On March 4, 2023, the World Health Organization observed World Obesity Day. I was about to write "celebrated," but of course the occasion is not something to be cheerful about. The problem is a collective failure of our global health systems, the inability of public health guidelines to keep pace with current nutrition information, and a lack of will among our political leadership to influence food policies that have caused this problem to explode in many countries — including the Philippines — just in the last generation or so.
I was looking for recent policy statements from Philippine health authorities about their understanding of the problem, but could not find one from this year. From last year though, and I would like to think it is recent enough to represent their current thinking, here is some of what was said.
"The risk of being overweight and obese can also be attributed to both individual lifestyle choices and lack of supportive environments to make healthy choices such as moving more and eating right. We need to make healthier food options in communities, schools and workplaces more available, affordable and accessible to all Filipinos, and we must make our public infrastructure such as parks, roads and pathways be more conducive to physical activity and active mobility. It is through the synergistic efforts of stakeholders from all sectors of society that we will be able to attain our vision of a Healthy Pilipinas where the healthy choice is the easier choice for everyone, everywhere, every time." (Excerpts of DOH statement on the occasion of World Obesity Day, 2022)
While the statement sounds profound for most of the public, to those who have looked at this issue in depth, it betrays an abysmal dearth of understanding of the issue, not that much different from stating that "the best way to address the problem of the West Philippine Sea is to acknowledge legitimate Chinese sovereignty over that territory." It is near-scandalous that health policymakers are so ill-informed on an area of health policy that is so critical because it will certainly bankrupt our health system in the near future if no action to correct it is taken. Because, in truth, the problem is so much more complex than eating less and moving more, which is the summary of our DOH's simplistic understanding of the biggest health crisis to confront us as a nation, Covid-19 included.
Let's start with the "eat less" part.
The whole premise of this viewpoint is that all calories are more or less created equal, and it matters less what food you eat, and more how much of it you eat. So let's do a simple thought experiment and see if this makes any sense.
When you eat a hardboiled egg, you take in 78 calories, five grams of fat, six grams of protein and less than a gram of carbs. Eating six pieces of Doritos, on the other hand, is 75 calories, nine grams of carbs, four grams of fat and a gram of protein. Not to mention that Doritos are made of highly refined flour, processed vegetable oils and tons of artificial preservatives and coloring, while all of the egg comes from nature. And when you factor in satiety, one hardboiled egg is usually already a hearty snack, but who can eat just six pieces of Doritos and call oneself "busog?" Most people, and I include myself among them, not so many years ago could go though a whole bag without even stopping to get a drink of Coke (of course they go very well together too, adding 95 calories and 24 grams of carbs, all as sugar, for the effort). Just on this head to head comparison alone, for someone to be equally full, eating one egg is probably equal to eating many multiples of six pieces of Doritos.
And I haven't even touched on the nutrition part of the egg and the Doritos comparison yet. Notice the composition of the macronutrients between the two? The calories in Doritos is almost 50 percent carbs, five percent protein and 45 percent fat. The calories in the egg are 30 percent protein, five percent carbs and 65 percent fat. The almost 50/50 ratio of refined carbs and vegetable oil fats in Doritos is typical of the "Standard American Diet" magic formula that make their food hyper-palatable but also hyper-calorically dense. How about the egg? Well, it has a lot of good healthy fats, high quality protein and only a trace amount of carbs. Nutritionally, rather than calorically dense. More good nutrients and more filling per calorie than Doritos. (For those who may find the nutrition talk here too "sciencey," don't worry we'll discuss this more in depth later).
So tell me again, DOH, do you still think all calories are really created equal?
And now what about the "move more" portion of the statement? Let's see.
Someone who weighs 75 kilograms (kg) walks off 75 calories per kilometer of distance covered. That's equivalent to the calories in six pieces of Doritos. Now who can really put a bag of Doritos down after just six chips? And worse, who still walks a kilometer to anywhere anymore? And granted, even if people were still walking a lot, would it even be enough to burn all the calories from the chips, ramen, milk tea and donuts they now typically consume in a "normal" day?
So how does the DOH advise Filipinos on how to balance their daily intake of calories from their food, versus their demand for calories in their daily activities?
Dr. Anthony Leachon, the DOH consultant on non-communicable diseases, who said that the recommended calorie intake for women is 1,500 and 2,000 for men daily, said it is advisable that Filipinos should aim for 500 calories a meal only.
To achieve this, one must divide his or her plate into four and each portion must consist of the following: a serving of fruit equal to 50 calories; vegetables (50 calories); one cup of rice (200 calories) and protein (200 calories)."
Seems easy, right? But wait? Where's the junk food here that is now a staple of most Filipinos' diets? What is to be done with those excess calories?
So the problem in the DOH's policy statement is now crystal clear. Eat less? Sure. But less of what? And move more? No worries. But move how?
More next week.