Obesity and dental issues in Maldives a growing concern

The main carb component of the meals enjoyed by ancient Maldivians had been derived from yams; sweet potato, taro and cassava -popular among the locally grown root vegetables back then. Biscuits grew popular with the dawn of the twentieth century, but this was still more fibre than carb and was still a delicacy. 

Now, however, Maldivians eat daily out of cans and packets. We have here, in a community of 600,000 people; KFC, Burger King, Manhattan Fish Market, Pizza Hut, Marry Brown, Dine More and hundreds of local outlets specialising in greasy fast food. 

Agriculture has never been one of our strengths, but with modern technology, we can grow anything anywhere now, even on our balconies. Today our agricultural capacities seem to be on the rise, but at a crawling pace yet. We, the people who sweetened all our sweet dishes with jaggery syrup (Ruku Raa) we extracted and made from palm trees, today are addicted to the sugar that takes precedence over flour in our daily bread, like literally.

A 2016 Health Ministry health screening conducted on school-going teeneagers showed that obesity and dental problems were the top health concerns for Maldivian teens. Up until just a few decades back, Maldivian children were reported by the United Nations Children's Fund (UNICEF) to have growth-stunts, being undernutritioned and wasted. Wasted is a condition that causes a child’s muscle and fat tissues to ‘waste’ away to the bone.

Both under- and over-nutrition are classified as malnutrition, and in contrast to the earlier UNICEF findings, recent Health Ministry studies have found 22 percent of first grade students to be overweight or obese. It might sound like an improvement from under-nutritioning statistics, but UNICEF stated that obesity in the Maldives is on the rise due to increased consumption of packaged, unhealthy foods and a limited knowledge of proper nutrition.

On the Global Obesity Observatory, our National Obesity Risk score is 7 out of 10, (10 being the highest risk score), and obesity has become an issue with more women than men of late. According to Knoema statistics, between 1997 and 2016, adult female obesity prevalence in Maldives grew substantially from 3.9% to 11.4 %, predicted to be on the rise since.

Social media spreads a lot of awareness on important issues such as proper nutrition. We are addicted to screens, so some of the health related global trends are beginning to take root in our minds too.

Atoll Times interviewed Dr Yahiya Zachariah at Maldicare, a beloved dentist who's seen the insides of thousands of Maldivians mouths, asking his expert opinion regarding the increasing dental problems in children. It is a growing concern in the country now that several milk teeth have to be removed in children before their permanent teeth set in. 

Dr Zacharia said that our age-old love for areca nut products and tobacco is the main downfall for adult teeth, but in the case of the little ones, what he had to say was, “In the nighttime after drinking milk they (parents) should at least wipe the teeth with a little normal water or at least give some water to wash the teeth down”. He believes whether it is in adults or children, good oral hygiene is key to avoiding dental problems. Children have so many cavity issues because their teeth are not kept clean.

Dr Zachariah is also concerned with the Maldivian habit of going to the doctor only when the pain starts or becomes unbearable. Noting how expensive dental procedures can get, Dr Zachariah said that regular dental checkups are the most cost-efficient way, instead of bringing him completely infected teeth that need complex medical procedures. Aasandha only covers the most basic dental procedures.

Gyms are becoming a part of our lifestyle and intermittent fasting is a growing trend today, but the majority of people looking to lose weight are neither physically active, nor have the mental tenacity to fast faithfully to see results. In the end, they fall upon tablets again, this time advertised as ‘herbal supplements for weight loss’. Katherine tea is very popular in the Maldives, especially amongst the elders, who suffer from constipation.

Obesity is strongly linked with respiratory symptoms and diseases, including very common long-term afflictions such as asthma, pulmonary embolism, and pneumonia. Although these next terms don't sound familiar, Exertional Dyspnea, Obstructive Sleep Apnea Syndrome (OSAS), Obesity Hypoventilation Syndrome (OHS) and Chronic Obstructive Pulmonary disease (COPD) are also very common health issues in people who are grossly overweight.

Although they successfully treat immediate symptoms, as they were meant to, -long term medication often causes more harm than good. There are both side effects and drug interactions to keep in mind here. Side effects will vary from person to person, as every immune responds differently to any external stimuli, not only medicine. Then comes cross interaction between two medications a person may be taking at the same time, or even how one medicine can interact with daily foodstuff. 

Atoll Times spoke with the energetic Dr. Ragulan Rajalingam, Senior Consultant Pulmonologist at Tree Top Hospital for locally applicable facts.

“Medications may cause overeating and weight gain due to various mechanisms- a few may increase appetite, slow down the body’s metabolic rate or retain water. Commonly used medications which are known to cause weight gain are insulin, antidepressants and antipsychotics, anti-epileptics, steroids, oral contraceptives and beta blockers”; Dr. Rajalingam responded to the question on how some medications can cause overeating. He did add that if he noticed significant weight gain in his patients after prescribing them a medication, he made sure to reduce dosage or switch to an alternative right away.

Knowing that a medication is causing hunger pangs or food cravings is the first step in identifying the reasons behind your impulsive behaviour. Once the knowledge has set in; it will be easier to monitor yourself, most especially eating habits. There is no such thing as "I don't know how I keep gaining weight!", or "I just don't lose weight no matter what I do". Every problem has its solutions, but the problem is where you want to start at.

Looking back at the herbal supplements that are being sold everywhere in the Maldives now, a lot of people have started opting for these to treat chronic illnesses, or as vitamin supplements, for cosmetic purposes and most popularly, for weight loss. Authentic Maldivian herbal medicine is a dying science in today's community, as practitioners take all their knowledge to their graves. 

Doctors advise against the use of herbal medication without a doctor endorsing it first, because there isn't enough research data on its uses, effects and drug interactions.  

Dr. Rajalingam’s advice is, “Herbal supplements should only be taken when we are 100% sure of the content of the product. Most herbal supplements are accompanied by a lot of hearsay, and blindly consuming them can be harmful to few patients, specially the at-risk population such as those at extremes of age, pregnant or menopausal women, patients on blood thinners, or those with comorbidities like diabetes, hypertension or hormonal illnesses”.

He says it is better to have a word with a physician and verify the contents and safety of the product in relation to the conditions of the patient before taking it.

It is very simple.

Food gives us energy. We all know what calories are. Calories burn when we are active. Unburned, they become bad cholesterol, adding to our stomach girth. When our natural energy reserve gets depleted, we get tired and hungry. We have the choice between ingesting food or fluid to restore our energy or to go to sleep to conserve it. This is the basics of hunger and energy dimensions. Eating out of boredom, habit or with stress is a bad habit that needs to be weaned off.

The best solution to unnecessary and excessive eating habits is Mindful Eating. Focusing on the food in your plate, recounting the nutrients you are about to take in, the quality of the food in your mouth, the calculated amount of chewing the food requires, the journey food takes through your body, and realising how the food will serve its nutrients to your body through the digestion process, are all steps that can put conscious eating to practice. As the term implies, it simply means to concentrate on the act of eating, understanding holistically what the act truly means to you.

We do not live to eat. We eat to live, right? If eating becomes a tendency or therapy, then obesity is our only outcome. Our Lord created fantastic systems within our bodies that will let us know when we are hungry, and for some who are very aware of their bodies and appetites, their bodies even let them know exactly what kind of food it needs at times. Most of us call this 'cravings'.

Sometimes, when we don't drink enough water, our bodies can give us hunger pang alarms. To easily discern what is happening, we can have a glass of water and wait an hour to see if the hunger pangs come back, or if it was just nature's call for hydration. 

With global food reserves on the decline and natural resources getting more depleted by the day, rationing our food will not only strengthen our bodies, but help our planet overall. The culturally established ‘meal times’, which are fueled by capitalists for their own profit, are all indoctrinations we consumers have become addicted to over time. Our biological systems are programmed to tell us when we need to eat, unless we have chronic illnesses of the digestive system.

The human body was made for movement and mobility, and if we do not lead active enough lifestyles that will burn the food we eat, there is no logical reason to stuff food on top again.

Just like our limbs fall asleep due to lack of movement, our bodies grow in width with the lack of movement as well.

Just like neglecting your body can make you look terrible, neglect can also irreversibly rot and decay the precious bones that are our greeting to the world when we smile.