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A Big Fat Loss for Trinidad and Tobago

By Ian Ho-a-Shu and Natalie Wegener Carmona

It’s no secret that being overweight or obese puts people at higher risk for illnesses such as heart disease, hypertension, certain cancers and Type 2 Diabetes[1]. Obesity comes with financial costs at the individual and population levels, but we all know there is no way to put a price on personal good health and wellness. As obesity continues to build towards an epidemic, the crisis has become more than a health risk, it is now an economic threat. In Trinidad and Tobago, Non Communicable Diseases (NCDs) account for 80 percent of deaths[2] and are mainly due to heart disease, hypertension, cerebrovascular disease, diabetes, cancer, and chronic respiratory illness. NCDs tend to occur early in a person’s lifespan, primarily affecting the working-age population, reducing productivity and imposing an estimated loss of 383,254 Disability-Adjusted Life Years (DALY) each year, the largest figure per capita among Caribbean countries. One DALY is roughly equivalent to one healthy year of life lost.[3] Risks of NCDs are associated with lifestyle behaviors common in Trinidad and Tobago like overuse of alcohol or tobacco, physical inactivity, and poor diet.

According to estimates from RTI International, the annual economic burden in Trinidad and Tobago (TT) from NCDs related to diabetes, hypertension and cancer is more than US$1.19 billion each year, which represents roughly 4.3% of TT’s annual Gross Domestic Product (GDP). A large proportion of this burden, approximately US$1.01 billion, is due to high blood sugar (diabetes) and high blood pressure (hypertension), which are both risk factors related to obesity[4].

Childhood obesity is a growing concern for TT, as revealed by BMI surveys of school children ages 5-18 years which showed there has been a 400% increase in obesity rates of their age group from 1999 to 2009[5]. This increase is significant because childhood obesity, a precursor to adult obesity, has immediate as well as long-term effects on health and well-being including heightened risks for cardiovascular diseases, cancers, diabetes, bone or joint problems, sleep apnea, and social issues.[6] According to Dr Rohit Doon, Public Health Advisor for the TT Ministry of Health, “many of our children are suffering from hand to mouth disease and are consuming high concentrations of poor nutrients: high in sugar, fat and salt.”

But not all the news is bad news. TT’s Ministry of Health has initiated responsive actions against NCDs, targeting obesity in particular with Fight-the-Fat Camps for children aged 7-12 years old and Wee Fit programs for adults. Implementing childhood obesity prevention efforts such as these contribute to reduction of adult complications, mortality and productivity losses related to diabetes and hypertension.  RTI International estimates that for every 100 cases of adult diabetes and hypertension prevented, the TT economy can reap savings of almost a quarter million annually. This would generate funding that could be put to other uses such as developing education or infrastructure across the country.

To assist in the fight against NCDs, the Inter-American Development Bank approved a loan for Trinidad and Tobago in the sum of US$48.4 million to prevent and control risk factors of chronic diseases among adults, and primary and secondary school students. The program will strengthen the delivery of integrated primary care services, an important preliminary step to reducing rates of NCDs. The loan will also implement behavior change programs and policies, improve health information management practices, and ensure adequate human resources for health. Through these initiatives, the IDB and the TT Ministry of Health hope to get the population up and moving, promoting healthier lifestyle choices and strengthening the health system, in order to dismantle the ticking obesity time bomb.

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[1] Health Risks of Overweight and Obesity, National Heart, Lung and Blood Institute https://www.nhlbi.nih.gov/health/health-topics/topics/obe/risks.

[2] World Health Organization, Cause of Death Data—Trinidad & Tobago.

[3] Worley, Chronic Diseases Beleaguer Developing Countries. Population Reference Bureau, 2009.

[4] Economic Burden of Non-Communicable Diseases in Trinidad and Tobago: Preliminary Estimates, RTI International, May 2016

[5] Situation Analysis on the Prevention and Control of Childhood Obesity, Dr Rohit Doon, Ministry of Health 2016

[6]    Daniels et al. (2005). Overweight in children and adolescents. Circulation, 111, 1999–2002.

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