04-03-2022
Friday, March 4 is World Obesity Day. A scourge that continues to claim more and more victims. Indeed, 800 million adults in the world suffered from obesity in 2021. As for the number of children and adolescents affected by this pathology, it has multiplied by ten over the past forty years.
And Tunisia is not to be outdone… The country is on an inexorably upward curve in terms of the number of people affected by this disease. To find out more, we spoke to professionals in the sector. Investigation.
Some numbers
Contrary to the collective imagination, obesity is not a state of affairs but a disease. It was recognized as such by the World Health Organization in 1997 and as a pandemic since 2016. Indeed, more and more adults but also children are affected and its consequences are devastating because of other resulting illnesses.
According to the latest survey established on this subject in 2016 by the National Institute of Public Health in partnership with the WHO, the prevalence rate among Tunisians was established at 26.2%. Among those aged 15 to 18, the latter is 10.2% and among those aged 30 to 64 at 32.7%. One in three adults in Tunisia is obese.
Obesity is calculated from what is called the BMI (body mass index). When this is greater than or equal to 30, we speak of obesity. From 30 to 34.9 we speak of moderate obesity. From 35 to 39 we speak of severe obesity and finally beyond 40, it is morbid obesity. It should be noted that obesity considerably reduces life expectancy.
There are two types of obesity. First, gynoid obesity, which is diagnosed when the excess fat is mainly located in the thighs. This is also called “saddlebags” and it particularly affects women.
Android obesity is diagnosed when the excess fat is mainly in the belly. It is also called abdominal obesity.
The main causes
The scientific definition of obesity is as follows. “Obesity corresponds to an excess of fat mass and a change in adipose tissue, leading to health disadvantages and which can reduce life expectancy”.
In order to know the main causes of this disease, we spoke with Dr Henda Jamoussi, Head of the Nutritional Diseases Department at the Zouhair Kallel National Institute of Nutrition and Food Technology, Head of the Obesity and also President of the Tunisian Association of Nutritional Sciences.
According to her, the first cause is the result of the lifestyle of Tunisians. “There is an imbalance in the energy balance. This means that we consume hyper-energetic foods and we spend little. Thus, the calorie intake exceeds the body’s energy expenditure,” she tells us. “The Tunisian diet is far too fatty, whether it be home-cooked meals or good fast food which is one of the main causes of obesity. We consume far too many sugary foods, industrial products, extra-processed foods and there is also a flagrant lack of vegetable consumption,” adds Dr. Jamoussi.
In addition to food, physical inactivity, ie lack of physical activity, is a vector of obesity.
We also contacted Ms. Wiem Attia, nutritionist in Hammamet. She explains that Tunisians do not have a culture of good food hygiene. “The ABCs of nutrition are not respected, especially in terms of timing: there is one hour to drink liquids, to eat fruits, sugars, etc. We were brought up with a mentality of thinking that when you are hungry you eat”.
Finally, there is also a problem at the level of collective beliefs. In the time of our parents and grandparents, a round person, or healthy, as they are often called, was synonymous with good health, even beauty for women. In reality, it is a danger, sometimes silent.
Obesity as a provider of other diseases… women more at risk
Obesity causes many symptoms that should alert. Thus, people suffering from this disease will develop joint pain, diabetes, hypertension, hyperuricemia (gout disease), respiratory problems (sleep apnea, nocturnal snoring, daytime sleepiness, etc.), and cardio complications. -vascular. Other very common symptoms, the formation of fat around the liver.
There are also psychological complications that arise from obesity with psychosocial repercussions: hiring difficulties, under-esteem, loss of confidence, teasing, stigmatization.
“As a general rule, the prevalence of obesity is higher among women,” says Ms. Jamoussi. In this respect, the latter explains to us that in Tunisia one woman out of three is obese. “The female prevalence is around 34.6 and among men it is 17.6%”, she specifies.
This is due to the different periods and physiological situation that the woman goes through throughout her life: puberty with the onset of menstruation, pregnancy, breastfeeding, menopause.
“Traditionally, breastfeeding women are asked to eat hyper-energetic foods to promote milk production, even though it is a false belief that promotes weight gain. On the contrary, you should drink a lot of water, juice and liquid products in general,” says the nutrition specialist.
Processing
The treatment of obesity must be multidisciplinary. “The patient must first see a medical specialist who directs him to a nutritionist who will provide nutritional education through a diet specific to him”, says Henda Jamoussi. Indeed, the latter warns against the diets that can be found on the internet and which in most cases are first dangerous for health and ineffective because they promote the “yoyo effect” (rapid loss and recovery fast and uncontrolled).
The patient must also receive parallel psychological and, if necessary, psychiatric support.
Finally, the last therapeutic component must go through physical activity through sport.
“Changing one’s eating habits is very difficult… it is above all a question of will, hence the importance of therapeutic monitoring. Those who follow all of these steps are more likely to succeed.”
Surgery
In case of failure of the nutritional management, ie the weighty objectives have not been reached, an ultimate solution remains possible, that of bariatric surgery. It consists of modifying the anatomical structure of the stomach and intestine with the consequences of modifying the hormones regulating appetite and energy storage, reducing the intake of food, and sometimes their absorption, reducing caloric intake. daily.
The most common is the sleeve gastrectomy. It is a restrictive and irreversible technique which consists in removing approximately 2/3 of the stomach and in particular the part containing the cells which secrete ghrelin, the hormone which stimulates the appetite.
Awareness day in Tunis
On the occasion of World Obesity Day this Friday, March 4, the National Institute of Nutrition has decided to organize an awareness day around this disease. The opportunity for us to talk to people who came to consult.
Indeed, many of them presented themselves at the entrance of the Institute in order to be screened. The first step is the calculation of the BMI. Thus, patients can weigh themselves and measure their height in order to establish the body mass index which will determine their stage of obesity. Then, they are invited to a glycemic reading to diagnose a possible diabetes and finally the taking of the tension.
A collective sports session is also planned as well as several awareness workshops.
With all this data, medical specialists establish a final diagnosis and a program for treatment, if the patient agrees to be followed.
This is the case of Hedia, whom we met on the way to the Institute… After climbing a few steps, she found herself out of breath even though she was only 38 years old. “I heard on the radio that there was this day. As I do not have the means to consult directly, I did not hesitate to come today because it is free. I know that I have a weight problem and it causes me a lot of health problems. I have diabetes, I’m hypertensive and I get out of breath at the slightest effort… so I’m worried”, she confides to us.
For her part, Sarah, 26, does not look like an obese person…yet she came to consult. “I think I only have a few pounds to lose…but my main goal in coming here is to learn how to eat a balanced diet,” she says.
This event, accessible to all and free, is one of the many actions undertaken by the National Institute of Nutrition and the Tunisian Association of Nutritional Sciences to combat this scourge which affects more and more Tunisians.
Wissal Ayadi