Feature: Type II Diabetes and Obesity II

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By Dr. Toyin O. Jenyo

Last week, we began a series on Type II Diabetes and Obesity and we have defined terms, such as Body Mass Index (BMI), Overweight, Obesity, and what it can result into. Overweight and obesity are because of energy imbalance between calories consumed and calories spent. This can be due to excessive consumption of calories by consuming energy-dense food or inadequate expending of calories because of a sedentary lifestyle. This week, we will continue the discussion by examining the Nutrition Paradigm in recent times.

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Nutrition Paradigm Today

Urban Johnson (2009) describes this era (2005- present) as an era of nutrition paradigm crisis whereby there was no mainstream applied nutrition paradigm and mainstream paradigms in the previous era were criticized for their inadequacies to solve nutritional health problems, particularly those the major players in International public health like The World Bank are interested in. Inability to solve nutritional health problems, new scientific discoveries, and/or a changing ‘ethical climate’, influenced by changing political and ideological positions, led to a paradigm shift from one era to another. Although the transition period is not clear cut, the approximate period of each era of the nutrition paradigm is highlighted below:

1. The period before 1950 

2. The Protein Deficiency Paradigm (1950-1974)

3. The Multisectoral Nutrition Planning Paradigm (1974-1980)

4. The National Nutrition Policy Paradigm (1980 – 1990)   

5. The Community-Based Nutrition Paradigm (1985-1995)

6. The Micronutrient Malnutrition Paradigm (1995-2005) 

7. A period of Paradigm Crisis (2005-present) (Johnson, 2009)

The two main nutrition paradigms emerging today are (1) The Investment in Nutrition Paradigm, and (2) The Human Rights Approach to Nutrition Paradigm, which can be differentiated using the two conditions to be satisfied in development i.e. the achievement of a desirable outcome, and the establishment of an adequate process to achieve and sustain that outcome. Ideally, every developmental process or intervention should be able to achieve the desired result through a sustainable process. (Johnson, 2009)

Investment in Nutrition Paradigm emphasized the desirable outcome with little or no attention paid to the sustainability of the intervention that brought about the outcome. It is more of a donor–beneficiary relationship that avoids the sensitive social and political causes and consequences of malnutrition (undernutrition (sub-nutrition) and overnutrition (MNT, 2010))(Johnson, 2009) by reflecting well on the currently dominating free-market economy and ideology. Major players in the global sector favoured this paradigm because it favours the project approach to health provision because the project approach deals with short course projects that can be easily assessed and appreciated globally through figures that can be easily gathered unlike the long-term project being advocated for through a Sector-wide approach that will take a longer time (Birm, Pillay & Holtz, 2009).

On the other hand, the Human Rights Approach to Nutrition Paradigm emphasized the sustainable process of implementing nutrition intervention that will yield long-term desirable outcomes. It is all about claiming rights to health/nutrition between claim-holders (or the subject of the right) and duty-bearers (or the object of the right). It addresses the inequalities issues in the society that challenge the dominating economic, political, and social causes and consequences of malnutrition. The sector-wide approach to health provision is the favorite of this paradigm, so it is not popular among the major health player globally. (Johnson, 2009).

To be continued, watch this space

Toyin Olawale Jenyo, MBBS(Ilorin) MPH(Liverpool) is a member of Fiji College of General Practice (FCGP). He is a Public Health Physician with vast experience in General Practice in four countries. He has more than 10 years’ experience in treatment and effective application of public health interventions in CDs and NCDs at PHC level. He has also been involved in training and mentorship of medical officers and medical students over the years of practice. He works at Olivet Medical Centre, Nakasi Suva, Fiji Islands

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