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Fat and Unhealthy

Dr. Joanne Paul- MBBS (UWI), FRCPCH (UK), FRCP (Edin)

So, I finally accept that cannot wine. I mean I can swivel my waist and pelvis in a circular motion, but I cannot really wine. In comparison most of my family members have sizable buttocks and a built-in sacral vertebrae coil that allows them to wine even at the level of Denise Belfon and I dare say for some, even higher a level. The coil allows for movement in the horizontal, vertical, circular, and diagonal directions at various speeds. The minimal wining ability got even worse over the past two years, and I got super rusty with no carnivals and no J’ouvert. When, in the middle of the pandemic, I found myself trying to do a groovy wine to the sounds of Kes’ ‘Hello’ and realising finally, definitively, unreservedly, that, what de hell, I cannot wine!

The pandemic stripped layers of veneer of most things and forced persons to get to know themselves better and learn some truths. What I learnt about myself was that I need people. Although I love my immediate Family to an infinite extent, family were not enough, and I need stimulation from various persons and groups to give me ideas and make me think and see things from various angles. As an extrovert, I get energy from being with multiple groups, even if just for the variety.



What I learnt about us as our population was that we are very unhealthy. I sort of knew beforehand, but it is one thing to know something in the background and another thing to have it staring at you, right in front your face. It is one thing when your spouse/girlfriend/boyfriend say that they are unhappy but another when they pack their bags and either leave or ask you to leave. You are seemingly shocked but when you think back, it was all being said for some time, but you heard but never really listened. I knew about our high incidence of non-communicable diseases (NCD’s) and our high levels of obesity, diabetes, and hypertension especially. I knew Diabetes, Heart disease, stroke and cancer are the leading causes of illness and premature death in the Caribbean, mainly secondary to risk factors like smoking, alcohol, lack of exercise and an unhealthy diet of  sugary and ultra-processed foods. NCD’s have been trending upwards with rising income, increased city living, and the mimicking of the diet and lifestyle from the closest developed countries, USA, and Canada.

The NCD alliance published report of 2014 breaks it down further. The Caribbean generally has the highest amount of NCD’s in the Americas. That means for this portion of the world of north, south and central America, we in the Caribbean have the highest amount of NCD’s. Trinidad has the highest rate of deaths from NCD’s in men. That means we are the highest in the Americas. From most recent surveys, it is thought that 1 in 5 persons in Trinidad have diabetes. Compared to USA and Canada, death from Diabetes is 800% higher in Trinidad, the highest in the Caribbean. Nope that was not a typo. You read correctly.

A few years ago, research by Cockburn and Professor Teelucksingh showed there was a high incidence of mutations in our population to the gene that produces insulin promoter factor 1 (IPF-1). This means that we have a strong genetic trend towards reduced insulin production. This means earlier and increased risk of type 2 diabetes. The E224K mutation especially causes type 2 diabetes in the younger population, child, and adolescent. Batson and Prof Teelucksingh also showed an increasing childhood obesity and diabetes. Our rates of obesity are also one of the highest in the Caribbean at above 30% where we alternate with Barbados and Bahamas for who is the highest. Obesity in Trinidad is higher in women than men. In terms of geography, in a paper done a few years ago, south Trinidad had more diabetes and alcohol issues. North had more smoking, stress, and obesity.

Definitively, unreservedly, we are one of the highest, if not the highest, with obesity, diabetes, death from diabetes, childhood obesity, childhood diabetes and NCD’s in all of the Americas. And we have an extra gene mutation that makes it all much worse. And this figure is not an exaggeration. When you look around and look at the people in your community, many of them are obese, hypertensive, diabetic, or have a strong family history of diabetes and feel super thirsty after they eat something sweet and do not realise the signs of prediabetes.

We all have to die but none of us want to die prematurely. NCD’s make that happen. We have reduced quality of life and we die earlier. And just to add to the reality check, Obesity and Diabetes are the main risk factors for death from covid.

Covid has made us take stock of our relationships, our family dynamics, our career goals, ourselves. It is time to look in the mirror, take a slap in the face and acknowledge the truth. Things are bad, bad, bad. We are extremely unhealthy as a nation and if we want to stop dying prematurely, step 1 is to accept how bad things are. Step 2, do something about it. Time for step 2.

Dr Joanne F Paul is a Lecturer, a Paediatric Emergency Specialist, and a member of TEL institute



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