By Dr SAMUEL HARRISON

World Obesity Day, observed globally on March 4, is a reminder that obesity is no longer regarded as a problem exclusively to high-income countries. In Nigeria, as in many low- and middle-income settings, rates of overweight and obesity are rising even while undernutrition and micronutrient deficiencies remain widespread among vulnerable groups [1,2]. This simultaneous presence of different forms of malnutrition—sometimes within the same communities or households—reflects the so-called double or triple burden and requires integrated responses [2]. It is no coincidence that the communities most affected by undernutrition are also increasingly exposed to cheap, calorie-dense processed foods such as refined grains (e.g., white bread, instant noodles) and sugar-sweetened beverages. This trend reflects deep inequities in how food systems are structured and who they serve.

Obesity is recognised by the World Health Organization (WHO) as a condition in which excess body fat accumulation threatens health [1]. Health workers commonly use Body Mass Index (BMI) to screen for obesity. It is calculated as weight in kilograms divided by height in metres squared (kg/m²) [1]. An adult with a BMI between 25.0 and 29.9 kg/m² falls into the overweight range, while a reading of 30.0 kg/m² or above indicates obesity. The measure relies only on accurate recording of weight and height, but its interpretation and subsequent clinical decisions must take place within a healthcare setting [1]. For people living with obesity, accessing that clinical support and receiving it without a judgmental approach remains one of the most significant barriers to effective care.

When assessing children and adolescents, BMI requires age- and sex-specific reference charts. For those aged 5–19 years, overweight is defined as BMI-for-age >1 standard deviation (SD) above the WHO Growth Reference median and obesity as >2 SD above the median [1]. For children younger than five years, weight-for-height indices are used for classification [1].

The earlier overweight and obesity are detected, the better the chance of stepping in before lasting complications develop.

The scale of overweight and obesity is large. In 2022, the WHO estimated that 2.5 billion adults were overweight worldwide, including about 890 million with obesity [1]. More than 390 million children and adolescents aged 5–19 years were classified as overweight in the same year, of whom over 160 million met criteria for obesity [1]. The World Obesity Federation warns that, without decisive action, overweight and obesity could affect about half the world’s population by 2035. [3] The financial burden of these trends is expected to be substantial. The 2026 World Obesity Day theme, “8 Billion Reasons to Act on Obesity,” stresses the need for coordinated global and national responses [3].

Central obesity and cardiometabolic risk

Although BMI is a practical screening measure, the pattern of fat deposition is an important determinant of risk. Central (abdominal) adiposity is closely linked with hypertension, type 2 diabetes and cardiovascular diseases. A study reported by News Express Nigeria (2025) highlighted associations between greater abdominal fat (sometimes described in the media as “beer belly”, though this is an informal rather than clinical term) and adverse structural changes in the heart that may raise long-term cardiovascular risk, particularly among men [4]. These observations strengthen the case for routine assessment of waist indices alongside BMI.

The WHO advises that BMI be supplemented by other anthropometric measures such as waist circumference (WC) and waist-to-height ratio (WHtR) [1]. Waist circumference is measured at the midpoint between the lower rib and the iliac crest after a normal exhalation [1]. Waist-to-height ratio is calculated by dividing waist circumference by height, using the same unit of measurement; a simple guide is to keep the waist measurement less than half of height. Increased cardiometabolic risk is commonly associated with a waist circumference greater than 94 cm in men and 80 cm in women, and a WHtR of 0.5 or higher. [5]

School feeding: combating undernutrition without worsening obesity

Nigeria’s nutrition response must act simultaneously against both undernutrition and obesity. School feeding schemes are essential to tackling child undernutrition; however, the nutritional composition of meals and the broader food environment around schools determine whether such programmes support long-term health.

The WHO notes that many populations continue to experience undernutrition while also being increasingly exposed to energy-dense, nutrient-poor foods [2]. The 2025 United Nations Children's Fund (UNICEF) Child Nutrition Report documents the pervasive availability and marketing of ultra-processed snacks and sugary drinks, which are changing children’s dietary patterns and contributing to rising overweight and obesity levels [10]. Children who develop obesity early are far more likely to carry it into adulthood, along with its associated risks of diabetes, hypertension and heart disease. For that reason, early preventive measures constitute one of the most impactful investments a country can make.

Reports indicate that suspension of the national school feeding programme left about nine million pupils without meals and disrupted roughly 250,000 livelihoods linked to the scheme [6]. Estimates suggest that reinstating the programme nationally could cost in the order of ₦1 trillion per year [7]. If implemented under clear nutrition standards, school feeding can help reduce both obesity and undernutrition. The programme should prioritise whole foods such as vegetables, fruit, and protein-rich pulses like beans and soybeans. It should also include minimally processed staples such as rice, maize, or tubers. Packaged snacks like potato chips and chin-chin, sugary drinks, instant noodles, fried street foods, and sweet pastries have no place on a school menu designed with children's health in mind.

Community food banks, home gardens and food security

In February 2026, Abuja hosted the launch of the National Community Food Bank Programme advocacy campaign, with the stated purpose of improving access to safe, nutritious food for vulnerable households through primary health centres [8]. The programme reportedly includes caregiver counselling and food-voucher arrangements linked to locally produced items [8]. Aligning social-protection mechanisms with primary healthcare delivery may extend coverage and improve accountability.

Through the First Lady, Senator Oluremi Tinubu's “Every Home a Garden” project, households are receiving support and encouragement to grow food at home [9]. Household gardens boost the availability of fruits and vegetables, expand dietary diversity, and limit dependence on processed foods [1,9]. They also offer light, regular physical activity, promoting healthier weight management. Strengthening local food networks, therefore, promotes both food security and chronic disease prevention [2,9].

Family meals and household food culture

Government policy can reshape what food is available and affordable, but the habits that last a lifetime are still mostly built around the family table. The WHO recommends reducing intake of foods high in fat and free sugars and increasing consumption of fruit, vegetables, legumes and whole grains [1]. UNICEF emphasises the growing reach of digital marketing aimed at children for energy-dense snack products [10].

Shared family meals offer practical opportunities for portion control, balanced choices and oversight of children’s intake. Regular communal eating can reduce reliance on ultra-processed snacks that supply calories with little micronutrient value [1,10].

Primary care and early prevention

The World Health Organization recognises obesity as a chronic condition shaped by environmental, behavioural and biological factors [1]. Prevention and management are most effective when they include routine screening, brief counselling and continuity of care. Studies from Nigerian family practice settings indicate that household circumstances and behavioural factors have a measurable effect on weight outcomes [11,12]. These results support community-based, patient-centred models emphasising longitudinal care in the prevention and management of obesity.

Every visit to a primary care clinic is a practical opportunity to record a patient's BMI, check waist circumference where there is a clinical reason to do so, and ask a few direct questions about what they eat and how active they are [1]. Early detection creates opportunities for intervention before complications such as hypertension, diabetes and cardiovascular disease become established [1,11,12].

Beyond undernutrition

Continued attention to stunting and wasting remains vital in Nigeria. Nevertheless, the World Health Organization stresses that malnutrition covers undernutrition, micronutrient deficits and overweight/obesity [2]. UNICEF data show rising prevalence of overweight and obesity among school-aged children across many low- and middle-income countries [10]. Tackling undernutrition without considering diet quality risks promotes dependence on calorie-dense foods that raise long-term disease risk [2,10].

What must be done

Reinstating school-feeding programmes under enforceable nutrition standards, integrating community food banks into primary-care platforms, supporting local agricultural production and incorporating obesity screening into routine clinical practice are complementary elements of a coherent national nutrition strategy. Households and individuals also have a role to play in improving nutrition, which includes cutting back on sugary drinks and processed snacks, choosing minimally processed staples, and ensuring regular intake of fruits and vegetables in line with established dietary recommendations [1,2]. Regular shared meals further strengthen these efforts by encouraging healthier choices and supporting consistent eating patterns within the family [1,2]. However, sustainable individual behaviour change depends on enabling food environments and coherent government policy.

Obesity and undernutrition are interlinked expressions of the same food-system failings. The global demand for action carries special urgency in Nigeria, where the double burden of malnutrition is already unfolding. World Obesity Day 2026 states it clearly: there are eight billion reasons to act in combating obesity. Nigeria must shift from symbolism to a structured strategy. The rising prevalence of obesity risks undermining health, economic productivity and resilience. What is required is not isolated programmes but a coordinated, evidence-driven Interdisciplinary national response that aligns health, education, agriculture and urban planning. Policy must be informed by data, guided by prevention, and sustained beyond political cycles. The urgency is real, and Nigeria’s response must be proportionate to the scale of the challenge.

•Dr Samuel Harrison, Chief Medical Officer, is a member of the Association of Resident Doctors, Federal Capital Territory Administration (FCTA) Chapter.

References

1. World Health Organization. Obesity and overweight [Internet]. Geneva: WHO; 2025 May [cited 2026 Feb. 26]. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight

2. World Health Organization. Malnutrition [Internet]. Geneva: WHO; 2024 Mar 1 [cited 2026 Feb. 26]. Available from: https://www.who.int/news-room/questions-and-answers/item/malnutrition

3. World Obesity Federation. World Obesity Day 2026: 8 billion reasons to act on obesity [Internet]. London: World Obesity Federation; 2026 [cited 2026 Feb. 26]. Available from: https://www.worldobesity.org/what-we-do/world-obesity-day

4. News Express Nigeria. ‘Beer belly’ linked to heart damage in men – study [Internet]. Lagos: News Express Nigeria; 2025 Dec 3 [cited 2026 Feb. 26]. Available from: https://newsexpressngr.com/news/285956/beer-belly-linked-to-heart-damage-in-men-study

5. Montoya Castillo M, Martínez Quiroz WJ, Suarez-Ortegón MF, Higuita-Gutiérrez LF. Waist-to-Height Ratio, Waist Circumference, and Body Mass Index in Relation to Full Cardiometabolic Risk in an Adult Population from Medellin, Colombia. J Clin Med. 2025 Apr 1;14(7):2411. doi: 10.3390/jcm14072411

6. News Express Nigeria. Suspended school feeding initiative leaves 9m pupils, 250,000 jobs stranded [Internet]. Lagos: News Express Nigeria; 2025 Jul 31 [cited 2026 Feb. 26]. Available from: https://newsexpressngr.com/news/270371/suspended-school-feeding-initiative-leaves-9m-pupils-250000-jobs-stranded

7. News Express Nigeria. Nigeria requires N1tr annually for school feeding programme — Shettima [Internet]. Lagos: News Express Nigeria; 2025 Aug 25 [cited 2026 Feb. 26]. Available from: https://newsexpressngr.com/news/273436/nigeria-requires-n1tr-annually-for-school-feeding-programme-shettima

8. News Express Nigeria. Oluremi Tinubu flags off National Community Food Bank Programme awareness campaign [Internet]. Lagos: News Express Nigeria; 2026 Feb 17 [cited 2026 Feb. 26]. Available from: https://newsexpressngr.com/news/295916/oluremi-tinubu-flags-off-national-community-food-bank-programme-awareness-campaign

9. Renewed Hope Initiative: Edo Women Empowered Through Agricultural Support from Nigeria’s First Lady 'Every Home A Garden' Initiative [Internet]. Abuja: FMINO; 2025 Jul 25 [cited 2026 Feb. 26]. Available from: https://fmino.gov.ng/renewed-hope-initiative-edo-women-empowered-through-agricultural-support-from-nigerias-first-lady/

10. UNICEF. Feeding Profit: How food environments are failing children – 2025 Child Nutrition Report [Internet]. New York: UNICEF; 2025 Sep [cited 2026 Feb. 26]. Available from: https://data.unicef.org/resources/feeding-profit-2025-child-nutrition-report/

11. Ogunbode AM, Owolabi MO, Ogunbode OO, Adebusoye LA, Ogunniyi A. Predictors of weight reduction in a Nigerian family practice setting. Ghana Med J. 2022 Sep;56(3):206-214. doi: 10.4314/gmj.v56i3.11.

12. Badru O, Ogunbode A, Olowookere O, Folasire O, Ladipo M. Family characteristics and childhood predictors of overweight and obesity in adults attending general outpatient clinic, Ibadan. Nig. J. Fam Pract [Internet]. 2021 Mar. 2 [cited 2026 Feb. 26];11(1):18-26. Available from: https://www.ajol.info/index.php/njfp/article/view/204375

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