Let Food Be Thy Medicine

By Lisa Jolly

An erupting volcano is an apt description for the impending obesity and chronic non-communicable disease epidemic in Dominica.(1) Obesity and its complications has certainly taken a toll on the health and wellness of the Caribbean community and our fragile health care systems. The goal of this article is to help elucidate some of the food policy changes that may be considered at the institutional and national level in order to combat the growing obesity epidemic.

Cardiovascular disease is the leading cause of morbidity and mortality in the Caribbean region and Dominica. In 2011, the World Bank reported that Dominica has the most obese population in the OECS and anticipates that by 2015, approximately one-third of men and two-thirds of women will be obese.(2)

While adult obesity needs to be addressed, there is also growing concern for childhood obesity.

At the national level, food policy changes are needed to address the growing obesity epidemic, however, there is a lot that can be done by schools to address this problem. Why target schools? Our eating habits are formed in early childhood and adolescence. Furthermore 80 percent of children who are obese during their teen years grow into obese adults. (3)Obese children are the future diabetics and hypertensives.

• I attended a high school in Dominica which allowed the sale of sodas daily to the students. Sugar sweetened beverages (which includes sodas and artificially sweetened juices are one of the main culprits of the obesity epidemic. Schools should prohibit the sale of sodas and other sugar sweetened beverages on their compounds and make water the beverage of choice.

• Snacking options at my school included white bread or "Johnny cake"/bakes served with a hot dog or some other salted/potted meat or fish. This snack was never served with vegetables nor was I given the option to purchase fruit. Schools need to regulate the type of foods that their students are exposed to while at school. Schools may opt to make it a requirement that vendors offer water and fresh fruit and vegetable options.

• Usually within 2-5 minutes' walk from most schools across the island, there are usually a few shops which sell sodas, candies and salted snacks. Laws should be enacted to prevent the sale of these items to children in the school zones and encourage the sale of healthier options. When we speak of creating a healthy food environment, we simply mean to make the healthy option, the easy option.

• Both my primary and secondary school limited "sports day" to a once weekly activity. Most children don't get the recommended 60 minutes of daily physical activity. Their lives have also become increasingly sedentary while sitting watching various screens. Schools should consider making every day a "sports day" to increase physical activity among their students.

Barbados has recently imposed a 10% tax on sodas and other sugar sweetened beverages. Mexico, which was once the most obese nation in the world, has imposed a similar tax and has noted a reduction in soda consumption. There is evidence that taxing unhealthy foods/beverages can potentially reduce consumption.(4) These taxes can be used to assist local farmers in their production of local foods or provide food subsides that will make locally grown fruits and vegetables more affordable for low-income families.

Legislation should also be enacted to prevent the marketing of unhealthy foods particularly "fast foods" to children. Conversely, there should be aggressive marketing of local fruits and vegetables. Meanwhile, ads should highlight the true health effects of consuming these unhealthy processed foods which include Diabetes (loss of vision, amputation and dialysis), High Blood pressure (Stroke and Heart Attack) and cancer.

As a region, we also need to address our perception of what constitutes a healthy weight. It is not surprising that twice as many women are obese as a larger physique is considered more desirable in the region. Regional women are also less physically active than men.(2) Consequently, 51% of deaths attributable to cardiovascular disease and 61% of deaths due to cerebrovascular disease were women.(2) Regionally, women will take appetite stimulants in order to gain weight in order to appear more attractive.

These recommendations are not new, most developed countries have failed to implement food policy changes due to a lack of political will and resistance from food manufacturers. Most Caribbean islands do not have a healthcare system that can manage the tsunami of chronic diseases and so changing the food landscape is our only option. Do we have the political will to make the decisions needed to curb the obesity epidemic?

Bibliography: 1. Dr. Carissa Etienne , Director , Pan- American Health Organization 2. World Bank-The growing burden of non-communicable diseases in the Eastern Caribbean. 3. Reducing Childhood Obesity Through Policy Change: Acting now to prevent obesity , 2010 4. Obesity 2; Smart Food Policies for Obesity Prevention 5. PAHO Health Statistics.