- Obesity is a growing trend worldwide. In Kenya, over a million five- to 19-year-olds will be obese by 2030. Kenyan doctors are diagnosing younger and younger people with noncommunicable diseases such as diabetes.
- At the same time, the East African nation is also plagued by hunger. More than three million people do not have easy access to good, nutritious food.
- Meet the kids at the forefront of a movement towards healthy eating, one taekwondo lesson at a time.
The kids at Bees Haven Kindergarten are about 15 minutes into their weekly taekwondo class when their teacher has a few stern words for them. “You’re not panting,” says Lizzanne Adhiambo with a grin. “I want to see the power! Let’s hit!
Aside from some confusion about left and right hands, Adhiambo’s students obey. They flap out in front of them with alternating arms, 15 four- to six-year-olds in white training uniforms shouting “Yeah!” because the teacher counts from 1 to 10.
“They love it so much,” says Beryl Itindi, principal of the preschool in Syokimau, on the southwestern outskirts of Nairobi.
After class, the children sit down to lunch of beef stew, leafy greens, ugali – Cornmeal porridge – and fresh fruit. “Thank you for our food and our many blessings,” they sing in unison. “Amen.”
These children are at the forefront of new efforts to promote lifelong exercise habits and healthy eating – and to fight off an enemy that’s becoming ever more visible in Kenya’s towns and cities: obesity.
As in much of Africa, the number of people classified as obese is also increasing in Kenya: According to the World Obesity Atlas, 1.4 million five to 19-year-olds will be obese by 2030. The World Health Organization (WHO) considers a person with a body mass index (BMI) over 25 to be overweight, while a BMI over 30 is considered obese.
A 2015 survey – the most recent – found that 20% of Kenyan men and more than 50% of women were either overweight or obese.
In a report last year, the Kenyan government recognized obesity as a major risk factor for noncommunicable diseases (NCDs) such as diabetes and cancer, which account for 39% of deaths in Kenya – up from 27% in 2014.
“The statistics show that obesity is increasing at a very alarming rate, not just in Kenya but regionally and globally,” says Stephen Kimutai Tanui, Strategy manager for Wellness for Greatness, the organization behind the Taekwondo classes.
When Tanui, 32, was a child, the education the group provides to the children was sorely lacking: “We weren’t told that physical activity had very many benefits … not just for fun and achievement in school, but for our health.”
In a hunger-stricken country where more than three million people are classified as acutely food insecure, the priority is getting enough food, regardless of its nutritional value, he says.
“When we were young, that connection between good nutrition and good health was missing,” says Tanui. “In Kenya and in most African countries we have a problem of malnutrition and that is what everyone is focusing on. People should have food, but we should also focus on getting good, healthy food because the speeds at which obesity is increasing go hand in hand: malnutrition and obesity. It’s a terrible burden.”
In parts of rural north and east, the worst drought in 40 years is driving thousands of Kenyans from their homes. According to the International Federation of the Red Cross, around 755,000 children under the age of five will be acutely malnourished by 2022.
In Nairobi, where fast-food chains like KFC, Burger King and Domino’s are on every other street corner and billboards tout “vitamin-enriched” chocolate drinks to motorists on the bumpy roads, the problem is “completely different,” says Dr. Davis Ombui, a diabetologist. “People go to work in the morning, get in [the] office, get back in their cars, drive home. They don’t walk to work as much anymore and fast food is a big issue in Nairobi now.”
The result is clear in his private clinic operations. “We are seeing younger people being diagnosed at a younger age. Today I had someone who was 21. type 2 diabetes. It’s all because of obesity; all because of the lifestyle.”
Last year, the Ministry of Health released a strategic plan to respond to the “epidemiological transition” in the burden of disease from communicable diseases such as malaria and tuberculosis to increasing numbers of noncommunicable diseases. It recognized obesity as a key risk factor, but doctors fear there is little concrete action.
“Perhaps these guidelines are on paper,” says Ombui. “But no one is putting that into practice on the ground. I am sure if you go to the cabinet you will find some really nice policy papers sponsored by the WHO and [other] Organizations – just gather dust.”
The Ministry of Health has been asked for comment. The government’s goal is to reduce the prevalence of obesity from 28% in 2020 to 26% in 2025, and time is ticking. By 2030, NCD deaths are expected to increase by 55%.
And there remains an enduring association in society between excess fat and material success.
“You can find young people at the university want to gain weight and grow a belly as a status symbol. It’s so bad,” said Stephen Ogweno, CEO of Stowelink, a youth-led noncommunicable disease company. “There’s still that perception that needs to change.”
For wealthy Kenyans, Dr. Wyckliffe Kaisha the answer. As one of the few surgeons in the country performing bariatric — or weight-loss — surgeries like gastric bypasses, he’s seen a significant increase in patient numbers, partly due to COVID-19, which has made more people aware of the consequences of obesity, diabetes and hypertension.
One of his patients, a 29-year-old who underwent gastric sleeve surgery last year to remove part of her stomach, has no regrets.
“It requires someone who is psychologically and emotionally prepared because it’s not easy, especially when you’re used to taking a lot of junk with you [food]. I really loved chips. Now I can’t even smell french fries,” she says.
The woman, who doesn’t want her name published, says she’s lost 40kg: “Now at least I can climb stairs. I don’t depend on elevators.”
Bariatric surgery has its detractors, but Kaisha insists it’s beneficial for the vast majority. His bugbear lies with insurers refusing to cover the procedure, meaning only the wealthy can afford his $5,000 (R77,500) fees.
He has told insurers that bariatric surgery is cost-effective because it prevents disease from developing. “They still deny it and say it’s cosmetic surgery. But it’s not at all,” he says.
The village of Njathaini on the northern outskirts of Nairobi is a world away from Kaisha’s clientele. With unemployment high and disposable income low, action is urgent in places like this, says Ogweno.
Thanks to genetics, diet and a lack of exercise, Ogweno, 26, once weighed nearly 127kg. Driven by a desire to “look like Dwayne ‘The Rock’ Johnson,” he lost weight in college and competed in Mr. Fitness contests.
He wants to prove that obesity, diabetes and cancer don’t just affect “the old and rich”. What he and his colleagues found at Njathaini shocked them: “[This is] a very low-income community, and nearly 70% of the households here live with diabetes or high blood pressure,” says Ogweno, who sits in the village chief’s office.
The traditional diet in poor neighborhoods relies heavily on carbohydrates and cooking fat with staggeringly high trans fat levels known to increase heart disease risk. You can buy cabbage for 70 shillings (R9.35) at a Njathaini shop. Another, a few houses down, has bags of chips for 20 shillings (2.65 Rand) and fried rolls for 10 shillings (1.32 Rand).
Then there’s the sugar. “Soft drinks are more readily available than clean water,” says Ogweno. The stores are crammed with fizzy drinks, Sprite, Coca Cola and Fanta as well as water and greet each customer with bunting.
Francis Njuguna, a community health worker, was born and raised in Njathaini. “Before [obesity] was not an issue. There have been very few cases. But nowadays there are a lot of people,” he says.
In collaboration with Stowelink, Njuguna advises local people on growing vegetables and other crops. “Kale, tomatoes, onions, spinach” are all possible, he says.
The worst thing, Ogweno says, is that once people are linked to obesity, they have trouble getting treatment.
“Unless you’re officially employed… you’re almost always uninsured [by national health insurance] and if you’re sick, you have to pay out of your own pocket,” he says. This applies, for example, to insulin for diabetics. “People literally have to get the whole village together to contribute money and then do it because otherwise it’s a death sentence.”
Ogweno, whose aunt died of diabetes after seeking help from a traditional healer, believes the government is slowly and belatedly moving to take NCDs seriously.
So for now, it’s the Bees Haven kids who are paving the way. Exuberantly after the training, the martial artists of the kindergarten eat their lunch enthusiastically – that too manage greens. Children often come in rather shy, says Itindi, the director, and the exercise “really opens them up both mentally and physically.”
This feature was originally released by The Guardian global development project – Part of Guardian News & Media Ltd.
Lizzy Davies writes about global development for The Guardian. Previously, she was news director at The Observer.