Obesity: diagnosis and prescription for action in the English-speaking Caribbean.

1 Based in part on papers given at the Mona Academic Conference “Health Issues in the Caribbean,” 31 August – 2 September 2001, University of the West Indies, Mona, Kingston, Jamaica, and at a Caribbean/Ministry of Health, Barbados/International Obesity Task Force Obesity Workshop, November 2000, Bridgetown, Barbados. 2 University of the West Indies, Tropical Medicine Research Institute, Chronic Disease Research Centre, and School of Clinical Medicine and Research, Cave Hill Campus, Barbados. A brilliant cartoon in Newsweek magazine eloquently depicts the paradox of world nutrition today: a grossly obese man from the United States of America is gorging himself from an enormous tub of ice cream, while a malnourished Rwandan child holds out an empty bowl, begging. The message from the lips of both is, “I’ve got a weight problem.” While 20% of the world remains malnourished or undernourished, 20% are now “dysnourished,” that is, overfed and grossly overweight, with serious consequences. Obesity has been the silent global epidemic of the last 30 years (1). Almost every country that has statistics has documented a progressive, oftendramatic increase. And ironically, while obesity was previously associated with perceptions of wealth and plenty, a large and increasing number of victims today are trapped in poverty and are from developing countries with high levels of poverty, particularly in Latin America and the Caribbean (2). But unlike AIDS, which appeared “out of the blue” and carries the stigma of both infectious and fatal features, obesity, as an epidemic, has been insidious, is not infectious in the accepted sense, and leads to death indirectly and surreptitiously. It has therefore been ignored as the major public health problem that it most surely is. This paper will briefly outline the dimensions of the problem in the English-speaking Caribbean; its enormous impact on health, quality of life, morbidity, mortality, and health care costs; its major causes; and a prescription for concerted, urgent regional action.