June 2002 contents

Childhood Obesity on the Riseby Carol Torgan, Ph.D.

Open your window on a sunny afternoon, and what do you hear? The chirping of singing birds? The yelling of playing children? Odds are these days that you'll hear the birds but not the children. As kids spend more time in front of television, computer and video screens, their physical activity levels have decreased. And their body weights have increased.

Obesity in kids is now epidemic in the United States. The number of children who are overweight has doubled in the last two to three decades; currently one child in five is overweight. The increase is in both children and adolescents, and in all age, race and gender groups.

Obese children now have diseases like type 2 diabetes that used to only occur in adults. And overweight kids tend to become overweight adults, continuing to put them at greater risk for heart disease, high blood pressure and stroke. But perhaps more devastating to an overweight child than the health problems is the social discrimination. Children who are teased a lot can develop low self-esteem and depression.

There are many causes of obesity. While there's no doubt genetics plays a role, genes alone can't account for the huge increase in rates over the past few decades. The main culprits are the same as those for adult obesity: eating too much and moving around too little. Almost half of children aged 8-16 years watch three to five hours of television a day. Kids who watch the most hours of television have the highest incidence of obesity.

If you're concerned your child may be overweight, talk with their doctor. A health care professional can measure your child's height and weight

Did You Know That...Obese children and adolescents have shown an alarming increase in the incidence of type 2 diabetes, also known as adult-onset diabetes. Many obese children have high cholesterol and blood pressure levels, which are risk factors for heart disease. One of the most severe problems for obese children is sleep apnea (interrupted breathing while sleeping). In some cases this can lead to problems with learning and memory.Obese children have a high incidence of orthopedic problems, liver disease, and asthma.Overweight adolescents have a 70 percent chance of becoming overweight or obese adults.

and calculate a ratio known as body mass index (BMI). This number is compared to a growth chart for children of your kid's age and gender to determine whether his or her weight is in a healthy range.

Encourage Activity

You can help your children maintain a healthy body weight by encouraging them to be active. Try taking them to a park. According to the National Recreation and Park Association (NRPA), 75 percent of Americans live within a two-mile walking distance of a public park.

The National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health has teamed up with NRPA to offer a nationwide program called Hearts N' Parks. Park and recreation departments and other community-based organizations receive assistance from NHLBI on providing activities for kids and adults that encourage healthy lifestyle choices. The goals are to reduce obesity and the risk of heart disease by encouraging nutritious eating habits and regular physical activity. Kids may go on field trips to local grocery stores and restaurants to learn how to make healthy selections and read food labels. They might participate in soccer, tennis, basketball, bowling, swimming, or hiking.

Karen Donato, coordinator of NHLBI's Obesity Education Initiative, says that the program emphasizes non-competitive activities where everyone joins in the fun. "There shouldn't be kids sitting on the sidelines," she says.

An increasing number of schools are also encouraging healthy lifestyle behaviors. More nutritious choices in cafeterias and vending machines, such as salad bars and baked food rather than fried, encourage kids to try items other than sodas, candy bars and french fries. Some schools offer opportunities for increased physical activity through intramural sports programs and good-old-fashioned recess. A recent report from the U.S. Surgeon General's office calls on schools to provide daily physical education (PE) for all grades. In schools where PE classes are offered, kids are now engaging in more activities that emphasize personal fitness and aerobic conditioning, rather than the competitive dodge-ball games you may recall from childhood.

Parents can get involved by making sure that their schools have healthy food options and provide PE. PTAs are a good place to speak out and take an active role.

While children can play ball at the local park and choose healthier foods in school, at the end of the day family support is what really counts. You

are a role model for your kids. Children form habits from parents, and usually maintain them into adulthood. If your children see you reach for a banana instead of a brownie, they are likely to do the same. If they see you go for a walk or wash the car, they may join in.

When was the last time you biked or shot some hoops? According to Donato, sometimes we all need to be reminded to have fun and appreciate the value of play. Instead of opening your window to listen to the sounds of the season, open your door, go outside with your children and play. – a report from The NIH Word on Health, June 2002

A Word to the Wise...Help your children maintain a healthy body weight

Be supportive. Children know if they are overweight and don't need to be reminded or singled out. They need acceptance, encouragement and love.Set guidelines for the amount of time your children can spend watching television or playing video games.Plan family activities that involve exercise. Instead of watching TV, go hiking or biking, wash the car, or walk around a mall. Offer choices and let your children decide.Be sensitive. Find activities your children will enjoy that aren't difficult or could cause embarrassment.Eat meals together as a family and eat at the table, not in front of a television. Eat slowly and enjoy the food. Don't use food as a reward or punishment. Children should not be placed on restrictive diets, unless done so by a doctor (for medical reasons). Children need food for growth, development and energy.Involve your children in meal planning and grocery shopping. This helps them learn and gives them a role in the decision making.Keep healthy snacks on hand. Good options include fresh, frozen, or canned fruits and vegetables; low-fat cheese, yogurt or ice cream; frozen fruit juice bars; and cookies such as fig bars, graham crackers, gingersnaps or vanilla

wafers. Focus on small, gradual changes in eating and activity patterns. This helps form habits that can last a lifetime.

Resources that can help!

For information on Hearts N' Parks, contact NIH's National Heart, Lung, and Blood Institute at:

NHLBI Information CenterP.O. Box 30105Bethesda, MD 20824-0105Phone: 301-592-8573Fax: 301-592-8563

E-mail: NHLBIinfo@rover.nhlbi.nih.govhttp://www.nhlbi.nih.gov/health/prof/heart/obesity/hrt_n_pk/

NHLBI's Obesity Education Initiative (OEI) has information about weight control, including tools such as a BMI calculator for adults (see your doctor about BMI calculations for children) and Menu Planner, at http://www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/index.htm.

Free materials for the public with practical information on weight control, physical activity, obesity and related nutritional issues can be obtained from the Weight-control Information Network (WIN), a service of NIH's National Institute of Diabetes and Digestive and Kidney Diseases. Contact them at:

1 WIN WayBethesda, MD 20892-3665Phone: 202-828-1025 or 1-877-946-4627Fax: 202-828-1028Email: WIN@info.niddk.nih.govhttp://www.niddk.nih.gov/health/nutrit/win.htm

http://www.nih.gov/news/WordonHealth/jun2002/childhoodobesity.htm

Monday, November 15, 2004

Childhood obesity--a looming epidemicBy Henrylito D. TacioHealth 101

CLEVELAND, Ohio -- Randolph, a chubby five-year-old boy, loves to eat. On weekends, his parents generally bring him to a restaurant. At one time, he ordered his favorite pork chops. His eyes glistened as the waiter laid the dish before him.

Immediately, the little kid separated the dripping fat from the juicy meat. Just when a passerby wanted to comment ("What a good boy!"), Randolph gobbled up all the fat and left the meat untouched.

Obesity is on the verge among Filipino children. "It is unfortunate that many of our schoolchildren are overweight, if not pathologically obese," decries Dr. Rafael R. Castillo, a noted cardiologist who works at the Manila Doctors' Hospital and writes a weekly column for a national daily. "And it is because of unhealthy eating habits which parents unwittingly allow their children to develop."

In an article he wrote for 'Health and Lifestyle,' Dr. Castillo quoted Dr. John Foreyt, a professor at the Baylor College of Medicine in Houston, Texas: "We're in the midst of an obesity epidemic. We have to start in the young."

"Worldwide, it is estimated that more than 22 million children under five years old are obese or overweight, and more than 17 million of them are in developing countries," the Geneva-based World Health Organization reports recently.

Obesity is the accumulation of excessive body fat. For most people, the condition of being overweight is easy to recognize. But medically, a distinction is made between being overweight and being obese. A person is considered overweight if he weighs 10 percent more than his ideal body weight. He is obese if he weighs 20 percent more than his ideal body weight.

The ideal weight should be based on the Body Mass Index (BMI). BMI is equal to a person's weight (in kilograms) divided by the square of his/her height (in meters).

Globally, an estimated 10-percent of school-aged children, between five and 17 years old, are overweight or obese, and the situation is getting worse. In the United States, for example, the rate of obese and overweight children and adolescents aged 6 to 18 years increased to more than 25 percent in the 1990s from 15 percent in the 1970s.

Such increases are not restricted to developed countries. In the Philippines--a country that still battles malnutrition--there is a one-percent increase in the prevalence of overweight children 0 to 5 years old and a 1.3-percent increase of overweight children 6 to 10 years old from 1998 to 2003, according to the Food and Nutrition Research Institute (FNRI).

Obese children are more likely to develop a cluster of health conditions that put them at increased risk of diabetes and cardiovascular disease, according to a study headed by Dr. Sonia Caprio of the Yale University School of Medicine.

The more weight children gain, the more likely they are to develop so-called metabolic syndrome, the study showed. Signs of the metabolic syndrome include abdominal obesity, high levels of blood fats called triglycerides, low levels of so-called "good" cholesterol, high blood pressure and high blood sugar.

Obese children tend to have higher blood pressure and higher cholesterol levels than children of normal weight, according to a study on juvenile obesity published in the 1991 Physician and Sports Medicine Journal.

The FNRI reported that childhood obesity and heart diseases among Filipino children are increasing.

Obese children are now developing heart diseases, said Dr. Edison Ty, chair of the Philippine Heart Association. "Cardiovascular diseases pose a serious risk to the health of the children," he pointed out.

The link between obesity and diabetes is well established. Around 90 percent of people with diabetes have type 2 diabetes and of these the vast majority are overweight or obese, reports the United Nations health agency.

Professor Pierre Lefebvre, president of the International Diabetes Federation (IDF), suspected that the obesity epidemic has contributed to the rising levels of diabetes in the United States. "The rise in Type 2 diabetes is, in great part, due to weight gain," he said.

Type 2 diabetes was once thought to be limited to adults but obese children are now developing the illness. "If the weight and degree of obesity increases, the child or the adolescent is at risk for the development of Type 2 diabetes," Dr. Caprio said.

(November 15, 2004 issue)Write letter to the editor.Click here.Join the Sun.Star message board.Click here.

http://www.sunstar.com.ph/static/dav/2004/11/15/feat/childhood.obesity.a.looming.epidemic.html

CHILDHOOD OBESITY: BREAST IS NOT NECESSARILY BEST Posted on Tuesday, April 24, 2007 (EST)

Long-term research into obesity suggests that being breastfed as a child does not help prevent obesity later in

life, a finding that contradicts guidelines in the United States and elsewhere.

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Mothers breast feed their children in the Philippines © AFP/File Jay Directo

PARIS (AFP) - Investigators in the United States looked at the health of 35,000 nurses working in the US between 1989 and 2001.

They asked the nurses' mothers to report on their breastfeeding habits when their child was a newborn, while the nurses themselves were asked to report their height, their current weight and their weight at 18.

The nurses were also asked to recall their body shape at ages five and 10 using a nine-level figure drawing.

Duration of breastfeeding did not affect the body mass index (BMI) -- a key indicator of fat -- in adulthood, according to their paper, which appears in the International Journal of Obesity.

Women who had been breastfed for more than nine months had a risk of becoming overweight or obese that was similar to that of women who had been breastfed for less than a week or exclusively bottle-fed.

"Breastfeeding, as good as it is, is not a solution to the obesity epidemic," Karin Michels, associate professor at Harvard Medical School and lead author of the study, told AFP.

"It's important to realize that there are much more important causes and reasons for the obesity epidemic."

The researchers found that women who had been breastfed for several months were indeed slightly slimmer in early childhood compared with those who had been bottle-fed.

But this difference is of "borderline statistical significance," according to Michels.

The mooted reason: breast-fed infants start off skinnier, but this is probably due to the natural limitations of available food in their first year of life -- and the difference does not extend to later years.

Breastfeeding does provide plenty of other benefits to mother and child, Michels pointed out.

Its vital nutrients help the child to build up its immune system and, as has been recently discovered, lessens a mother's risk for diabetes and heart disease, Michels said.

The paper contradicts the recommendations of the US Centers for Disease Control (CDC) and the European Union's Childhood Obesity Programme, which promote breastfeeding as a method for controlling childhood obesity, with the

eventual aim of curbing adolescent and adult obesity.

In another study released on Tuesday, the British journal Archives of Disease in Childhood concluded that primary schoolchildren should not be routinely screened for obesity and weight problems if there are no means to treat them.

The British government has introduced population weight monitoring in primary schools.

But the authors, led by Marie Westwood of the University of York, northern England, found no evidence to say the screening strategy worked and suggested it may even be potentially harmful if counseling and other help were not available.

Obesity is gaining pandemic proportions in many developed countries but also in emerging economies. Experts point the finger at sedentary lifestyle, persistent snacking and food that is rich in calories. Genetic factors, too, may be significant.

©AFP http://news.sawf.org/Health/36250.aspx

Globalisation and health

The maladies of affluenceAug 9th 2007From The Economist print edition

The poor world is getting the rich world's diseases

AFP

IN 1619 an English captain sailing past Cape Cod reported that the Massachusetts shore was “utterly void”. The Indians “died in heapes as they lay in their houses” confirmed an English merchant. By killing much of the population of the Wampanoag confederacy, the epidemic that raged from 1616-19 made possible the first permanent European settlement in north America, that of the Pilgrim Fathers in 1620. The Indians had caught the illness, thought to have been viral hepatitis, from prior contact with Europeans, probably captured French sailors.

Europeans have been exporting their maladies throughout history. They seem to be doing it again, but in a new way. In the past, the problem was infection. Now, illnesses associated with Western living standards are the fastest growing killers in poor and middle-income countries. Chronic disease has become the poor world's greatest health problem.

For many in the West, diseases are a bit like birds: everyone gets them but poor countries have more exotic species. Rich-country maladies are things like heart disease, cancer and diabetes: “chronic” conditions often resulting from diet or physical inactivity. Developing countries suffer more lurid and acute infections: malaria, tuberculosis, measles, cholera. HIV/AIDS is unusual in that it affects rich and poor alike. But otherwise, poor countries are presumed to have their own health problems. The sixth of the United Nations' millennium development goals (a sort of ten commandments of poverty reduction adopted in 2000) is concerned with infections only—the ailments of poverty. The progress report issued last month half way through the millennium programme's 15-year course tracks HIV/AIDS, malaria and tuberculosis. Combating chronic disease is not part of what the UN calls its “universal framework for development”.

Yet the distinction between illnesses of affluence and illnesses of poverty is misleading as a description of the world and doubtful as a guide to policy. Heart disease—supposedly an illness of affluence—is by far and away the biggest cause of global mortality. It was responsible for 17.5m deaths worldwide in 2005. Next comes cancer, another non-infectious sickness, which caused more deaths than HIV/AIDS, tuberculosis and malaria put together (see chart 1). Chronic conditions such as heart disease took the lives of 35m people in 2005, according to the World Health Organisation (WHO)—twice as many as all infectious diseases.

If you look at lower-middle income countries, such as China, or upper-middle income ones, like Argentina, you find that what kills people there is the same as in the West (see chart 2). Four-fifths of all deaths in China are from chronic sicknesses. That is also true of countries as varied as Egypt, Jamaica and Sri Lanka.

The main difference between these countries and rich ones is that chronic illnesses are more deadly there. Five times as many people die of heart disease in Brazil as in Britain, though Brazil is not five times as populous. Rich countries have become better at dealing with chronic conditions: death rates from heart disease among men over 30 have fallen by more than half in the past generation, from 600-800 per 100,000 in 1970 to 200-300 per 100,000 now.

This has not happened in middle-income countries. In 1980 the death rate for Brazilian men was below the rich-country average (300 compared with 500-600). Its death rate has not changed—and is now higher than all but a few rich countries. Russia is worse off. In 1980 its death rate was 750 per 100,000. Now it is 900, about four times as high as most rich countries.

It may not seem surprising that upper-middle income places such as Russia suffer from “Western” ailments. But chronic diseases are mass killers in the poorest nations, too. Indeed, the only unusual thing about these countries is that they suffer from infections as well as chronic disease: a double burden. Chronic diseases were responsible for over 12m deaths in countries with annual incomes below $750 a head in 2005—almost as many as were caused by communicable ones. Africa is the only continent where infectious illnesses cause more deaths than the non-communicable kinds.

Chronic diseases are becoming deadlier and more burdensome to the poor. By 2015, says the World Bank, these ailments will be the leading

cause of death in low-income countries. They already account for almost half of all illnesses there and impose substantial economic costs.

People in poor countries get chronic diseases younger than in the West. There, chronic conditions bear heavily upon the old. Not so in poor and middle-income nations. Death rates for those between 30 and 69 years of age in India, Russia and Brazil are two or three times higher than in Canada and Britain. Almost half of deaths from chronic problems in developing countries occur in people below 70.

As a result, the poor suffer from chronic illnesses longer and are more likely to die of them. The death rate from chronic disease in poor countries is obviously higher than in rich countries; more surprisingly, it is often higher than the death rate from infections. India, Pakistan, Nigeria and Tanzania all have roughly the same death rate for cardiovascular disease: 400 per 100,000. That is at least twice as high as the Western norm and, at least in India and Pakistan, more than four times the average death rate from infections (in Nigeria and Tanzania, HIV/AIDS, malaria and tuberculosis are still deadlier).

Chronic disease bears down especially hard on working adults, imposing a heavy economic burden. Families in poor countries are much more likely than in the West to spend their savings looking after a chronically ill relative, or to pull children out of school to act as nursemaids.

In short, developing countries suffer more from “rich world maladies” than the rich world itself. Overall in 2005, only a fifth of deaths attributable to “illnesses of affluence” (chronic conditions) actually took place in the most affluent nations. Three-quarters happened in poor or lower-middle-income ones.

Death eaters

Why are poor countries so vulnerable to the diseases of the rich? And why does public attention and aid money ignore them and focus on infections?

The simplest explanation for chronic diseases' increasing importance is that people in poor countries now live long enough to suffer them. Thanks to better sanitation, more food and improved public health, average life expectancy in low and middle-income countries has risen from 50 in 1965 to 65 in 2005. The increase in the poorest countries

was proportionately greater: from 47 to 63. There are now more old people around to be vulnerable to chronic maladies.

At the same time, because of increased health spending and safer water, infectious diseases have declined relative to chronic ones. International financing for malaria control has increased more than tenfold in the past decade. The Bill and Melinda Gates Foundation, with its $33 billion endowment, concentrates largely on infections. As a result, the incidence of tuberculosis, measured by the number of new cases per 100,000, has fallen slightly. In Africa fatal malaria cases among children under five (the main victims) fell between 1960 and 1995, though the decline has since levelled off. The WHO reckons that deaths from infections will decline by 3% over the next ten years. So more people in poor places will survive infections in their dangerous childhoods to reach an age when they are susceptible to heart attacks and cancer.

Since chronic disease among the poor is not the preserve of old age, another part of the explanation for its increasing importance must lie in the harmful things middle-aged folk do. Of these, smoking and unhealthy eating are most important.

Around 300m Chinese men smoke. In China, Egypt, Indonesia and Russia, people spend 5-6% of their household income on cigarettes—far more than the share in rich countries. Smoking and its associated ailments are still rising in poor countries, even while they fall in rich ones.

Middle-income countries are also experiencing extraordinary levels of obesity. According to one study, half of all households in Brazil contain at least one obese person; the share is three-quarters in Russia. According to another, Mexico is the second fattest nation among the 30 (mostly rich) countries of the Organisation for Economic Co-operation and Development, after America. It has the highest rate of diabetes among large countries, with 6.5m diabetics in a population of 100m. Not coincidentally, Mexicans are among the biggest swiggers of fizzy drinks in the world. Coke and tacos, anyone?

Obesity affects rich countries, of course: it is a symptom of affluence and urbanisation. But it is occurring much earlier than anyone had expected in middle-income places. Obesity among children there used to be unheard of. Last year China's vice-minister for health, Wang Longde, said more than a fifth of Chinese children between seven and 17 who live in cities are overweight—a proportion that presumably reflects not only the wealth of China's urban elite but the amount of

money they lavish on their “little emperors” (the single children they are limited to by China's one-child policy).

Yet despite all the evidence that chronic disease is the world's biggest health problem, most poor countries focus on infectious disease and their health policies are usually based on the idea that infections should be controlled before chronic conditions. These choices no doubt partly reflect bureaucratic inertia at health ministries and investment in fighting infections by medical charities and drugs firms.

Not just statistics

It is true that there are better reasons why poor countries might want to concentrate on infections despite the growth of chronic disease. Infectious illnesses are usually simpler to deal with than chronic ones, requiring inoculation campaigns rather than long-term care, changes of lifestyle and the uphill work of public education. Moreover, if you inoculate a child against malaria, you considerably reduce his or her chances of dying from that disease, since most deaths from malaria occur among children under ten. If you lower someone's risk of getting a heart condition at 50, you might well find they get it at 60. The disease can only be managed.

Still, it can be managed better: the contrast between death rates from heart attacks (falling in the West, rising elsewhere) shows that. Stalin said a single death is a tragedy, a million deaths, a statistic. But millions of avoidable deaths are millions of tragedies. Chronic disease is already the biggest problem for poor and middle-income countries. To concentrate so much on infections is to add to the health burden of the next generation in what are already the world's poorest, unhealthiest places.

http://www.economist.com/world/international/displaystory.cfm?story_id=9616897

Diet and hyperactivity

Food for thoughtSep 13th 2007From The Economist print edition

Why it is difficult to prove that food additives damage children

JUNK food is unhealthy and many parents avoid feeding it to their kids. But can the combination of colourings and preservatives added to all sorts of food harm children, making it harder for them to concentrate and to learn? That was the question which a team of researchers led by Jim Stevenson of the University of Southampton, in Britain, set out to answer. Their findings suggest that, if there is an effect, it is highly complicated.

In an earlier study the researchers had asked three-year-olds living on the nearby Isle of Wight to swallow drinks containing a cocktail of additives. They found that parents reported a deterioration in the behaviour of hyperactive youngsters fed on a mixture of four food colourings and a preservative. But independent observers noticed no difference.

In an attempt to clarify this contradiction, the researchers repeated the study. This time, they recruited two groups of children typical of those living in the area, aged three and between eight and nine, from nurseries and schools in Southampton. Their study also used two different cocktails of additives as well as a placebo drink that contained no food colourings or preservatives.

The first drink was the same as in the first study, containing a mix of sunset yellow, carmiosine, tartrazine and ponceau 4R with the preservative sodium benzoate. But the manufacturers of sweets and fizzy pop have changed the additives they use in recent years, mostly ditching tartrazine, a violent yellow dye that had been linked to asthma attacks and itching in susceptible people. So the researchers also tested a second concoction chosen to mimic more closely what an average child might reasonably consume every day. It contained sunset yellow, carmiosine, quinoline yellow and allura red, plus sodium benzoate.

The diets of roughly 150 children from each age group were changed so they contained no food colouring or preservatives. Then some of the children were assigned at random to drink one of the two cocktails containing additives daily during three of five weeks, alternating with a placebo. Others were given drinks that did not contain any additives.

Neither the children nor those dispensing the drink knew who was drinking what.

To measure the effect of the beverages, the researchers asked parents and teachers to assess the children's behaviour. Observers watched them in the nursery or in the classroom. The older children also sat a computerised test designed to measure attention span. The results of these tests were added together to form an aggregate score for each age group.

The researchers concluded that children quaffing the cocktail containing tartrazine from both age groups were less well behaved than those who had been downing the placebo. The results for the second concoction were less clear. The behaviour of the eight- and nine-year-olds was significantly affected but that of the three-year-olds was not, compared with the children who had not received any additives. Some parents noticed changes when their children received both the additives and the placebo, while others saw behaviour deteriorate with the placebo but not the additives. Moreover the researchers noted that the overall result for the second cocktail concealed large differences in the sensitivity of individual children. The work was published in the September 6th issue of the Lancet.

On September 10th the British government agency responsible for food safety—which funded the study—revised its guidelines in light of the study's conclusions. It recommends that parents of children who show signs of hyperactivity should consider cutting some artificial colours from their diets. The agency says it will share its findings with its European counterpart which, at the behest of the European Commission, is reviewing the safety of all the food colourings that are used in Europe.

Dr Stevenson meanwhile cautions that parents should not think that simply removing food additives from a child's diet would prevent their offspring from becoming hyperactive. Children with the severest form, called “attention deficit hyperactivity disorder”, exhibit such disruptive behaviour that it impairs their learning and function at home and at school. It may affect some 5% of the population. Yet less than half of these children see any improvement if they modify their diets. Medics suspect that the condition is at least partly genetic.

http://www.economist.com/research/articlesBySubject/displaystory.cfm?subjectid=348945&story_id=9794915

Posted on 28 November, 2004

The Face of Hunger is Femaleby VINIA M. DATINGUINOO

THE LAST time Lina Macaurog visited her youngest child Fatima, the four-year-old was running a fever and had cried violently when her mother was preparing to go. "I had a hard time leaving," recalls Lina. But she had to go home to Culiat in Quezon City, where she works and lives with her two older daughters.

Two years ago, Lina's husband and Fatima went to live with relatives in Pasig because their family of five was already barely eating. The husband had lost his job, and Lina's income could not feed them all. Today she is still the family's sole breadwinner — and she remains hard-pressed stretching her average income of less than P100 a day selling trinkets at the talipapa to feed herself and her two other daughters.

Most days, Lina and her two children eat just rice and instant noodles. On bad days, it is rice with soy sauce. Yet whatever food she manages to put on the table, Lina makes sure her children have their fill first. "Ako kahit kape na lang (I can make do with just coffee)," she says.

In many parts of the world, this country included, women, especially mothers, are always the last to eat when the family faces starvation or food shortage. This was true in the late 1990s, when the Philippines reeled from the effects of the East Asian economic crisis. In a report published in 1998, the PCIJ chronicled the "female famine."

Today, despite poverty alleviation measures that have been in place for the last two decades, millions more families have slipped under the poverty line, and even more mothers are going hungry as their husbands and children make do with less and less food on the table.

That women bear the brunt of poverty is hardly a new observation, just as hunger and poverty are themselves old issues in this country. But indications are that the situation has gone from bad to worse, with far too many families now subsiding on rice and so-called "surrogate ulam" such as salt, bagoong or soy sauce — and the mothers surviving on even less than that.

Mothers also bear the psychological stress of finding ways to stretch meager budgets and of scrounging around for food when husbands don't have jobs. Filipino women have traditionally been the keepers of the family purse and it is they who have to devise coping mechanisms to deal with crises. Today those coping mechanisms include eating less or not eating at all and sending off children to live with relatives.

Observes Lina, who looks older than her 34 years: "'Pag wala nang makain ang mga anak ang babae ang unang natuturete ang utak sa pag-iisip kung saan kukuha ng pagkain. Ang lalaki puwedeng magyosi lang 'yan sa labas (When the children no longer have anything to eat, the mother is the first one to go crazy thinking where to find food. The man just smokes outside)."

Lina remembers that five years ago, her family could still afford two pieces of pan de sal for each of them each day. "There was also leftover rice to fry for breakfast," she recalls. "Nowadays, even the tutong (rice burnt black) is eaten." There are no longer any leftovers, she says. Thus, far too frequently, she has gone without eating just so her children and her husband could have a few more bites.

Ill health among women is already evident in studies done by the Food and Nutrition Institute (FNRI). Anemia, for example, continues to impair 43.9 percent of pregnant women and 42.2 percent of lactating women. Severe anemia among pregnant women is the leading cause of

death during childbirth; low iron in lactating women, in turn, manifests in similarly ill health in the child.

Lina's predicament and that of millions of other mothers can be traced to worsening poverty. In Southeast Asia, the Philippines has one of the highest poverty incidence rates, with a large segment of its population living below $1 a day: 15.5 percent, which is lower than in Laos (39 percent) and in Cambodia (34.1 percent) but higher than 13.1 percent in Vietnam and 7.5 percent in Indonesia.

The Philippine government defines the poor as those who fall below the per capita poverty threshold of P32 a day. That is 40 percent of the population, about the same figure 20 years ago. In absolute numbers, however, there is a significant increase, given the leaps and bounds in population growth: In 1985 there were 4.36 million families who were poor; by 2000 the estimate was 5.14 million families or over 31.2 million people.

A recent World Bank report says the Philippines is reducing malnutrition much slower than most of its Asian neighbors. The Bank defines the malnutrition rate as the prevalence of underweight children under five years of age. It says the country is reducing malnutrition by 0.6 percent annually, lower than the figures posted by Cambodia (1.1 percent), Laos (0.9 percent), and even Burma (0.8 percent), which is an international pariah outside of Southeast Asia.

The latest National Nutrition Survey that will be released Dec. 15 also says that despite a decline in the prevalence of undernutrition between 1998 and 2003, malnutrition persists.

Malnutrition occurs when a person's diet is lacking or in excess of one or more of the basic nutrients that include protein, carbohydrates, fats, vitamins and minerals. In a poor country such as the Philippines, the problem is largely of undernutrition, although obesity is being observed in certain age groups.

Malnutrition reduces the working capacity of adolescents and adults and makes them vulnerable to chronic illnesses such as hypertension and tuberculosis. But malnutrition affects young children the harshest, retarding their growth. Children who suffer from growth retardation are in turn more prone to infectious diseases such as diarrhea and pneumonia.

Experts say the plight of these children is largely invisible. According to the United Nations' 2002 World Health Report, more than seven of every 10 children who die from causes related to malnutrition were only mildly or moderately malnourished, showing no outward sign of their vulnerability such as reed-thin limbs and bloated bellies. For the children who survive, frequent illness saps their nutritional status, locking them into a vicious cycle of recurring sickness and faltering growth. Medical anthropologist Michael Tan has described these malnourished children "who are slowly being wasted away by hunger."

Aside from rice and instant noodles, the new staples in the poor Filipino family's table are the surrogate ulam that are often salty: soy sauce and bagoong, as well as plain salt.

Yet in the latest National Nutrition Survey, the FNRI says that there has been "general improvement" in the Filipinos' nutrition and food intake in the last decade, and showed an increased intake of most of the basic food groups except fruits, higher contribution of animal foods to total food intake and protein intake, and increased intake of energy and most of the nutrients except iron and vitamin C.

Dr. Ma. Regina Pedro of the FNRI explains the seeming disparity between these data and what poor families are actually eating by saying, "What the survey is looking at is the mean intake. One income class is probably eating more. Class E are probably eating less, but this (survey) is

mean." She says they would next look at the relationship between incomes and food intakes, although she adds that surveys done in 1987 and 1993 showed consistently that the lower income eats less than the higher income

In a 2001 study, marketing guru Ned Roberto, who first coined the term "surrogate ulam," found that in Metro Manila, over a third of Class E and over a tenth of Class D had begun resorting to eating various "new viands," among which he included coffee, pork oil, brown sugar, and Pepsi. In Cebu the proportion was more than 66 percent of Class E and over a third of Class D, and in Davao, almost 75 percent of Class E and nearly a fourth of Class D. But those proportions may have since increased, considering that initial results of the latest Family Income and Expenditures Survey (FIES) show average household incomes in real terms as having fallen by 10 percent from 2000 to 2003.

With their wallets depleted, many families have turned to carbohydrate-heavy diets to keep their stomachs from churning. Short on nutrients but packed with calories, these have also helped them from looking thin and gaunt. Indeed, despite her self-deprivation, Lina is rather plump, as are her children. But that is no indication of good health. According to nutritionists, overweight people are at higher risk of acquiring illnesses related to high cholesterol levels such as hypertension.

FNRI's Daily Food Guide for Children

FOOD GROUPS RECOMMENDED AMOUNTS

  4-6 years 7-9 years

Vegetables Green, leafy and yellow 1/3 cup, cooked 1/3 cup, cooked

  Others 1/4 cup, cooked 1/2 cup, cooked

Fruits Vitamin C-rich 1/2-1 medium size or 1 slice of a big fruit

1 medium size or 1 slice of a big fruit

  Others 1/2-1 medium size or 1 slice of a big fruit

1 medium size or 1 slice of a big fruit

Fats and Oils   6 teaspoons 6 teaspoons

Sugars   5 teaspoons 5 teaspoons

Water and Beverages   5-7 glasses 6-8 glasses

Rice and Alternatives Rice and Others 3-4 1/2 cups, cooked 4-5 cups, cooked

 

1 serving = 1 cup rice, cooked, or 4 pcs pandesal (about 17 g each), or 4 slices loaf bread (17 g each), or 1 cup macaroni or spaghetti, cooked or 1 pack instant noodles, or 1 small size root crop (180 g)

   

Meat and Alternatives Fish/Meat/Poultry/Dried Beans/Nuts 1 1/3 servings 2 1/3 servings

  1 serving of fish = 2 pcs (55-60 g each), about 16 cm long fish

   

 

1 serving of meat/poultry = 30 g lean meat, cooked or 1 1/2 cups cooked dried beans, preferably take at least 3 times a week

   

  Egg 1/2 piece 1/2 piece

  Whole Milk 1 glass 1 glass

 

1 glass = 240 ml (1 glass whole milk) is equivalent to 4 Tbsp powdered whole milk or 1/2 cup evaporated milk diluted to 1 glass water

   

Experts from the FNRI meanwhile worry over the popularity of salty surrogate ulam and sodium-laden instant noodles. They say that although the body excretes salt through normal processes such as sweating, there is still a chance that it will retain more salt than it needs, which can then affect vital organs such as the heart and kidneys.

"The guideline is to eat a variety of foods," says Pedro. Except for breastmilk, no single food can provide all the nutrients a person needs. Pedro thinks that "if money is spent wisely," even families with low income can fix their budgets in a way that proper food remains a priority.

The FNRI has prepared a menu for children that it says would fit a budget of what it calls the "national food threshold," which Pedro says is the "least cost to meet your nutritional requirements." At present, this threshold is estimated at P8,037 per year or P22 per day for each person. The food guide includes about four cups of rice or its alternatives such as bread and macaroni, a slice of fruit, a third to half a cup of green, leafy vegetables, and a glass of whole milk. At least three times a week, the FNRI says mothers should serve children meat or poultry (30 grams) or other protein-rich sources such as fish (about 55 grams) and cooked dried beans (1.5 cups).

Families like those of 38-year-old Divina de la Cruz in Pandacan, however, are already having difficulty coming up with P100 for the family's entire expenses each day. If she were to feed her five children according to the FNRI menu, Divina would have to have at least P110 for her daily food budget alone, and that would be just for the kids. De la Cruz already counts herself lucky if husband Carlos makes P150 hawking shampoo on the streets. For the de la Cruzes and other poor families, basic necessities such as adequate food have themselves become luxuries, their choices reduced to whether to use three cups of water to cook the instant noodles or six cups to feed more.

As it is, the de la Cruzes can afford to eat only twice a day now, although this excludes their shared breakfast of a peso's worth of coffee. The situation has driven one of the sons, 12-year-old Cesar, to scavenge for enough junk he can sell for about P10, which he then uses to buy instant pancit canton for his siblings and parents.

If the Manila social welfare office had its way, Cesar would not be working. The social workers had already tried sending the boy to Boys' Town in Marikina, but Cesar ran away and went back home. Divina says she cannot keep him off the streets. "And that's because I have nothing to give them," she says.

The Macaurogs are not faring any better. Lina's two daughters who are still with her — Jamella, 16, and Janina, 13 — say that in the past, they would wake up at six a.m. to help with the household chores. Now they deliberately sleep in late, getting up just in time for an early lunch, the better to save on meal expenses. And since they have no money for food to keep them going while they are in school, which begins at 12 noon and ends at seven in the evening, they drink a lot of water. They have to see to it that it is not cold, though, since they both have ulcer.

Yet even if they had a little bit more money, families like those of the Macaurogs and de la Cruzes may still not be able to follow the FNRI guidelines. After all, the food being sold in nearby sari-sari stores is often canned or instant and short on nutrients. If families want fresh produce, they would

have to fork over more pesos for a ride to the markets, which are usually some distance away from impoverished communities.

Cooking from scratch is also often not an option, since low-income mothers either keep long hours at work or are run ragged caring for their children, doing chores, and looking for someone to loan them some money to buy the food itself.

Acknowledging the popularity of quick-cooking or prepared food especially among the poor, concerned government nutritionists have also been wracking their brains to develop nutritious and fortified instant food. Some of the results of their work have already been shared with small manufacturers who are now producing goods like iodine-rich drinking water, rice crispy bars, and canton noodles with squash.

The government has a three-pronged strategy of supplementation, nutrition education, and food fortification to curb the incidence of micronutrient malnutrition, particularly deficiencies in vitamin A, iron and iodine. The health department says food fortification is the most cost-effective and sustainable strategy to address micronutrient malnutrition. This is why the government has the "Sangkap Pinoy Seal" program, which grants a seal of certification to processed-food manufacturers who fortify their products with nutrients.

There have also been laws such as one mandating the fortification of all salt with iodine, and another stipulating the fortification of rice from the National Food Authority with iron, sugar and edible oil with vitamin A, and wheat flour with vitamin A and iron.

But it has come to a point where families can no longer even buy these fortified food. Some feeding stations across Metro Manila, for example, have reported a rise in the number of daily "clients." Meant only as a temporary means of staving off hunger, the plain rice porridge offered by these stations have become the breakfast, lunch, and dinner of many impoverished folk who come day after day. Just recently, newspapers and television also ran stories about people who have resorted to eating food scrounged from garbage heaps.

As Divina de la Cruz says, "Kanya-kanyang diskarte na lang para makakain. At kapag walang makain matulog na lang. (To each his own way of finding ways to get fed. But if there's really no food, well you can just go straight to sleep.)" The asthmatic mother has one more sacrifice to make: in just a few months, Desiree, the youngest child, will go and live with her grandmother in San Jose, Nueva Ecija.

De la Cruz sounds calm talking about what she believes has to be done, even if it means sending her seven-year-old away. She has been counseled that it is for the best, especially for her, "para naman raw makaginhawa ako dito nang kaunti (so that my troubles here will be eased a bit)." But then Desiree is still with her, and her resolve may not be as strong once her little girl goes to the province.

In Culiat, Lina's cheeks are streaked with tears as she recounts her last visit to her youngest daughter. "I want to take her home so we can all be together again," she says. But she knows that may not happen anytime soon. So long as she and her husband are unable to earn enough to feed their entire family, they will have to live apart.

http://www.pcij.org/stories/print/2004/hunger.html

Battling the obesity pandemicPosted by: Vinia Datinguinoo on 5 September 2006 at 10:55 am

“THIS is the first generation in history where children may die before their parents.”

If those words don’t give you a fright, I don’t know what will. That was Kate Steinbeck, co-chair of the 10th International Congress on Obesity, ongoing in Sydney. Steinbeck was speaking of what experts say is “a mounting epidemic” of obesity among children across the globe.

Experts gathered at the Congress are calling attention to the global pandemic, labeling obesity as an “insidious killer,” a direct cause of a host of diseases that run from head to toe. Worldwide, some 1.5 billion people are overweight.

The Philippines isn’t a stranger to obesity. Though still small in absolute numbers, the proportion of overweight children in the country has increased threefold between only 1998 and 2003, alarming health experts. More adults are also growing overweight, with the increasing trend being more pronounced among women.

But experts insist, too, that overweight and obesity — especially in children — can be reversed. In 2005, PCIJ’s i Report featured the story of Clara Buenconsejo, now 14, who battled overweight. (Read the story.)

Clara’s tale tells the good news: If recognized early, overweight can be turned around, with proper diet, exercise, and a lifestyle that minds the balance of food taken in and energy expended.

Clara was diagnosed with borderline diabetes when she was 11. She underwent medication to normalize her insulin level, and engaged in a change in diet that was carefully watched — not only by a professional nutritionist, but by her devoted mother as well. The girl also began an exercise regimen.

Before long, Clara lost the harmful pounds.

Many other stories, though, do not have a similarly happy ending. By most accounts, seeking professional help to reverse overweight entails amounts of money which ordinary wage-earning families will be hard pressed to spare.

Health experts, in fact, theorize that obesity is probably going deeper into the poorer populations, where people do not have the funds to be able to buy foods that are healthier. Thus, there have been accounts of what has been called “the bloating of the poor” in Asia, as ever-falling incomes lead poor families to buy more of mass-produced foods that are cheap and filling but very nutrient-poor, and less of low-energy dense foods such as fruits, vegetables and whole grain cereals that are more expensive.

Experts thus wish to know more. Filipino nutrition scholar, Dr. Cecilia Florencio, for example, says too much remains unknown. “Which Filipinos are we talking about?” she asks, referring to figures pointing to increasing overweight. “We haven’t even mapped out where overweight is, where there is more of, less of, where it is rising faster, not rising so fast and so on.”

Knowing these characteristics, Florencio says, will allow the formulation of the appropriate response. Right now, the official response has been to trumpet the need for a healthy lifestyle, the main components of which are to stop smoking, do regular exercise, and have a healthy diet. From this perspective, the point of having a healthy diet is to consume enough of the nutrients needed by the body to function properly, including drinking a lot of water and eating more fruits and vegetables.

But Florencio warns that it would be naive to think that teaching nutritive values would make the problem of poor eating habits go away. After all, she says, food is not just about nutrients: “Food is a source of contentment, of pride, success, of regularity of one’s life.”

At the Sydney Summit, experts agree that research on obesity should be given top priority, if we are to have any hope of combating the pandemic.

New studies tackled at the Summit suggest that environmental and genetic factors contribute to obesity.

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151 and 8 months