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The fight against the obesity epidemic

74 percent of deaths in The Bahamas attributed to non-communicable diseases — hypertension, elevated cholesterol numbers, coronary heart disease and Type II diabetes according to the World Health Orga
Guardian Lifestyles Editor

Published: Oct 22, 2013

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Obesity has become an epidemic around the world, and The Bahamas is right in there, according to nutritionist Donovan Ingraham as global statistics have shown that since 1980, obesity has doubled.

According to World Health Organization (WHO) statistics, obesity in adults has risen to 1.8 billion people — and these are people over the age of 20. And 40 million children in 2011 were diagnosed as being overweight, with 200 million men and 300 million women diagnosed as being obese.

In The Bahamas, according to Ingraham, a nutritionist at Bahamas Medical Center (BMC) on Blake Road, the risk of coronary heart disease and cardiovascular death has increased, and that deaths in The Bahamas, according to the WHO is 74 percent attributed to non-communicable diseases — hypertension, elevated cholesterol numbers, coronary heart disease and Type II diabetes.

And he says since the 1980s, the body mass index (BMI), which is a person’s weight to height ratio has increased steadily since 2008, which he says is a problem in the country due to people’s eating habits, physical inactivity, poor choices, societal habits, and cultural changes that have not happened.

Speaking at a recent Doctors Hospital Distinguished Lecture Series, Ingraham says obesity is classified a disease because fat tends to settle around the brain area, the heart, and kidneys — major organs. And that obesity leads to several issues — bone and muscle damage, hypertension, elevated cholesterol numbers, Type II diabetes and even cancer.

“It’s a problem, because not only is obesity a problem, but it tends to lead to even more problems, so it becomes a spiraling effect,” said Ingraham.

Anyone, male or female, with a BMI over 25 is described as overweight. To be classified as obese, a person has to have a BMI of 30 or higher. More recently, the WHO has used more individualized measurements of obesity. A waist circumference for a man greater 40-inches indicates that the person is overweight and obese and in a woman, a waist circumference greater than 35-inches indicates that they are obese.

“Waist circumference is now suggested to be more superior in measuring obesity than BMI,” said Ingraham. “When obesity occurs and diabetes is occurring, this means you have decreased glucose tolerance, reduced insulin sensitivity and adverse lipid profiles.”

Causes of obesity

According to the nutritionist, obesity is caused by many factors — genes, hormones, fetal origins (Barker hypothesis), breast feeding, sleep pattern, physical inactivity, diet, psychological/emotional well being, parental influences, environment/culture, behavior, convenience, food availability and poor nutritional knowledge. And that increasing your knowledge of nutrition leads to reduced risk of obesity.

He also said what has been termed a food epidemic plays a part in the problem, with people who skip breakfast which then leads to an elevated daily caloric intake.

“When you miss breakfast you in turn make bad choices at lunch time and at dinner time,” said Ingraham.

He further said that people then resort to consuming high energy density foods such as potato chips, croissants, burgers, sweet drinks, desserts that are high in fat and low in antioxidants from fruits and vegetables, and that the result of the high-fat meal, is that the level of fullness is only short-lived, and it leads to elevated caloric intake, because they snack so over the course of the day they increase their daily caloric intake.

He also said a part of the epidemic is that eating has become a convenience and that poor planning leads to elevated daily caloric intake.

The nutritionist said that the result of obesity results in increased insurance premiums, less work days, poor work productivity, increased public health spending, poor family bonding, low energy, increased appetite, increased weight gain and poor health.

And obesity is no longer an adult problem, according to the nutritionist, obese parents equal obese children as parents pass on their habits to their children.

“When we are not educating our kids on how to live a healthier lifestyle, eat healthy, how to be active, then they would only follow what we do. So we (adults) have to lead by example. If we lead by example we then reverse the issue of obesity in generations to come,” said Ingraham.

Low energy density meals that are more ideal he said would include incorporating fruit and vegetables, adding lettuce on a sandwich, yogurt, milk, orange juice, coffee and more fruits and vegetables.

Low energy density meals have a calorie intake of around 1,500 per day, while high energy density meals had a calorie intake of over 3,000 per day.

“We need to become a society where fruits and vegetables are seen as the ideal meal,” said the nutritionist.

Changing the trend

In order to change the obesity trend, Ingraham said people have to change their lifestyles — eat healthy and get active.

“Studies have shown that obesity and the risk of staying obese is because of poor eating habits — and that’s 90 percent of the problem.

Ten percent of the problem is being physically inactive. Our ancestors led vigorous lives. They walked long distances, carried heavy loads and ate high starch foods. In today’s society those foods are still common, however we haven’t changed our eating habits, we’re still eating large plates and high starch foods, but we’re not active anymore. We drive everywhere and exercise less. Because this is the age of technology, and we sit down and watch television, there is very little physical activity happening. We eat our meals and go to sleep.  We have to change the way we see food. Food can no longer be like what it was 100 years ago with our ancestors because they were active … they deserved to eat heavy foods. We have to incorporate more fruits and vegetables into our diet to lower the energy density of these meals,” he said.

At BMC as they focus on health and wellness, the nutrition program focuses on nutritional assessment (identifying a person’s nutritional status); nutritional consultation (learning how to improve their health and lose weight); grocery store visits (plan meals and spend less to eat healthy) and even cooking demonstrations (to learn to make quick, delicious, yet healthier meals).

“Each person is an individual, so no goal would be exactly the same as any other individual and we make small changes into a gradual big change.”

In an effort to turn the tide of nutritional intake, Ingraham says people need to plan their meals and consume proper portion sizes; eat a healthy breakfast daily; eat a balanced meal of protein, fats and carbohydrates; have fruit and vegetables at every meal; eat 2 to 3 three servings of fruits per day; eat a minimum of 3 servings of vegetables per day; choose high fiber carbohydrates and not white flour carbohydrates; choose healthy fats: nuts, seeds, fish avocado, olive oil; and drink a minimum of 6 to 8 servings (8 ounces) of water per day (if you drink 12 he says you’re winning).

Weight loss solutions

Also speaking during the talk was Sharad Johnson, an exercise physiologist at BMC who says it’s not just about being overweight, but about being healthy.

“Some of us look fine, we don’t look like we need to lose any weight, but our cholesterol is through the roof and we don’t know it,” said Johnson.

At BMC he said they decided to do their part to make the community healthier, through the addition of their fitness center, a comprehensive program for individuals who need to get healthy again.

BMC patrons he said would see all the accoutrements that people would expect at their local gym — yoga, Pilates, equipment and even the Cellulite Cottage for spa services, but he said unlike a gym, you don’t just sign a membership and go workout. At BMC everyone undergoes a health assessment first, and a program is tailored for the individual — and everyone gets personal training. He said everyone gets an individual approach to helping them get healthy.

“To make sure this is a sustainable program, we’ve put together a six or 12-month program for individuals to come in, meet with a team, get an assessment, get a physician to check health status first to know what their issues are, what they have to work on and what they need improvements with,” said Johnson.

And the exercise component he said can affect every system inside the body — cardiovascular, musculoskeletal system, respiratory system to the digestive system.

“It speeds up your digestive system, your metabolism starts to boost as well as your digestive. Respiratory, you start breathing easier, you start lasting longer during the days, you’re not as sleepy or tired, you can breathe easily and do things for a longer period of time. Musculoskeletal builds your bones in density and helps you to last longer during daily activities, gardening, household chores, and keeping up with the kids.”

Johnson said a regular exercise routine keeps people running and moving.

“Most individuals we find have a lot of knee pain or back pain due to excessive weight which mostly around the midsection, the hips, the thighs … and all of that is compressing down on the body as gravity is a daily factor. We encourage you to help your body systems not only for your weight, but to help your body systems become more efficient as life goes on,” said the exercise physiologist.

As studies have shown that most people lead sedentary lifestyles due to increased technology, he said parents should push their kids outside, and turn off the video games, get them off the computer and away from the television. Due to the increased use of technology, he said they quite often see 12-year-olds weighing up to 200 pounds who haven’t fully developed as yet.

At BMC, Johnson said their weight-loss solution strategy is to combine nutrition and exercise and that for it to work, the majority focus should be on nutrition. To lose weight he said people have to create a calorie deficit that they can do by decreasing their calorie intake and increasing their exercise work output.

“We have to be in the negative to lose weight. The less you take in or the less you decrease in your daily diet, you will gain all you need,” he said.

A healthy weight loss is one to three pounds per week.

And he said as they lose weight, most people may not notice anything happening on the outside right away, but that the gains are coming as getting to healthy works from the inside out.

“You feel sore, you feel tired, but you haven’t seen the gains yet, but the gains are going to come,” he said.

The benefits of exercise includes reduced risk of heart disease, stroke, hypertension, colon cancer, diabetes; help keep bones, muscles and joints healthy, reduce anxiety and depression, better sleep, boost energy and controls weight.

And that at BMC, the exercise program is a team approach, supervised by fitness professionals in a private setting. He said it’s non-intimidating with the use of advanced technology and goal based through fitness counseling and education.


Plan meals and eat your portion sizes.

Eat a healthy breakfast everyday.

Eat a balanced meal of protein, fats and carbohydrates.

Have fruit and vegetables at every meal.

Eat 2 to 3 three servings of fruits per day.

Eat a minimum of 3 servings of vegetables per day.

Choose high fiber carbohydrates and not white flour carbohydrates.

Choose healthy fats: nuts, seeds, fish avocado, olive oil.

Drink a minimum of 6 to 8 servings (8 ounces) of water per day (if you drink 12 you’re winning).


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