“Botswana has been slow to acknowledge the dichotomy of undernutrition and obesity. We have taken these two types of malnutrition as detached problems rather than interconnected,” says Public health consultant, Muriel Sepapi.
Sepapi’s sentiments are plausible. Over the past decade, Botswana has been slowly slipping in the obesity battle, reflecting national findings that Botswana obesity rates have reached notable levels.
What is more concerning for Sepapi is that although Botswana is growing to become one of the fattest nations on the African continent, the country still has no concrete obesity strategy. With approximately thirty percent of Batswana overweight or obese, the figure is expected to rise to more than 50 percent by 2025 if the government doesn’t change the food environment through hard policy.
“Despite numerous warnings and reports from the United Nations (UN) and Food and Agriculture Organisation (FAO) about the soaring obesity crisis, Botswana has had successive governments not regulating junk food marketing to manage obesity,” says Sepapi. It is a fact that the role of government is not to put a ceiling on individual freedoms, but to enable them through policy and legislation which allows people to truly and freely exercise their personal responsibility.
She also indicated that “unless the government changes the food environment through hard policy and legislation, it’s doubtful that the country will make any progress in its bid to tackle obesity.”
Countries where 20 percent or more of the adult population are obese (equivalent to the global median prevalence for that indicator) are considered to be facing a public health threat related to obesity. Obesity or overweight is a condition whereby a person has abnormal or excessive fat accumulation which poses a risk to the health and well-being of that person. Adults over 20 years of age are considered obese when their body mass index (BMI) is greater than or equal to 30. BMI equals body weight in kilograms divided by height in metres squared. The overweight and obese impose economic costs on society directly through increased health care spending and indirectly through reduced economic productivity.
According to the National Center for Biotechnology Information a dietary shift away from high-fibre to energy dense foods is to blame for the increase in obesity in Botswana. “Overweight and obesity are therefore assuming epidemic proportions in the country. The growing prevalence of overweight and obesity, with a national prevalence between 30 and 60% of populations over the age of 15 years, is largely due to dietary shift away from high-fibre, low-calorie diets rich in fruits and vegetables towards refined, energy-dense foods high in fat, calories, sweeteners and salt, and this affects females disproportionately,” states the centre which is a branch of the National Institutes of Health.
On the other hand, the World Food Programme this year said the prevalence of undernourishment in the total population in Botswana between 2017 and 2019 is 15–24,9%. Undernutrition refers to insufficient intake of energy and nutrients to meet an individual’s needs to maintain good health.
“The prevalence of undernourishment (PoU) is an estimate of the proportion of the population whose habitual food consumption is insufficient to provide the dietary energy levels that are required to maintain a normal, active and healthy life,” says the World Food Programme.
Undernutrition measures progress towards Sustainable Development Goal Target 2.1 which aims to end hunger and ensure access by all people, in particular the poor and people in vulnerable situations, including infants, to safe, nutritious and sufficient food all year round by 2030.
According to Sepapi any hard policy strategy that can be formulated should not view obesity through a narrow prism of what people eat, but should also be on equal footing with physical activity. Although Botswana intends to introduce the sugar tax, Sepapi says it would be prudent if the government uses part of that money to address malnutrition problems.
The 2020 Global Nutrition Report Action on equity to end malnutrition highlighted that Botswana will not meet the 2025 global nutritional target of achieving “a 40% reduction in the number of children under-5 who are stunted”, adding that Botswana will also not be able to reduce and maintain childhood wasting to less than 5% by 2025.
The unprecedented Covid-19 pandemic is also expected to pose risks to the nutritional status and survival of young children in Botswana. Research suggests that malnutrition will surge because of declines in household incomes, changes in the availability and affordability of nutritious foods, and interruptions to health, nutrition, and social protection services.
According to the World Food Programme (WFP): “The Covid-19 pandemic also risks becoming a nutrition crisis, as overburdened healthcare systems, disrupted food systems and income loss prevent children and women from accessing nutritious diets and essential nutrition services, including those for the early detection and treatment of child wasting.”
Experts have also said that as the Covid-19 pandemic reaches countries such as Botswana with a high burden of child undernutrition, it is essential to include wasted children in the list of vulnerable groups to Covid-19.
