Obesity crisis is not just a lifestyle issue

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The “obesity crisis” has been given much media attention in recent months for two important reasons: there are many more people who are overweight and obese now than a generation ago in most countries worldwide, and there is a rising trend that is more than experts previously predicted. The UK in particular has the highest levels of obesity across Europe which has trebled in the last 25 years, while Mexico has the highest rate of increase in levels of obesity across the globe. Carrying extra pounds has many health consequences which create a heavy burden on the individual as well as their families and society more broadly. So, there is indeed a great need to raise public awareness about the importance of keeping a healthy weight and how governments and care providers can support people in doing so.

The causes reported in the media and elsewhere often focus on an individual’s balance between the energy consumed and the energy expended. And it is the consequences for national welfare, particularly for cost-constrained healthcare systems, that place obesity and its causes high on the agenda of policymakers. However, experts and researchers in the area recognise that the causes of obesity are complex and extend beyond an individual’s lifestyle choices related to diet and physical activity. Both sleep and stress are known to influence a person’s weight, but much less attention is given to these factors and to initatives that tackle them such as stress management.

More importantly, obesity is a prime example of a social inequality in health because not all social groups have the same levels, or rates of increase, of obesity. For example, there are strong and consistent educational differences in obesity levels such that lower educated groups have a higher proportion of individuals who are obese.

Financial hardship

However, even when individuals share similar levels of education (or social class or wealth), they may differ in their experience of everyday financial troubles. One of the largest drains on disposable income, especially for older people, is paying bills and affording adequate food and clothing. Yet both policy and health research give little attention to how financial hardships may be a unique determinant of obesity.

Recent research on British adults aged 50 and over showed that different types of financial hardship were more strongly correlated with the likelihood of obesity than education, social class or home-ownership. Findings also showed important differences between women and men in which type of financial hardship was most related to which type of obesity. In women, both body mass index (general obesity) and waist circumference (central obesity) were most likely to be highest when they reported the greatest level of difficulty paying bills. In men, greatest difficulty paying bills was most strongly related to a higher odds of general obesity while having less than enough money for needs was most strongly related to a higher odds of central obesity. Moreover, among adults employed in the British civil service, women but not men were more likely to gain excess weight (≥5 kg) when they experienced insufficient money for food or clothing at least twice or more over 11 years, after considering their education, employment grade and home-ownership. This study also found the relationship between financial hardship and excess weight gain remained robust to possible explanatory factors such as diet, physical activity, smoking and alcohol consumption.

Overall, current evidence indicates that public health policies need to consider the role of different types of financial hardship as part of strategies to support women’s and men’s effort to achieve or maintain a healthy weight. The research suggests, furthermore, that strategies to tackle obesity must address additional pathways of influence beyond energy balance.

Difficulty paying bills or frequently insufficient money for food or clothing is a bigger problem than simply an everyday financial trouble. A recent Science article indicates that financial concerns block cognitive function among poor individuals and that the impact of consuming more mental resources was comparable to losing a full night of sleep. Thus a considered approach to novel interventions could have significant health benefits.

*Annalijn Conklin [2011] has completed her PhD in Medical Science at the MRC Epidemiology Unit. Picture credit: http://www.freedigitalphotos.net and Stuart Miles.

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The need for an Afghan voice in reform

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The Western World is aware that international assistance is required to help rebuild less developed countries – providing institutional reform and capacity building that will, in turn, create a more democratic state. Unfortunately, there is a lack of awareness of what it takes to make these systems work in the different cultural settings. This is especially the case with Afghanistan, which is years behind in progress due to 35 years of conflict, and which struggles to maintain the proper equipment, electricity, literacy and so on needed for success.

Afghanistan is going through a critical period with the combination of the military drawdown and a transition to a new government leader. Therefore, international donor approaches should be realigned to coincide with this changing environment. In order to do this, it is important to speak with the Afghans who will, ultimately, be responsible for protecting their citizens and providing justice on a daily basis. In a recent report by USIP titled Rethinking Afghan Local Governance Aid After Transition, Francis Brown (2014) suggests that now is the time to reconsider donor approaches in order to ensure a successful transition in Afghanistan. In this report, Brown emphasises the need not only to re-examine top-down approaches in international aid, but to also consider bottom-up approaches simultaneously. It is the bottom-up approach, which the international community should recognise is the key to understanding the culture and what is needed for reform measures to be effective. Many scholars have studied the country – they understand the politics, they understand the culture, and they make recommendations for change. However, there may be a difference in the goals of the international community and those of the Afghan people.

For this reason, I have dedicated the last year of my life to understanding perceptions of the criminal justice system in Afghanistan from the perspective of those who are directly involved in the training – including Afghan trainees in criminal justice and their Western trainers. My research involves taking a closer look at criminal justice training programmes in Afghanistan, specifically police officers, lawyers and judges in training. I want to understand what the Afghan trainees believe to be the root of the problem and what they feel is needed most by the international community rather than how Westerners evaluate this. Therefore, I conducted interviews with Western trainers and I arranged for structured interviews in a written format to be distributed throughout Afghanistan, where Afghan trainees would be given an opportunity to speak their mind. I created questions about the rapport and the usefulness of the training and provided them with an opportunity to open up, and anonymously report what they felt was useful and what was lacking in the training and mentoring programmes. I posed questions such as ‘What do you see in the value of international aid?’,What are the challenges you face in delivering justice?’ and ‘What recommendations do you have in order to overcome these challenges?’. 

Tailoring training needs

With this research, I want to understand what prevents reform in transitional countries, such as Afghanistan, from progressing. If the international community opens the channels of communication with the individuals who are perhaps not the decision-makers or the leaders of the country, but rather the ones who are providing justice on a day-to-day basis, perhaps training and reform measures can be tailored to fit the needs of their local community and culture.

After hearing from numerous Afghans in the criminal justice sector and from their Western mentors, it is clear that it will take more than money, education, security and training to overcome the issues facing their criminal justice system. While this is, of course, a good start, successful reform requires participant buy-in. The individuals responsible for helping their country progress must first understand the importance of reform, and contribute to it by speaking up about their needs – whether it is based on training methods, topics or the cultural/religious needs for reform.

I feel privileged to have had the opportunity to talk with numerous individuals involved in the criminal justice reform and even more privileged to have been able to obtain the thoughts and perceptions from many Afghan trainees – including police officers, lawyers and judges. I hope research of this sort can be expanded to other areas of reform and spark interest in the international community to seek out more answers from the bottom.

*Lindsey Murray [2013] has been studying an MPhil in Criminological Research. Photo credit: Salvatore Vuono and http://www.freedigitalphotos.net.