Poor food choices pose  huge risk to healthcare

The country’s health system could grind to a halt in the not-too-distant future due to a sharp increase in the number of diabetics, thanks largely to the excessive consumption of sugar in the country.

Addressing the African Food Manufacturing and Safety Summit in Nairobi last month, Mr Bimal Shah, the director of Broadways Bakery Ltd, said the looming crisis in the healthcare system is attributable to poor food choices.

 “More than five per cent of 25-year-old Kenyans are developing diabetes, a lifelong condition that causes kidney failure, loss of limbs, comas and a range of debilitating and life-threatening complications triggered profoundly by excessive sugar consumption,” he said, quoting a World Health Organisation report on diabetes in Kenya.

According to the WHO, Kenyans consume twice as much sugar as Tanzanians, and more than all other Africans, with the exception South Africans and Swazis. Kenyans consume 60gms of sugar per day, compared to Tanzanians’ typical 23gm, 5gm for Indians, and an average of just over 15gm a day for the Chinese.

“The consequences of this are feeding straight to surging diabetes and other lifestyles diseases amongst Kenyans,” Mr Shah said.

The wrong choice of breakfast foods has resulted in the consumption of foods high in sugar and health problems, including Type 2 diabetes, obesity and high blood pressure.

The country’s mounting diabetes crisis is placing acute pressure on hospital services, and in particular, facilities such as kidney dialysis, Mr Shah says.

By 2025, 22 million Kenyans will be between the ages of 10 and 40 years, and around 1,000,000 of them will have diabetes, Mr Shah said, adding that the Ministry of Health alone will not be able to  cope with the onslaught of lifestyle diseases.

He noted that Kenyans consume 49.5 gm of sugar at breakfast alone, compared with the WHO’s recommended 50gm per day.

Poor eating habits and the availability of substandard processed foods are among the major causes of lifestyle diseases in Africa, and Kenya, in particular. Despite growing public pronouncements and awareness that the intake of too much sugar is bad for health, the availability of manufactured products containing high levels of sugar  in the country is on the rise, Mr Shah said.

“As diets shift towards manufactured and processed foods, we have a responsibility, as an industry, to start addressing the excessive sugar content in some of our foods and beverages,” he said while launching the “Be sugar smart” campaign, which is aimed at raising awareness on sugar consumption across Kenya.

Kenya’s processed foods manufacturing recorded a six per cent growth rate in 2015. This is predicted to rise to 6.6 per cent in 2016, and to 7 per cent in 2017, according to the Kenya Economic Update 2015.

As a result, sugar consumption in the country will continue to grow due to an increase in demand and the growth of the industrial and food service sectors in Kenya.

“Therefore, manufactures of processed foods should be urged to become more health conscious, and work towards producing healthier foods with low sugar, fat and cholesterol content,” said Mr Shah. “Bad foods are bringing on a health disaster in our nation. It is an issue that food producers need to act on, consumers need to wake up to, parents need to understand, and we all need to play a part in preventing their consumption,” he added.

“Sugar is not a bad if it is consumed in moderation. However, when Kenyans shift to excessively high-sugar diets, the price is paid by many in hospitalisation and long-term health issues. The key is to be vigilant and check labels where applicable, as well as enquire from manufacturers if there is uncertainty,” Mr Devan Shah,  the business development executive at Broadway Bakery Ltd, said.

DAMNING REPORT

According to the Kenya STEPwise Survey for Non-communicable Diseases Risk Factors Report 2015, NCDs, including diabetes, are the leading causes of morbidity and mortality globally, causing more deaths than all other causes combined.

NCDs kill 38 million people each year, accounting for 63 per cent of deaths globally, with 80 per cent of these deaths occurring in developing countries, whose fragile health systems are still grappling with a heavy burden of communicable diseases, resulting in a dual disease burden.

Cardiovascular diseases account for most NCD deaths, or 17.5 million people annually, followed by cancers with 8.2 million, respiratory diseases (4 million) and diabetes (1.5 million). These four groups of diseases account for 82 per cent of all NCD deaths.

Tobacco use, physical inactivity, use of alcohol and unhealthy diets all significantly increase the risk of dying from an NCD.

Non-communicable diseases account for more than 50 per cent of total hospital admissions, and more than 55 per cent of hospital deaths. The main NCDs are cardiovascular conditions, cancers, diabetes, and chronic obstructive pulmonary diseases, the report indicates.

This rise in diabetes is associated with demographic and social changes such as globalisation, urbanisation, an ageing population and the adoption of unhealthy lifestyles, such as the  consumption of unhealthy food and physical inactivity.

The International Diabetes Federation estimates the prevalence of diabetes in Kenyan adults at 4.56 per cent, resulting in almost 750,000 cases, and 20,000 annual deaths.

The prevalence is highest among urban dwellers at approximately 10.7 per cent, and 2.7 per cent among rural dwellers, according to The Diabetes Atlas 2014. “This figure is based on regional projections and is likely to be an underestimation, as more than 60 per cent of people diagnosed with diabetes in Kenya usually present to healthcare facilities with seemingly unrelated complaints.

The report notes that 28 per cent of Kenyans always add sugar to beverages, and estimates that that about 14 per cent of the population has impaired glucose tolerance. Owing to poor glycemic (the presence of glucose in the blood) control, most patients referred  to the national referral hospitals or abroad for specialised and organ damage treatment are diabetics.

Diabetes is not the only sugar-related disease that will place a heavy burden on the country’s health system: the report says that 27 per cent of Kenyans are either overweight or obese, with the percentage significantly higher in women (38.5 per cent) than men (17.5 per cent).

In urban areas, 12 per cent of the residents are obese, while the percentage in rural areas is seven, indicating a high risk of NCDs and their complications. Mr Shah said, adding that almost one fifth of pre-school Kenyan children are now obese.

Kenyans also consume less fruit and vegetables than recommended by WHO. They eat fruits 2.5 days a week and vegetables five days a week. WHO recommends at least five servings of fruits and vegetables a day.

PHYSICAL EDUCATION

Generally, 6.5 per cent of Kenyans do not engage in the recommended amount of physical activity. WHO recommends that adults aged 18 to 64 do at least 150 minutes of moderate-intensity physical activity throughout the week, or at least 75 minutes of

vigorous-intensity physical activity throughout the week. It established that 68.6 per cent of total physical activity is work-related, 26.1 per cent transport-related and 5.4 per cent recreation-related among Kenyans.

Over the past two decades, lifestyle diseases have become the leading health risk factors in low- and middle-income countries. Dietary diseases are now ranked the highest health risk factor in middle-income countries, according to WHO; in the ’90s, they were ranked fourth. 

More people are getting affected by NCDs, with diabetes, heart diseases, cancer, chronic lung infections, neurological, psychiatric diseases and injury all on the rise. And the trend is forecast to continue as more Kenyans attain middle-class status.

The World Health Organisation is advocating for lower intake of sugar, salt and saturated fats, as well as limiting the marketing of foods high in these substances, especially to children, by using taxes and pricing policies to influence food consumption.

Diabetics face an even greater threat from long-term complications like foot, cardiovascular, eye, nerve and renal complications, the STEPWise report says, and proposes the implementation of the Kenya National Nutrition Action Plan 2012-2017, and continuous engagement with the agricultural sector to promote healthy diets and eating habits.

It also proposes the introduction of legislations on the production, packaging and marketing of food and drinks to reduce the consumption of unhealthy foods. Further, it encourages the adoption of active lifestyles and the reduction of sedentary ones.

In an effort to counter the prevalence of lifestyle diseases, governments across the world have passed, or are formulating legislation to regulate sugar content in products by food manufacturers through the introduction of sugar taxes. These taxes aim to promote the reduction in overall sugar consumption.

Reducing daily free sugar intake (sugars added by food manufacturers or sugars that are naturally present) to less than 10 per cent of total energy intake, significantly reduces the risk of becoming overweight, obese and developing tooth decay, accord

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From a nutritionist’s viewpoint

Mr Kepha Nyanumba, a nutritional consultant with AAR Healthcare, concurs that Kenyans take to much sugar. “Breakfast is the meal that is resulting in too much sugar intake. A Kenyan breakfast typically consists of white tea accompanied by bread, and most prefer white — which is high in sugar and doesn’t contain fibre — and refined starches such as mandazi, cake and doughnuts. The white bread is also accompanied by spreads with a high sugar content. The accompaniments and spreads, coupled with the sugar added to the tea, is too much per person, per day,” he pointed out. 

He said Kenyan adults take two to three cups of tea for breakfast, and use two to four teaspoonfuls per cup, which is excessive.

Besides, some of the cereals and yoghurts they eat during breakfast also contain a lot of sugar. Further, some people take processed juices with no nutritional value.

“Kenyans also think snacks should be indulgence foods, and therefore, consume unhealthy options. Many take another cup or two of tea with the same accompaniments or biscuits, chocolate, juices, carbonated drinks such as sodas, confectioneries, etc. as a mid-morning or mid-afternoon snack,” Mr Nyanumba said.

He noted that lifestyle diseases are not only killing the older generation of Kenyans, but also increasingly ruining the health and lives of younger people. “It is not uncommon nowadays to find small children suffering from diabetes,”  Dr Nyanumba  observed.

He advises that Kenyans opt for healthy starch alternatives such as sweet potatoes, arrowroots, brown bread, whole-meal bread and brown chapati, accompanied by proteins such as milk, boiled eggs, beans (not baked beans since  they have a lot of sodium) and balance it  with fruits.

Porridge is also a healthy alternative when taken in moderation. One cup for breakfast, with a protein source such as milk, boiled egg and a fruit, makes for a healthy breakfast, Dr Nyanumba added. Snacks are also not meant to be indulgence foods, since a fruit can also be a snack, Dr Nyanumba said.

“This sugar overload in our bodies is affecting performance. Foods high in sugars and calories, but with no nutrients, are resulting in growth and developmental challenges in our school children, resulting in poor performance,” says Dr Nyanumba.