W

hile successfully tackling malnutrition, Indonesia is also facing the problem of obesity, which can lead to various non-infectious diseases and health disorders, resulting in high medical costs.

Long considered as a problem in industrialized countries, obesity has begun to escalate in low- and middle-income countries including Indonesia, according to Roger Shrimpton, a nutrition consultant at the World Bank.

“You see more and more households with obese people. This has become a trend,” he said.

Data from the 2010 Basic Health Research (Riskesdas) shows the percentage of obese people aged over 18 with a body mass index (BMI) greater than 27 stands at 21.7 percent. The same data shows obesity among kids below five years old had increased to 14 percent from 11 percent in 2007.

“Younger children are getting fatter,” said Shrimpton, an adjunct professor at Tulane University, US.

“Obesity among Indonesians is a hidden burden. With the same levels of BMI, they have twice the
level of body fat. This is a metabolic problem in the population,” said Shrimpton.

Double-burden malnutrition, introduced as a new concept in 2000, recognizes that most countries have to deal with undernutrition and overnutrition problems, which affect individuals in the same population throughout their life cycles.

Undernutrition in early life increases the risk of overnutrition in later life. Children with undernutrition in their early lives are more susceptible to infectious diseases, which may lead to death.

Even if they survive, they will have impaired capacity to fight diseases, to perform physical work, or to achieve progress at school.

In turn, obese people are at higher risk of noncommunicable diseases, including high blood pressure, stroke, cancer and heart failure.

Soekirman, a nutritionist from the Bogor Institute of Agriculture (IPB), said noncommunicable disease was considered in the past to be solely a problem in rich and developed countries.

“This problem is no longer monopolized by wealthy, developed countries anymore,” he said.

With income per capita of more than US$2,000, Indonesians — including those from low-income families — now have greater purchasing power for food, and yet their knowledge about healthy eating remains poor.

“They don’t realize that obesity is an ongoing problem. It starts with undernutrition and is then followed by other problems, such stunting, obesity and noncommunicable diseases,” said Soekirman.

A lack of physical exercise aggravates the problem.

The 2007 Riskesdas showed that 70 percent of children aged 10-14 were not getting enough exercise. Other studies show that Indonesian children spend more than 26 hours a week watching television, averaging nearly four hours a day.

“They spend more time in front of a television than in classrooms,” said Schrimpton, adding that core food-based messages promoted on television were all contrary to dietary guidelines.

Endang L. Achadi, a nutritionist from the University of Indonesia’s School of Public Health, said proper intervention on maternal malnutrition was the key to preventing a double burden of malnutrition.

“Stunted growth in children is very high here and this is caused by maternal malnutrition both before and during pregnancy,” she said, adding that the course of maternal malnutrition, especially among the most impoverished, was far more pressing than lifestyle-related nutrition problems.

In defining obesity, the 2010 Riskesdas stated that adults were categorized as obese if they had a BMI equal to or greater than 27.

However, the Indonesian Society for the Study of Obesity and several Indonesian experts suggest that the BMI’s cut-off for obesity in Indonesia should be 25. Shrimpton said setting a lower “overweight” limit in Riskesdas at 25 was appropriate. “The cut-off point being used in Riskesdas is either wrong or completely underestimates the problem of obesity in Indonesia. Perhaps it should be 23,” he said.

Citing the 2010 Riskesdas, he said that only 1.4 percent of people aged 16-18 years were obese, but for people over eighteen it suddenly reached 21.7 percent. “So the cut-off is obviously wrong,” he said.

A recent study has suggested that the BMI figure for what constitutes someone being overweight in the Asia-Pacific region should be equal to or greater than 21. The study showed that although they had the same BMI, Asian people had twice the level of fat.