Distler/TYG

It is our second night in Dar es Salaam, and we’ve ventured seaside for dinner. Packed tightly around the worn wooden tables, we hungrily discuss what we want to eat for the evening. The waiter comes over to take our order: I ask for fresh fish. They’re out. I ask for calamari. Also not available. No salads on the menu either; nothing but pizza left in the restaurant. Sighing, I give in and order a pie with chicken, all the while wondering why someone would travel all the way to Tanzania just to eat pizza.
    
Tanzania differs from other African nations in many ways: a relatively peaceful country, it has never experienced civil war and has seen substantial economic growth and poverty reduction since the 1980s. But as Tanzania emerges on the international scene, the country has opened its doors to more than just tourists and trade. The sides of the majestic mosques are adorned with ads for hamburgers and mayonnaise; fresh coconut peddlers and Coca-Cola vendors set up shop next to each other on the corners of the busy streets. Indeed, even the bottles of water sold at most convenient stores are owned by Coca-Cola.

In a country where HIV/AIDs and malnutrition are still the number one health concerns, it is hard to believe that obesity and the related non-communicable diseases that come with it are on anyone’s radar. But as a few researchers, NGO and education workers are beginning to notice, obesity is on the rise. And many are beginning to fear that Tanzania will not be able to handle both looming nutritional crises.

A breakthrough in improving general nutrition in Tanzania came in 1995, with the establishment of the Tanzania Food and Nutrition Center (TFNC). Built against the backdrop of a picturesque waterfront, the center was founded with the goal of providing “quality nutrition services to the Tanzania community in the prevention and control of all forms of malnutrition,” according to the center’s website.

Dr. Joycelene Kaganda, one of the nutritionists at the center, has been leading a project on advocating proper nutrition in conjunction with HIV/AIDs treatment, a relatively new idea in Tanzania. While many studies have shown that malnutrition at the onset of antiretroviral therapy (the treatment for HIV) is linked to lower rates of survival, HIV/AIDs programs in Tanzania have taken more time to make the connection. Dr. Kaganda explains that proper nutrition “is need[ed] to take HIV drugs. People don't understand nutrition, [they] don’t care. That’s why when HIV/AIDs intervention came out, nutrition was left out,” she tells the small group of us crowded into her office. “Hospitals have only recently started employing dietians – only two or three years ago.” In 2005, she began developing nutritional guidelines for people living with HIV/AIDs, tailoring it to different regions by asking health care workers to provide lists of available foods in their area.  

Across town, Dr. Lyuna Kyungu, paints a very different picture of nutrition in Tanzania. A former nutritionist for TFNC, she co-founded the Center for Counseling, Nutrition and Health in 1998 – a project that began at TFNC and slowly branched out. Although she tells me that “most of our projects are aimed for malnutrition and people with HIV/AIDs,” she has also begun working with overweight people suffering from diabetes – as recently as two years ago. Unlike the United States, where people with high-incomes are statistically thinner than those of lower-income, poverty and malnutrition in Tanzania are closely linked:  processed “junk” food from supermarkets is more expensive than the fresh fruits and vegetables sold at the markets.

“The attitude is different – the higher and middle classes think they know nutrition. They eat fatty, sugary foods, and they think it is healthy. They seldom come here for obesity because they don’t think it is a problem. They only seek advice when diabetes and hypertension appear - only when there is a medical problem,” Dr. Kyungu says, adding that the recent economic changes and westernization have led many people to “think [that] eating at fast food restaurants makes them look western.” Her words remind me of something Dr. Kaganda had said to me a few days before: in a country where being too skinny or frail-looking is associated with disease and poverty, “They believe if a man does not have a belly, he is a poor man.”

On a visit to the Al Muntazir Islamic Seminary, Principal Karim, as she introduces herself to me, also discusses some of the changes she has seen in body types. “Looking around, girls are thicker,” she says of the ten years she spent as principal at the primary school. But in her mind, “it is not food, it is laziness.”  Mrs. Fali, the section coordinator for the girls’ seminary (boys and girls are taught separately) acknowledges that 1-2% of students obese but believes that it is “all due to their bad heating habits from home – many times eating junk food.”

However, both express concern over the canteen on the school’s premise. Run by two women who are not affiliated with the institution, the canteen sells French fries, pizza, bags of chips, and variety of sodas and candy. And just like “competitive” foods in American cafeterias, “students eat this more than their home-cooked lunches,” Principal Karim informs me. Mrs. Fali adds, “I would prefer it to change. I have advised them that if they could sell fresh fruit, vegetables, juice. But they were reluctant because they said students won’t buy it.” And if the canteen does not offer students what they want, “they are bound to buy unhygienic and unhealthy food from outside vendors,” she continues. Despite these setbacks, both women feel that they are educating the girls properly on how to eat well. Besides encouraging them to take aerobics, and teaching them how to balance a meal with carbohydrates and proteins, Mrs. Fali says the girls themselves are very diet conscious: “they say [to each other] you will not get a good partner if you’re fat.”


Although malnutrition rates have dropped substantially in the last few years, there is still much work to be done. The silver lining, however, is that the issue continues to garner attention. “Donors tend to fund malnutrition and AIDs nutrition, but few have opened their eyes to a big problem parallel to nutrition,” Dr. Kyungu warns, “Obesity is a big problem in children, [but] people just keep quiet as if the problem is not there,” adding that obesity-related diabetes has become just as common as malaria. Research in malnutrition and maternal health has been generously funded by organizations like USAID which recently earmarked $20 million for the purpose. In contrast, obesity research and related policy prescriptions are relatively non-existent. At the time of publication, there is no government regulation regarding food advertising to children, or regarding competitive foods in schools, and soda consumption has no signs of slowing down (“People love this stuff, even where there is no electricity, they bring fridges so they can have cold soda,” Dr. Kaganda tells me).

“The government says that obesity is not that common,” Dr. Kyungu laments, “But I think it’s becoming worse. We’re going to have a lot of people with cancer, diabetexs, and hypertension. The problem could double in 10 years time.”     

She takes a moment to reflect, looking at the stacks of papers and files on her desk – designs for programs aimed at tackling malnutrition, her predictions on obesity echoing in the room. She concludes, “Under-nutrition will continue to be the main problem in this country, but we will face a lot of problems stemming from over-nutrition.” Pausing, she adds, “The government cannot tackle both types of nutrition issues.”

Rebecca Distler is a sophomore Political Science major in Davenport College.

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