African minors’ health challenges are comparable to those in the rest of the world

Abstract

Today’s youth in rich and poor countries faces comparable health risks and challenges. There is the temptation to enjoy too much food that is advertised as delicious and to eat too little healthier food. An increasingly sedentary lifestyle makes physical activity voluntary, no longer based on the daily need for physical activity in rural production. This is a serious medical problem, as today’s young people are threatened tomorrow (and sometimes, already today) by cardiovascular disease and type 2 diabetes mellitus, later by further challenges including arthritis, stroke, and more. But this is a challenge far beyond medicine. Young people need to be empowered to distinguish between good and bad lifestyles and be strengthened in their willingness to make an effort for future health. It may not seem very sexy to eat mostly fruits and high-fiber traditional foods instead of hamburgers, snacks, sweets, or to eat in posh restaurants. Everyone needs a certain resistance to advertising today, whether they grow up in Nigeria, Europe or anywhere else. Medical doctors, teachers, and many other professionals with responsibilities for young people have a key role in this endeavour.

Key Words: Obesity; Overweight; Nutrition; Healthcare education; Physical activity; Cardiovascular diseases; Hypertension; Dyslipidemia; Social media; Sedentary lifestyle

Core Tip: Mankind is transitioning towards a sedentary lifestyle where physical exercise is voluntary. This has led to a true epidemic of overweight and resulting health challenges including cardiovascular disease, hypertension, and more. This affects people in low-, middle- and high- income countries. Traditional education and communication channels are insufficient to help minors to adapt their lifestyle to more healthy approach that balances physical exercise with balanced nutrition. Helping them to resilience against temptations by marketing and social media is a task for future generations, going far beyond medicine. New technologies need to be considered and used.

INTRODUCTION

People of all ages in low-, middle- and high- income countries share a common health challenge which by all measure have been deemed an epidemic. This challenge commonly termed obesity or overweight emerged from poor diet and gluten on one side and a commensurate lack of exercise on the other. The medical literature has examined the link between obesity and a range of chronic debilitating diseases that manifest more harshly later in life. These conditions include insulin resistance and type 2 diabetes, hypertension, dyslipidemia, fatty liver disease, psychosocial complications, cardiovascular disease, arthritis, stroke, kidney failure, visual impairment, limb amputations, as well as depression and low self-esteem among younger people[1-3]. Recent publications have shed light on additional factors and aspects of this epidemic, including the role of adipokines[4], inflammatory mediators[5], and peripheral and central regulation of neuro-immune crosstalk[6-8]. This epidemic has reached such global proportions that an increasing number of national and international taskforces publish statements, recommendations, proposed action plans and more, including the International Obesity Task Force together with the European Association for the Study of Obesity[9], the World Health Organization[10,11], and more. A recent publication is the first one to emphasize and correctly outline that this challenge is taking place also in Africa[12]. Most authors and institutions desire to turn back the development to former times when young people were lean and skinny and enjoyed physical activities. However, no one can turn back the wheel of history. There is a mismatch between the amount of food eaten and the body’s ability to digest it. This is complicated when advertisers continually represent all meals as delicious and healthy. Furthermore, development has pushed populations to an increasingly sedentary lifestyle where physical activity is voluntary.

COMMUNICATION CHANNELS, TEMPTATIONS, AND RESELIENCE

Obesity is complex and warrants a deconstruction of thoughts and approaches that are holistic and geared toward lifestyle choices. Addressing these barriers requires a multifaceted approach, including education on nutrition, promoting the benefits of healthy eating, making healthy options more accessible and affordable, and encouraging positive social norms around food choices. Advertising and its powers of persuasion have not been given the necessary credence on the psyche of healthcare practitioners and consumers alike. While advertising is a powerful tool for promoting products, its potential to foster addiction is significant, particularly in cases where it targets vulnerable groups and encourages unhealthy consumption patterns. Addressing these issues requires thoughtful regulation and a focus on promoting healthier choices in media and advertising.

Globalization has many dimensions. Only one is the physical availability of nourishment. The other, probably even more important dimension is the expansion of spiritual spheres through modern means of communication such as radio, television, internet, iPhones and the channels that reach young people in particular, be it TikTok or whatever else. They are all passed on and amplified through what is still the most powerful medium: The word of mouth. Globalization has ushered in changes to norms and values resulting in children seeking to forge their own paths - paths that may not always sync with their parents’ viewpoint and further complicated by the advent of smart phones, the internet and social media platforms that reach previously pristine villages and communities. This scenario creates a classic dichotomy where tradition must be interrogated in the context of progress governed by new and young leaders. The resultant approaches must respect the past while embracing the future. New knowledge warrants a change to practices that promote unhealthy living while reducing cost. This is especially true in developing countries.

Medical care in high-income countries can at least get some of the health risks under control by modern medicines that help to reduce weight, in extreme cases by surgery that reduces the amount of food somebody is able to consume with each individual meal, and by surgery that can help when after decades of overuse joints deteriorate or coronary artery disease clogs the heart’s own bloodflow. Such provisions are less or even non-existent in low-income countries. In theory, this means that young people have a much greater responsibility for their own bodies and their development in the coming decades.

Many intervention systems that try to handle obesity in young people use family-based approaches and address specific lifestyle behaviours, including food habits and physical activity, and including at least one family member in addition to the respective young person. Such family-based behavioural interventions have shown improvements in lifestyle and in obesity-related outcomes. However, they have limited effects if they fail to address family patterns and dynamics that shape the entire family’s lifestyle behaviours[13]. United States and European Union legislation aims at approval for new drugs also for minors. Unfortunately, this is more of a regulatory aim and does not correspond to a true clinical challenge. The clinical value of this movement is at least questionable for both high-income and middle and low-income countries[14,15]. One of the many avenues for exploring new technologies that need to be considered to overcome the challenge discussed here are triboelectric nanogenerators that generate power from biomechanical movements and offer a promising solution for developing self-powered neurostimulation devices without the need for an external power supply[15].

Among the key questions here is whether it will ever be possible to reach the majority of young people in such a way that they lead healthier lives. Not all young people in developed or less developed countries are overweight. Not all fall victim to modern marketing channels without protection. Not all remain under the influence of stimuli throughout their lives that later prove to be harmful. Some are more resilient than others. There are different perspectives. Parents try to influence their own children. Medical doctors and healthcare professionals try to influence their respective patients or clients. Governments have the perspective of influencing more abstract populations which are recorded and described in statistics.

CONCLUSION

Humanity is in transition to adopt new ways of life and normalizing new practices. Responsibility for one’s own destiny is increasingly less controlled by external parameters and is becoming more and more a matter of self-responsibility of the individual. This global trend affects people on all earth’s continents, with the exception of Antarctica which is currently uninhabited with the exception of a number of research institutes. Medical reports can document the occurring changes in Africa and other countries. But it is a challenge that by far transcends classical medicine.