its citizens. Poverty is the fundamental cause of malnutrition. In 2018, an estimated 16.6 % of Filipinos, approximately 17.6 million people, lived below the poverty threshold. According to the United Nations Children’s Emergency Fund (UNICEF), around 95 children in our country die from malnutrition each day (1).

Overweight and obesity are not directly related to such a disturbing death toll. Yet, although many Filipinos suffer from hunger, have limited access to healthy foods, and are deprived of proper nutrition, obesity is considered one of the principal concerns identified by the Philippine Plan of Action for Nutrition (PPAN).

It seems a paradox that obesity and malnutrition would somehow be related. However, overnutrition and undernutrition may be two sides of the same coin. And developing countries are at an increased risk for both these conditions. Many studies support that food scarcity early in life can predispose to obesity later in life. Sixty-two percent of those overweight live in developing countries.

There exists a looming health crisis of obesity and malnutrition, disproportionately affecting the poor. Related to this are decreased physical activity and increased access to soft drinks, processed and fast foods. The article outlines these contributing factors to obesity in the Philippines, and it can be applied to any country.

Obesity in the Philippines

Overweight is a state of being above one’s normal weight. When you reach over 20% of your ideal weight, you are considered obese. Having these excessive fats accumulate in the body presents health risks.

Prevalence of overweight among children 0-5 years old has doubled from 2.4% in 2003 to 5.0% in 2013 (2). Similarly, 3 out of 10 adult Filipinos (31.1%) were reported overweight and obese, according to the 2013 National Nutrition Survey (3).

What Causes Obesity?

Generally, obesity occurs when you overeat and move too little.

However, several factors contribute to the increase in weight that is more than what is considered healthy for a given height. To name a few, these are the common drivers that lead to obesity in the Philippines:

Insufficient Activity

Lack of physical activity is an assumptive factor related to obesity. Many Filipinos have jobs that involve sitting at a desk for most of the day. Government employees and those in the Business Process Outsourcing (BPO) industry are a few examples.

For relaxation, Filipinos tend to watch TV while having snacks, browse the internet or play computer games, and rarely exercise regularly. The growing popularity of smartphones and various Social Media platforms like Netflix, YouTube, and Tiktok certainly does not help to encourage them to do physical activity. You rarely see children playing on the streets nowadays because mobile phones occupy their attention.

With the current situation like the Covid-19 pandemic globally, the problem only worsens as people are craving more food due to inactivity. Several cities in the Philippines are either on General Community Quarantine (GCQ), Enhanced Community Quarantine (ECQ), or total lockdown. People cannot go out in public unless it’s essential. Hence, Filipinos are at even more risk of becoming obese and overweight.

Soft Drink Consumption

Filipinos love to drink soft drinks. From 2010-2015, children ages between 12 and 17 years old had an average daily frequency of carbonated soft drink consumption of 0.91%, according to a report released by the World Obesity Foundation (WOF) (4). This report shows that children from that age group consume almost one (1) soft drink per day.

Consider this:

  • Drinking just 12 ounces of soft drinks or other sugar-sweetened beverages (SSBs) a day for a year amounts to 55,000 calories, or 15 pounds a year.
  • Consumption of these types of beverages is an essential contributor to weight gain. Drinks such as these contain a lot of calories with little or no nutritional benefit.

The problem with SSBs is that the body does not register it entirely even after drinking hundreds of calories. A hormone known as ghrelin might be responsible for that. It is produced in your stomach and lets you know when you’re hungry. When the hormone increases, you feel hungry. It goes down after you eat. However, this process only works after the stomach fills with food, less so with liquid. Drinking SSBs does nothing for your hunger, even if you consume hundreds of calories. In other words, the human gastrointestinal system is not designed for drinking calories.

But then again, even in low-income communities, soft drinks are easily accessible and affordable. Whether consumed as a snack or with meals, soft drinks have become a mainstay in the Filipino diet.

Fast Food and Processed Food Consumption

Filipino children ages 12-17 consume fast food 0.84 (times per week) on average, according to WOF (5). This data shows that, on average, children consume fast food close to once per week.

The Philippines is no stranger to fast food. Whether it is street foods or franchise food chains, the whole country is flooded with this type of food. Whether rich or poor, Filipinos love fast food and consider it a part of the culture.

Children and youth are often affected worse than adults because fast foods target children and the youth sector. There is a sustained pattern of eating fast foods and eating out more often. 

The problem with fast food and processed foods is that they contain unhealthy ingredients. They mainly contain large amounts of sugar, fats, and carbs and fewer minerals and vitamins. This means that you simply are taking in large amounts of unhealthy calories within the shape of these foods, which results in weight gain and, ultimately, obesity.

What makes the Filipinos susceptible is the convenience that these fast-food chains offer. You can always find one near your home and can also get food delivered quickly to your doorstep and drive-thru’s as well. During this pandemic, the emergence of food delivery services such as Food Panda or Grab Food only puts many of us at an even bigger risk.

showcase of bakery with fresh pastry
Photo by Uriel Mont on Pexels.com

Fruit Consumption?

The Philippines has the highest estimated per capita fruit intake among its Asian counterparts with 143.36 g/day, followed by South Korea at 135.66 g/day, based on the Global Burden of Disease (6), the Institute for Health Metrics and Evaluation.

The abundance of fruit in tropical countries like the Philippines is typical. It’s no wonder why fruits have no trouble finding their way to the hands of many Filipinos. Coincidentally, many believe that fruits can help weight loss as they are commonly used as a meal replacement for those who want to avoid getting fat.

Fruit contains large amounts of simple sugars such as fructose, glucose, and sucrose, which are well known to lead to weight gain. Thus considering the simple sugars found in fruit, it is reasonable to expect that their increased consumption could contribute to obesity rather than weight reduction.

However, scientific research has consistently shown that the majority of fruits have anti-obesity effects likely related to their high fiber content. Thus, thanks to their fiber, vitamin, mineral contents, and anti-obesity effects, health organizations encourage fruit consumption for weight reduction purposes.

Despite this paradox, it is important to remember that many factors contribute to being overweight. It is likely that a diet high in ultra-processed foods and sugary drinks counteracts any positive effect of consuming fruit. There is no single solution to the problem but rather a collective effort and discipline.

Fruits are found in abundance in the Philippines. Are they contributing to obesity or is it the excess of processed foods and sweet drinks?
Photo by Ian Turnell on Pexels.com

Conclusion

Healthy eating habits and proper nutrition have to start early in childhood. According to the WHO, children who are overweight or obese are more likely to stay that way into adulthood. They may develop non-communicable diseases (NCDs) like type II diabetes and hypertension at an earlier age. Findings from the Expanded National Nutrition Survey conducted by the Food and Nutrition Research Institute in 2019 reported that overweight Filipino adolescents tripled within the last 15 years.

So how are Filipinos getting fat despite not having much to eat? There is a misconception that obesity is the opposite of malnutrition or the lack of proper nutrition. The truth is that obesity and malnutrition, and specifically micronutrient deficiencies, are linked, as they stem from diets that are calorically excessive but not nutritionally adequate. Regrettably, despite the recognition of the PPAN regarding the alarming rate of increase of obesity among Filipinos, it has not been made a priority.

Malnutrition, however, is not a hidden problem. It has been a lingering issue not just in the Philippines but globally as well. Governments from around the world and various humanitarian organizations are all campaigning against malnutrition. But will it ever be enough? The effort of these humanitarian advocates can only do so much. Ultimately, it is up to the people to choose what they eat and how they live. We could only hope that a creative and massive information campaign will help people be more aware and make better choices. Small, collective agricultural efforts may also be beneficial in ensuring that children have a variety of natural foods available.

Julian Martin Dollente, RN

About the Author

Julian Martin Dollente was born in Cagayan de Oro City, Philippines. He is a Registered Nurse and is currently in line with the government in giving Social Services to the people in his country. He works hard so that he could  help his family have a better future. As a father and a husband, he aims to provide his family a life that is both blissful and comfortable. In his free time, he loves to travel and would take every opportunity to visit places and see the world.

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Christopher M. Cirino, DO MPH
Founder of Your Health Forum

Categories: Featured Articles

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