Situation in Nepal
A nationwide population-based 2022 survey conducted in Nepal found prevalence of diabetes mellitus to be 8.5 percent. The research paper published in National Library of Medicine by Namuna Shrestha and others sampled 13,200 participants aged 20 years and above in 400 clusters of 72 districts of Nepal. The research findings revealed that the prevalence of diabetes was 8.5 percent in the country. The occurrence of diabetes was higher in the upper age groups (40-59) and 60+ years compared with the group aged 20-39 years. Overweight and obesity are important risk factors for diabetes, the research revealed. It showed that participants who were overweight and obese had about two times higher odds of having diabetes than those with a normal BMI. A cross-sectional study conducted among 266 students of class 9 and 10 in Chitwan found 9.77 percent students overweight and three percent obese. The paper published in the Journal of College of Medical Science-Nepal found that the majority of overweight was among female students of 13-15 years age group from private school. Also eating snacks while watching television is associated with being overweight. Students who take snacks while watching television were significantly overweight as compared to those who do not 13.33 percent vs 6.11 percent. The National Demographic Health Survey 2016 concluded that overweight/obesity in men and women increases with wealth and household food security. Obesity The World Health Organization has defined overweight and obesity as abnormal or excessive fat accumulation that presents a risk to health. A body mass index (BMI) over 25 is considered overweight, and over 30 is obese. It has said that 39 million children under the age of five were overweight or obese in 2020. For adults, WHO defines overweight as BMI greater than or equal to 25 and obesity as BMI greater than or equal to 30. “Body-mass index is a simple index of weight-for-height that is commonly used to classify overweight and obesity in adults. It is defined as a person’s weight in kilograms divided by the square of his height in meters (kg/m2).” Childhood obesity The prevalence of overweight or obese children and adolescents aged 5–19 years increased more than four-fold from 4 percent to 18 percent globally from 1975 to 2016, the WHO says. One in 13 children and adolescents in Nepal between the age of 5 and 19 are obese in Nepal. Obesity among children and adolescents (between the age of 5 and 19) has increased 29 times in the past four decades, UNICEF says. Keeping in view the increasing number of obese children and adolescents, the American Academy of Pediatrics has issued its first guideline on childhood obesity. Children struggling with obesity should be treated early, including with medication and surgery, the new US guidelines says. Health problems Excessive weight gain has numerous health problems. “People who are obese are under a risk to develop diabetes, sleep apnoea, heart problems, raised cholesterol level, blood pressure, problems during pregnancy, etc,” said Dr Alark Devkota, Rajouria DM diabetes and endocrinology, Nepal Diabetes Endocrine Polyclinic, Baneshwor. Dr Devkota also points to psychological stress, difficulty during pregnancy and the risks of obesity. Lifestyle modification and regular exercises are recommended to maintain weight. But those who have tried all the measures of losing weight and have failed there are weight loss surgeries available. Bariatric surgery Nepal’s health centers are providing weight loss surgery for people who are very obese. This surgery is also called bariatric or metabolic surgery. The process involves surgery of the stomach and making it smaller in size. “The treatment helps to decrease one’s appetite, changes hunger hormones and control hunger cravings. It restricts the amount of food which can be consumed and also decreases hunger,” said Dr Koshish Pokharel, bariatric and metabolic surgeon at HAMS Hospital. A total of 15 such surgeries have been conducted at HAMS hospital in the past three months. The cost for the surgery is between Rs 350,000 and 400,000. “The surgery is conducted on persons with more than 35 BMI,” informed Dr Pokharel. “It is also beneficial for people with obesity, diabetes, have sleep apnoea, etc,” said Dr Shail Rupakheti, gastrointestinal surgeon and director at Star Hospital. Junk food popular among children Children craving for foods rich in sugar and savoring to their hearts’ content is what we see each day. Consumption of junk food such as noodles, chips, cakes and similar other items are the causes of obesity in children, point the doctors. “When children grow up eating such junk food, they suffer from diseases such as diabetes, back pain, high blood pressure from a young age,” said Dr Aruna Uprety, a nutritionist and public health expert. Eat local Consumption of locally available foods is healthy and nutritious. Children should be given foods rich in protein, minerals, carbohydrates, fats and fiber. Prof Dr Uma Koirala said, “Baked items should be avoided as they have trans fat. There is trans fat in processed and baked items such as cakes, breads, cookies, pizza, fried foods, French fries, doughnuts, instant noodles, etc. Consumption of such foods poses risks to cardiovascular diseases.” The nutritionists advise eating healthy and balanced diets to maintain good health. They advise eating foods we have been consuming for ages. “Rice, lentils, green leafy vegetables, roti, pickles and our seasonal foods are both nutritious and healthy,” said Uprety. They advise regular exercises to maintain weight and stay healthy.
