What’s the Deal With Smoking and Malnutrition?

It seems like it is all we hear: Smoking is bad for you!

Yes, we know that by now.. smoking causes a lot of bad health outcomes. High risk of cancer, respiratory problems, heart diseases, etc. appear as consequences to smoking tobacco. But did you know it has a significant effect on  weight and nutrition status too?

Just like alcohol, tobacco smoking promotes malnutrition in two ways:

  1. The smoker’s diet consists of less nutritional value
  2. Smoking holds the body back in taking up the vitamins and antioxidants from food.  Deficits in vitamins C and E are the consequences of just smoking only 1 cigarette a day!!

Adding up to this, smokers frequently show a deficient in vitamin A, which normally protects the body from lung infections, which might lead to cancer later on in life.

Many studies and investigators are prone on this topic, since the population of Indonesia is especially affected. It ranks third in the number of men smokers and 17th for women smokers. The country is the third-largest cigarette consumer in the world. Speaking numbers..  there are approximately 57 million smokers in Indonesia. In comparison, this amount of smokers is almost 20 times larger than in The Netherlands..

Cigarette smoking is widely associated with reduced body weight, an effect which has often been attributed to the nicotine. However, When you smoke tobacco, you can have a reduced feeling of hunger.  This causes smokers to lose weight. According to the findings, Smokers weigh 3 to 5 lbs. less than nonsmokers.

Smoking during pregnancy not only causes Indonesian women to be undernourished, they are known to give birth to babies with a significant lower birth weight. These children are also known to have a high potential of getting undernourished and being obese in the future.

Even worse, smoking among children under 18 is happening there. 41 percent of 13 to 15 year-old boys smoke, according to the World Health organization. This has immense effects on the child’s health in later life. Resulting in reduced height and malnutrition. The effect of child smoking has shown higher risks in both being underweight and overweight. In 2015, a video on youtube caused a lot of commotion. The shocking video (you can find the video below) showed an Indonesian baby boy called Aldi Rizal smoking 40-cigarettes a day when he was just 2 years old.

Smoking does not only have consequences on health.. Investigators found that 68 percent of a family’s money monthly is spent on food, whereas in a nonsmoking family, this percentage was just over 75 percent.  This implies that that 70 percent of the expenditures on tobacco products are financed by a reduction in buying food. This decrease in food-spending has immense nutritional consequences for children whose parents smoke, resulting in a decrease in height (which is often used as a variable in measuring nutrition in children. Besides spending less money on food, smoking families tend to buy food that is lower in quality. This is often because the high-nutrient products such as fruit, vegetables and meat is more expensive.

Written by Eline

Sources:

Shils M, Shike M, Ross A, et.al. Modern nutrition in Health and Disease. 10th edition. Lippincott Williams & Wilkins. New York. Part V  Prevention and management of disease.

World Health organization. Global Adult Tabacco Survey: Indonesia Resport 2011.

Rijksinstituut voor volksgezondheid en Milieu. CBS-Gezondheidsenquête, CBS-GE. 2016. zorggegevens.nl

Perkins, K. A., Sexton, J. E., DiMarco, A., & Fonte, C. (1994). Acute effects of tobacco smoking on hunger and eating in male and female smokers. Appetite, 22(2), 149-158.

Steven A. Block and Patrick Webb. Up in Smoke: Tobacco Use, Expenditure on Food, and Child Malnutrition in Developing Countries. 2009. Economic Development and Cultural Change, 58:1.

“Gemukness”

Gemukness: “Deliberately unspecific term meaning overweight/obesity but in the Indonesian context. Hidden fatness.”

Ever wonder what the Indonesians refer to overweight or obese? Well now you know that it is “gemukness” or “gemuk.”

Now why am I writing about obesity on a blog about malnutrition in Indonesia? Good question. Malnutrition actually incorporates both the aspect of undernutrition and overnutrition– and in this case, obesity is associated with overnutrition.

In Indonesia, undernutrition however is a huge issue and is given more of a priority compared to overweight and obesity, because these are believed to be problems of wealthier countries.

Obesity is not just a problem for the wealthy.

However, obesity is not just seen in wealthy, high income countries or regions of the world where people can afford lavish meals and can afford to eat 10 meals a day. It is true that obesity does in fact increase with income, but that doesn’t mean that lower wealth areas aren’t affected as well. It has been shown that in Indonesia, especially in the outer islands, the rates of adult overweight and obesity are of similar, if not greater, magnitude as undernutrition. In this specific area, the poverty rates are higher than the major cities of the country, and the problem of “gemukness” is actually a greater double burden than undernutrition. Poor nutrition in the younger years and in mothers continue to contribute to the increased risk of obesity later on in life among adults who survive the malnutrition as a child and then end up in environments where they are more prone to be caught in obesity.

Because of this “surprise,” obesity in Indonesia is even more of a problem because of it is a “hidden problem.” Many people are not fully aware of the consequences they are faced with in their particular environments.

The rate of gemuk adult men and women in Indonesia has been significantly increasing over the last few decades, while the rate of malnourished men and women has decreased considerably. This research and information was taken from the Indonesian Family Life Surveys, and it was additionally shown that the proportion of gemuk men and women, of a BMI of greater than 25, almost doubled, and that the greatest increase was found in obese women. We see that undernutrition is actually declining, while overweight and obesity is increasing in Indonesian adults and the risks increase with age.

Of course, genetics was also tested and researched, just to see if it played even a slight role in the gemukness issue. But researchers were left to find that there is no absolute evidence that genetics plays a role in the growing problem of obesity. Rather, it has been found that the obesity problem is mainly caused by consequences seen during childhood like stunting and constrained fetal growth.

On the other hand, in more areas of the country where income increased, food consumption patterns seemed to suggest increased food intake which contributed to obesity in many people. The greatest increase in food intake was found from meat, fish and eggs, and in prepared foods, where the rates were nearly doubled! Indonesian people be eating lots of animal products!… and processed foods… However, with the scenario with processed foods, many people in low income areas of Indonesia are found to consume more processed foods because they are more affordable than food, say, compared to a farmers market with organic fruits and vegetables. With this said, many of these Indonesian people are found eating instant noodles instead of a good, healthy meal, just because they simply cannot afford it. Instant noodles are good and all, but the constant consumption of these cups of deliciousness are not beneficial for anyone’s health.

And on top of that, much of the physical and built environments in Indonesia are not very friendly in terms of encouraging physical exercise. Instead of bike lanes, pedestrian sidewalks, and parks, there are many many streets where processed foods are sold. Many of the school children purchase snacks from these street vendors and shops, but they do not get the right exercise to burn off the excessive snack consumption.

While undernutrition is a big issue in Indonesia, Gemukness, or obesity, is also just as big of an issue in this region of the world.

Now the questions we are left with are — What other consequences come from obesity? What do we do about it? How can we fix it?… After researching and studying about the obesity problem in Indonesia, I personally believe that one practical way to help control the problem is to continue to educate the people of Indonesia about the extent of the problem and how to change their lifestyle and diet to reduce the risks. This is due to the fact that many Indonesians are not even aware of the severity of the obesity issue in the country!

Written by Hannah

Shrimpton R., & C. Rokx. (2013). The Double Burden of Malnutrition in Indonesia, World Bank Jakarta, Report 76192-ID. Retrieved from http://documents.worldbank.org/curated/en/955671468049836790/pdf/761920WP0P12640Box0379884B00PUBLIC0.pdf.