Food systems emerged with the dawn of civilization when agriculture, including the domestication of animals, set the stage for permanent settlements. Inhabitants could grow more crops and raise more animals than necessary to feed those who tended them.

This changed human culture; unlike earlier hunter-gatherers, agriculturalists did not need to be in constant motion to find new sources of food. That set the stage for the current dual system where there are food producers in the rural areas and city or town dwellers who rely on the surplus foods grown in the rural areas or even imported from other countries.

“As time becomes more expensive in the urban areas, there is increasing consumer demand for “ready-to-eat” foods has fueled the growth of quick-service restaurants and fully cooked, frozen dishes that only require reheating, further expanding supply chains,

This modern food is usually attractively processed that includes flavors and spices and attractively packed and marketed that sends the message that it is a modern and great food that is more nutritious. This encourages people to associate the processed and well-marketed food to be better and more nutritious’ observes Dr. Sindi. According to Dr. Christophe W. Ngendahayo, air and climate health expert, and founder of Air Health Now — working at Kibagabaga Hospital, “the term ‘processed’ is commonly used to describe certain foods with low nutritional value, including snacks, desserts, and carbonated beverage. Dr. Kirimi Sindi, an agricultural economist, and a food system expert adds that“highly processed or ultra-processed foods like bread, biscuits, breakfast cereals, sugar, maize flour, wheat flour, cassava, spaghetti, noodles are full of carbohydrates and most of the other nutrients have been removed. Therefore, he says, most people are eating ‘too much energy’ or “empty calories.

He notes that when it comes to dining out, people eat foods like French fries, bread, burgers, ice cream, and drink soda and beer, all of which are full of sugar. This, Sindi says, combined with our sedentary lifestyle, becomes an issue.“When this happens, the excess energy taken in is converted to fat, creating high chances of becoming obese. Dr. Sindi goes on to add that these foods, coupled with sedentary lifestyles, lead to many non-communicable diseases that as a result of our lifestyle and hence called “lifestyle diseases”.

“Heavily processed foods are often high in sugar, fat, and empty calories. Consuming lots of these foods has long been linked to an increased risk of a wide variety of health problems that can lead to heart disease or an early grave, such as obesity, high blood pressure, elevated cholesterol, cancer, and depression” observes Dr. Sindi. “There is an association between the consumption of ultra-processed foods and an increased risk of cardiovascular diseases when all lifestyle factors were accounted for, and these associations are not fully explained by the nutritional quality of these ultra-processed foods,” lead study author Bernard Srour of the University of Paris.

“Frequent consumption of ultra-processed foods is associated with poorer health, and more mortality,” said Maira Bes-Rastrollo of the University of Navarra, senior author of a mortality study. However, Dr. Sindi observes that it is good to note that not all processing is bad. “Most food needs some degree of processing, and not all processed foods are bad for the body. Mechanical processing — such as grinding beef, heating vegetables, or pasteurizing foods — does not necessarily make foods unhealthful. If the processing does not add chemicals or ingredients, it does not tend to lessen the healthfulness of the food.

The problem is usually chemically processed foods. These often only contain refined ingredients and artificial substances, with little nutritional value. They tend to have added chemical flavoring agents, colors, and sweeteners as observed at the beginning of this article. “Most of us in the cities live a life where we rarely move much. Most of our time we are in an office or a shop sitting or on our couches in the evening with a domestic worker who does most of the house chores. When we want to go even a short distance, we have to use a moto (motorcycle), taxi, or our private cars,

For these reasons, we cannot spend the energy we eat in a day hence this is converted to fat thus the increasing rate of obesity,” he says.“It is interesting that we eat too many carbs and then we have to go to the gym to exercise it off. This is the paradox of the modern lifestyles in the cities” Dr. Sindi observes. Ngendahayo says food is a fundamental part of society; however, it is also at the centre of many challenges we face now and will likely continue to face in the future from a health, social, economic, and environmental perspective.

Ngendahayo points out that for many, traditional diets are being replaced by processed fast foods where fat and sugar have become the cheapest way to get calories, cheaper than staples like grains, beans, lentils, or fruits and vegetables.

The implications

As mentioned above one of the results of a sedentary city lifestyle is obesity. World Health Organization (WHO) defines overweight and obesity as abnormal or excessive fat accumulation that may impair health. Body mass index (BMI) is used to classify overweight and obesity in adults. Overweight is when BMI is greater than or equal to 25; and obesity is BMI greater than or equal to 30. The fundamental cause of obesity and overweight is an energy imbalance between calories consumed and calories expended. Changes in dietary and physical activity patterns, WHO notes, are often the result of environmental and societal changes associated with the development, and lack of supportive policies in sectors such as health, agriculture, transport, and food processing, among others.

Overweight and obesity is a new epidemic globally, Ngendahayo says, we are experiencing health and environmental disasters, with rising rates of obesity and non-communicable diseases and severe challenges posed by climate change. Globally, more than 1.9 billion adults aged 18 and older were overweight in 2016.  Of these, over 650 million adults were obese. In Rwanda, according to the available statistics from Rwanda Biomedical Centre (RBC); overall, the Rwanda NCD survey found that 2.8% are obese, 14.3% are overweight and 7.8% underweight.

Obesity is prevalent in the age group 35 to 54 and females account for 4.7%. Additionally, the prevalence of obesity is more predominant in urban areas with 10.2% and Kigali City with 7.7%. Overweight and obesity are linked to millions of deaths worldwide more than underweight and are the fifth highest risk factor for death, according to WHO. Low-income economies are also starting to suffer from these lifestyle diseases. “This is a big burden to the country’s health system and is very costly to manage,” observes Dr. Sindi. “These diseases cause enormous human loss and impose heavy costs on health systems. They also reduce overall productivity by killing and disabling people in their productive years,” he adds.

Way forward

Private Kamanzi, a nutritionist at Amazon Nutrition Cabinet, Kigali, says eating a healthy diet and being physically active is essential as it will keep these conditions at bay. He notes that turning to whole foods reduces, or cutting off processed and sugary drinks, is vital as well. Given the threats we are faced with particularly by obesity and overweight, Ngendahayo says urgent radical change is required. “Government and non-government organizations have vital roles to play in changing the policies and practices that shape behavior around diet and physical activity,” he says.

These, he says, include the trade, agriculture, transport, and other urban planning policies that determine whether people have healthy options, as well as investment in education, media, and marketing that influence people’s choices. Experts say there is a lot of measures government and individuals can take to alleviate this problem. Effective public health measures are urgently needed to promote physical activity and improve health around the world. The challenge of promoting physical activity is as much the responsibility of governments, as of the people. However, individual action for physical activity is influenced by the environment, sports and recreational facilities, and national policy.

It requires coordination among many sectors, such as health, sports, education and culture policy, media and information, transport, urban planning, local governments, and financial and economic planning, according to the experts.

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