•Why too much body fat is not good for pregnancy, children
VINCENT KURAUN explores the complex impact of obesity on individuals and society in Nigeria as experts bemoaned the increasing prevalence of this health issue within the country.
FOR many years, healthcare professionals in Sub-Saharan Africa have primarily focused on infectious diseases as the central health threats and leading causes of mortality. However, over the past three decades, this narrative has shifted significantly, with an increasing number of individuals being diagnosed with chronic, non-communicable diseases.
This trend is largely attributed to the growing Western influence on dietary habits and lifestyle choices, resulting in what is termed the “double burden of disease.” This concept refers to the coexistence of both infectious (communicable) and non-communicable diseases within the population.
Experts warn that conditions such as obesity, diabetes mellitus, hypertension, and various cancers once thought to primarily affect adults are becoming serious concerns for children and adolescents as well.
Obesity, previously regarded as a challenge confined to Western nations, is now on the rise in cities, towns and even rural communities across Nigeria. This trend is driven by rapid urbanisation, a decline in physical activity and the increasing consumption of high calorie, processed foods that have become integral to the modern Nigerian diet.
The severity of the situation is underscored by comments from a paediatrician and paediatric cardiologist, Dr Emmanuel Eyo-Ita, who recently spoke with Sunday Tribune while referencing a study published in The Lancet that highlighted a staggering 67.1 per cent increase in the prevalence of overweight children aged 5 to 14 years in Africa from 1990 to 2021. Alarmingly, the obesity rate surged by an extraordinary 215.8 per cent during the same period.
Looking ahead, projections suggest these figures may continue to rise, with estimates indicating a further increase of 33.3 per cent in the prevalence of overweight children and 140.3 per cent for obesity by 2050.
A physician and public health advocate, Dr Charles Adedamola Adeogun, echoed these concerns, emphasising the profound medical implications of obesity. “Obesity is not merely about body size; it is a disease in itself, closely associated with hypertension, type 2 diabetes, heart disease, infertility, arthritis, stroke, and even cancers. What is most alarming is the growing prevalence among children and adolescents,” he stated.
He attributed this rise to sedentary lifestyles, excessive screen time and poor dietary patterns, which are exposing youths to chronic illnesses once predominantly seen in adults.
In 2024, the World Health Organisation (WHO) highlighted the escalating global obesity crisis, noting that the rates continue to rise, particularly among children, and are now a significant public health challenge.
WHO further stated that over 35 million children under age five were estimated to be overweight in 2024, with obesity becoming a concern in low- and middle-income countries as well. The WHO emphasised the complex nature of obesity, which is linked to noncommunicable diseases, and continues to promote its Acceleration Plan to Stop Obesity through comprehensive, life-course and multi-sectoral policies.
Dr Adeogun further stated that the economic cost of this health challenge is equally staggering. Nigerian families spend millions of naira each year managing obesity-related complications, while the nation bears the burden of lost productivity and increasing healthcare expenditure. If this is left unchecked, this silent epidemic will strain the already fragile healthcare system.
The rising tide of childhood obesity
Explaining the implication of the Lancet study, in an interview with Sunday Tribune, Dr Eyo-Ita, said: “Considering the devastating consequences of obesity, I can say it is a frightening monster that is growing very rapidly, and we are ill-prepared to confront it.”
He highlighted the two predominant factors as the primary causes of childhood obesity as genetics and lifestyle choices, pointing to the increasing acknowledgment of a third contributing factor, the fetal onset of adult diseases.
“Numerous genetic conditions can predispose individuals to overweight and obesity,” he explained. “These genetic influences are present regardless of geographic location and are only minimally affected by lifestyle factors. While they do play a role in obesity, they cannot fully explain the significant surge in obesity rates we have witnessed in recent decades.”
Dr. Eyo-Ita further elaborated on the concept of fetal onset of adult disease, indicating that fetuses exposed to starvation or malnutrition may develop a metabolic profile that predisposes them to chronic conditions such as obesity, hypertension and diabetes mellitus.
He added that this phenomenon has been particularly rampant in Nigeria and continues to pose challenges to public health today.
He also identified diet and physical activity as the two critical lifestyle factors contributing to childhood obesity.
“First and foremost is diet,” he stated. “Incorporating junk food or what we refer to as empty calories into a child’s daily nutrition is a guaranteed pathway to obesity. Additionally, when daily activities are centered on sedentary behaviour, this further exacerbates the risk of unnecessary weight gain.”
He explained the physiological consequences of these lifestyle choices: “If I consume the same amount of food but expend less energy, my body will naturally store the excess calories as fat, preparing for a hypothetical ‘rainy day.’ When these excess calories come from processed foods that are difficult for the body to utilise efficiently, they are more likely to be stored as fat. If this ‘rainy day’ fails to materialise, these fat reserves increase, becoming apparent both visually and on the scale.”
Regarding childhood obesity, he stressed the importance of parents being vigilant for several key indicators that may signify potential risks.
“One notable sign is a child’s level of physical activity,” he noted. “Children who avoid outdoor play, cycling, dancing or any form of physical recreation and instead spend their days watching television, playing video games or using tablets are likely engaging in a sedentary lifestyle, which elevates their risk for obesity.”
He advised parents to pay close attention to clothing sizes. He said: “If parents find themselves purchasing clothes that are two sizes larger than what is typically appropriate for their child’s age, this could be an alarming indication of a trend toward overweight or obesity.”
While highlighting the significance of active engagement in physical activities, Dr Eyo-Ita said: “It is crucial for parents to participate in physical activities with their children. If a child exhibits disinterest in walking, playing, or other forms of exercise, or if they tire easily, this could further suggest a risk for obesity.”
He underscored the impact of family history on obesity risk. “A known family history of obesity should be a cause for concern. Since lifestyle factors are often shared within households, it stands to reason that children raised in similar environments may face an increased risk of developing obesity-related conditions.”
Also, in addressing the short-term and long-term health complications associated with childhood obesity, Dr Eyo-Ita highlighted several critical concerns that parents should be aware of.
“Health is defined as a state of complete physical, mental and social well-being,” he stated. “Obesity has a profound impact on all these dimensions and adversely affects every organ system in the body.”
He noted that the cardiovascular system is particularly vulnerable, with significant risks including hypertension, heart failure and hyperlipidemia. Additionally, the endocrine system can be affected, leading to conditions such as diabetes, thyroid disorders and complications related to puberty and menstruation in girls.
The respiratory system is also at risk as children with obesity are more likely to develop obstructive sleep apnea. Furthermore, various musculoskeletal problems may arise due to excess weight along with potential micronutrient deficiencies. Alarmingly, the rate of stroke among children has been increasing, particularly in conjunction with obesity and hyperlipidemia.
In terms of psychosocial implications, Dr Eyo-Ita emphasised that obese children face a heightened risk of body dysmorphic disorders, bullying, with adverse effects on their academic performance.
“Ultimately, we are nurturing individuals who may become depressed, angry and socially withdrawn,” he cautioned.
He concluded with a stark warning about the economic ramifications of this growing issue. “With an increasing population of overweight and obese individuals, we can anticipate a rise in chronic disabilities, which will place additional strain on an already overburdened healthcare system. This trend also poses the risk of removing young people from the workforce due to chronic conditions such as joint problems, strokes, kidney diseases among others,” he said.
He also advocated that families must prevent childhood obesity from an early age by engaging in physical activity.
“It’s essential to get children moving,” he stated. “Encourage them to play outside and engage in physical activities, reminiscent of past generations when outdoor play was commonplace,” Dr Eyo-Ita said.
He emphasised the importance of limiting screen time when outdoor play is not feasible. “Parents should establish strict limits on how much time children spend watching television, playing video games or even reading books. As my teacher once advised, let children experience boredom. It’s beneficial not to fill every moment with structured activities; this encourages kids to create their own play activities, which often involve significant movement,” he said while also highlighting the need for mindful dietary choices.
Dr Eyo-Ita stressed that it is counterproductive for parents to indulge in junk food while expecting their children to maintain healthy eating habits, adding that “This endeavour needs to be a family commitment. It’s unrealistic to expect one child to follow a separate meal plan while the rest of the family indulges as they wish. All family members must participate in the same programme for it to be effective.
“While I do not oppose occasional treats, it is crucial to practice moderation and ensure that these indulgences do not become a regular part of the diet.”
As for final advice to parents regarding obesity prevention and fostering healthy habits for their children, Eyo-Ita advised families to “seek information to understand the extent of the damage being done to children. Knowledge can inspire necessary changes.
“Secondly, acknowledge that preventing or treating overweight and obesity is a gradual and collective effort that should involve the entire family.”
Challenges of obesity during pregnancy
To understand the intricacies and effects of obesity during pregnancy, Sunday Tribune spoke with a resident physician in the Department of Obstetrics and Gynaecology at Lagos University Teaching Hospital in Idi-Araba, Lagos, Dr. Margaret Obienu, who explained that “A person is classified as obese when the calculated body mass index (BMI) is equal to or greater than 30 kg/m².”
She stated that “calculating BMI during pregnancy may not provide a precise correlation with morbidity due to increased body water content. However, BMI remains a common tool for screening and monitoring obesity in pregnant individuals.”
She noted that the implications of obesity during pregnancy are significant and multifaceted, elaborating that “Obesity in pregnancy poses a serious concern to the obstetrician because of the associated challenges and possible complications. Most often, obese women have co-existing medical conditions which could worsen during pregnancy.”
Dr Obienu outlined the specific risks of obesity for both mothers and their babies, saying, “For pregnant women, obesity increases the risk of miscarriage, gestational diabetes mellitus, gestational hypertension, pre-eclampsia, venous thromboembolism and preterm labour. For the fetus, there is an increased risk of congenital anomalies, fetal macrosomia and its related complications, as well as prematurity.”
She also discussed the challenges of providing antenatal care to obese pregnant individuals. “Complications can arise, including difficulties measuring blood pressure due to a lack of appropriately sized cuffs, challenges in performing obstetric examinations to assess fetal well-being and complications in conducting ultrasound scans.”
The resident physician further warned of potential complications during labuor, stating, “Assessing maternal and fetal well-being can be challenging, with an increased risk of slow progress in labuor, difficulties in delivering the baby, the need for instrumental delivery, traumatic injuries to the mother and/or baby, perinatal asphyxia, emergency cesarean sections, excessive bleeding after delivery, and poor wound healing.”
Dr Obienu highlighted additional obstacles faced during cesarean deliveries, including challenges in transporting the woman to the operating theatre, administering anesthesia and prolonged surgery times.
To address weight management prior to conception, Dr. Obienu advised, “Obese women who wish to conceive should seek preconception care to assess their health status and implement necessary interventions. These may include lifestyle modifications such as weight loss, exercise, and dietary changes.”
She emphasised the importance of folic acid supplementation and stabilising co-existing medical conditions prior to conception, noting that such preconception care can mitigate complications during pregnancy.
Regarding prenatal care for obese women, Dr Obienu stated, “It is essential for obese pregnant women to register early for antenatal care. Their management should be multidisciplinary, involving obstetricians, dietitians, physicians, neonatologists, midwives, anesthetists, and other healthcare professionals.”
She added, “For women with obesity during pregnancy, optimal weight gain should be limited to 5-9 kg, whereas those with a normal weight are advised to gain between 11.5-16 kg.” Dr. Obienu also emphasised the necessity for dietary control during pregnancy, recommending a daily caloric intake of approximately 1900-2000 kcal.
Finally, she discussed the potential long-term health implications for children born to mothers who were obese during pregnancy, stressing that these children are at increased risk for childhood obesity, which may lead to diabetes mellitus later in life.
Dietary recommendations
A registered dietitian, Toluwalope Phoebe Farodoye, also spoke with Sunday Tribune to shed light on dietary recommendations for pregnant individuals dealing with obesity.
She stated that, “Nutritional management for this demographic focuses on achieving appropriate gestational weight gain, ideally within the recommended range of 5 to 9 kg (11 to 20 lb). A balanced, calorie-controlled diet is essential, prioritising the inclusion of fruits, vegetables, whole grains, lean protein sources and low-fat dairy products.”
Key strategies include portion control, minimising the intake of added sugars and saturated fats and ensuring adequate consumption of essential micronutrients such as folate, iron and calcium.
In her recommendations for women planning to conceive, Farodoye emphasised the importance of adopting a nutrient-dense diet that supports optimal micronutrient intake. She advised that women should begin a daily folic acid supplementation of 400 µg at least one month prior to conception to help reduce the risk of neural tube defects.
Furthermore, a sufficient intake of iron, zinc, vitamin B12, and essential fatty acids, including omega-3 and omega-6, plays a crucial role in promoting reproductive health and supporting fetal development. Farodoye also highlights the significance of maintaining a healthy body mass index (BMI), avoiding alcohol and tobacco, and effectively managing stress as vital components of comprehensive preconception care.
In exploring the relationship between diet and obesity, Farodoye emphasised the critical role of nutrition in this pressing public health issue, noting that obesity often results from excessive caloric intake, a high consumption of sugar-sweetened beverages and energy-dense foods and insufficient intake of fruits, vegetables and whole grains.
To combat this trend in children, she recommended several dietary changes while advocating for balanced meals that include appropriate portion sizes, an increased intake of fruits and vegetables and a preference for whole grains. Furthermore, she advised limiting sugary snacks and beverages and encourages regular family meals as a means to foster healthier eating habits.
While highlighting the importance of reducing ultra-processed foods and instilling healthy eating behaviors early in life, Farodoye said that the first five years are particularly vital for shaping dietary habits, adding that caregivers should focus not only on feeding children to ensure they are full but also on the nutritional quality and developmental benefits of each meal.
On the obesity epidemic affecting children and adults, Farodoye pointed to the significant impact of processed and fast foods, asserting that these food options contribute markedly to excessive caloric intake and compromised dietary quality.
“Characterised by high levels of saturated fats, refined sugars and sodium while lacking essential nutrients, processed foods promote a positive energy balance, leading to weight gain across demographics,” she said.
To combat this growing concern, she recommended several family-oriented strategies to reduce the consumption of these unhealthy foods, noting that the key approaches include increasing the frequency of home-cooked meals, limiting the intake of sugar-sweetened beverages, diligently reading nutrition labels and enhancing access to fresh fruits and vegetables.
About healthy alternatives to common snacks and meals, Farodoye emphasised that making thoughtful substitutions can greatly enhance diet quality for families.
To curb sugary beverage consumption, Farodoye said water, unsweetened fruit-infused water, smoothies, or low-fat milk as healthier choices. Furthermore, she encouraged parents to replace pastries and candies with fresh fruits, yogurt or roasted nuts.
These straightforward and family-oriented substitutions, according to her, not only promote greater satiety but also improve nutrient balance and help reduce the risk of obesity.
In addressing how parents can better understand appropriate serving sizes for children to prevent overeating, Farodoye emphasised the importance of adhering to age-specific dietary guidelines, such as the World Health Organidation (WHO) growth standards and the My Plate model. Given that children’s stomachs are still developing and have a limited capacity, it is recommended that parents serve small, frequent, nutrient-dense meals rather than adhering to the traditional three large meals per day.
Farodoye also urged families to prioritise healthy eating and effective weight management through strategic meal planning.
She emphasised that successful meal planning starts with preparation, particularly selecting nutritious food items and preparing balanced meals in advance, adding that families are encouraged to develop weekly menus that feature a diverse array of fruits, vegetables, whole grains, lean proteins and healthy fats. Shopping with a list is crucial as it helps to minimise impulse purchases of processed foods.
Additionally, practices such as batch cooking and portioning meals not only support consistency but also facilitate portion control.
She added that involving the entire family in this process, including setting regular meal times and engaging children in meal preparation, can foster healthier habits and promote long-term adherence to balanced eating.
When asked if there are any dietary supplements or functional foods she would recommend for adults struggling with obesity, Farodoye emphasised that an adequate, calorie-controlled diet combined with regular physical activity remains the cornerstone of effective weight management.
She clarified that while dietary supplements and functional foods may offer supportive benefits, they should not replace a balanced diet, adding that the use of supplements should be tailored to address specific nutrient deficiencies rather than utilised routinely. In cases where clinically indicated, nutrients such as vitamin D, iron, or omega-3 fatty acids may provide significant benefits.
Additionally, functional foods that are rich in soluble fiber, plant proteins and probiotics have the potential to enhance satiety and promote metabolic health; however, their inclusion should be individualised and overseen by a qualified registered dietitian or licensed professional to ensure safety and efficacy.