Addressing the emerging overweight and obesity public health challenges in West Africa

By Karin Christianson, Food and Agriculture Organization, Regional Office Accra, Ghana and Lucy Billings, International Food Policy Research Institute

Undernutrition, historically a focus for the West African nutrition community, took a back seat at a recent event entitled Addressing the emerging overweight and obesity public health challenges in West Africa. This multi-stakeholder consultative dialogue, organized by the Food and Agriculture Organization of the UN between 20-22 March 2019 in Accra, Ghana included representatives from government, civil society, academia and research institutes and private sector. Inter-governmental organizations including the Economic Community of West African States (ECOWAS) and the West African Health Organization (WAHO) were also represented. Participants gathered to discuss the trend of increasing prevalence of overweight and obesity in ECOWAS member countries and to propose interventions to address this emerging health challenge. Given the multifactorial nature of these forms of malnutrition, consultation among sectors remains critical to preventing further increases in prevalence.

The objectives of the dialogue were threefold: i) to assess the current situation and deliberate on the contributing factors, ii) to share country experience on initiatives undertaken to address the issue, and iii) to discuss future strategies for multi-sectoral coordination and mutual accountability. Through the course of the dialogue, the seriousness of the situation was made apparent by multiple presenters. A recent study estimated 52 million adults in the region could be affected by obesity or overweight (Cornelia F.A. van Wesenbeeck 2018). Yet these figures alone do not capture the broader picture of the co-existence of multiple forms of malnutrition (under, over and micronutrient deficiency) which can coexist in the same community, household, or even individual.

Drivers of overweight and obesity are commonly understood; however, they are complicated to address as they include individual physiological and external environmental factors. Dietary intake as well as physical activity are critical components as are issues of access, affordability, convenience and appeal. As the highest burdens of overweight and obesity occur in urban settings, addressing linkages to urban food systems was identified as a key measure. Country representatives shared summaries of efforts underway to address nutrition issues at large, including mainstreaming nutrition into regional and national agriculture investment plans, working with political stakeholders such as parliamentarians to raise visibility, and increasing coordination among actors (potentially utilizing existing platforms such as the Scaling Up Nutrition network). Participants readily acknowledged the need to expand this dialogue beyond Ministries of Health and Agriculture to include trade, education, commerce, agriculture, development, and finance as well as bringing in partners from academia, research, civil society and private sector. While formal recommendations from the dialogue are being finalized, there was consensus on the need for increased nutrition education, adoption of legislative incentives to promote consumption of locally produced foods and reduce consumption of ultraprocessed foods, and increased prioritization of data collection for strengthening evidence.

Transform Nutrition West Africa identified overweight and obesity as a major emerging challenge for the region during the project inception phase from secondary data analysis. The top priorities for Transform Nutrition West Africa, as identified by regional stakeholders, are in alignment with the strategies discussed during this dialogue. These include 1) capturing, documenting and learning from implementation experiences; 2) strengthening capacity to collect, analyze, and report relevant data; 3) accelerating equitable program coverage of MICN interventions at scale; 4) assessing and strengthening institutional capacity and leadership/championship to implement policies and hold governments to account; and 5) making food systems and value-chains work better to address nutrition challenges.
A number of current evidence generation and synthesis activities under Transform Nutrition West Africa are designed in response to these priorities. Three current activities with focus on the issue of overweight and obesity are summarized here:

  • The Stories of Challenge in Ghana study (2018-2020) will investigate how economic transformation and urbanization affected rural and urban food environments, identify the socio-economic factors that drive food choices across different vulnerable sub-populations, build understanding on the interactions between the food environment and food choices, and identify policies and programs that have influenced the food environment.
  • An assessment of data integration identifies all nationally representative data sources covering a set of key nutrition indicators including six related to overweight and obesity. Country data profiles will be available on the Transform Nutrition West Africa web platform in April to guide data users in their data source selection and highlight data needs at country level.
  • A secondary analysis on spatial patterns of multiple malnutrition burdens and associated drivers in West Africa is being conducted to understand the overlapping and co-existing malnutrition burdens among women of reproductive age and children under 5 at national and subnational levels and to identify shared drivers that influence multiple burdens of malnutrition for the development of a conceptual framework.

Reference: van Wesenbeeck, C. F.A. (2018) Disentangling urban and rural food security in West Africa. OECD, West African Papers.