Obesity in Kenya: A Synthesis of the Literature

The prevalence of obesity in Kenya has risen in the past decade and this is causing a worrying situation. Various factors have been suggested to cause this rise, namely; the environment, culture and poor health care system. This review aims at describing the factors that cause the increase in the prevalence of obesity, analyses the public health responses and provides recommendations. Several chronic diseases are associated with overweight and obesity, namely diabetes, cardiovascular diseases and cancer. In the past, obesity was only a problem in high income countries but is now dramatically on the rise in low-and middleincome counties, especially in urban settings [1]. Worldwide obesity has more than doubled since 1980. In 2008, 1.5 billion adults, 20 years and older, were overweight. Of these over 200 million men and nearly 300 million women were obese. 65% of the world’s population live in countries where overweight and obesity kills more people than underweight. Nearly 43 million children under the age of five were overweight in 2010. Obesity is preventable [1]. Overweight and obesity are the fifth leading risk for global deaths. At least 2.8 million adults die each year as a result of being overweight or obese. In addition, 44% of the diabetes burden, 23% of the ischaemic heart disease burden and between 7% and 41% of certain cancer burdens are attributable to overweight and obesity [1]. Methods

model being the most recent and complex explains the complexity of health and that the individual also has power to influence their environment.

Environment
People migrate from rural areas to settle in the urban setting to seek employment and possibly better health care. For the situation in Kenya, the employment opportunities afforded in the urban setting, create an increase of income, leading to an improvement in well-being which results in the individual response which may be positive (health and function) or negative (disease being obesity).
However, due to the demands of urban living that leads to a sedentary lifestyle, the amount of exercise reduces, as stated by Onywera [3]. This is regardless of the level of education, socio-economic status or behaviour, resulting in obesity. Obesity appeared to be prevalent in women in the high-income group (7278 kJ) in urban areas (7049 kJ) with 34.5% total fat intake than in rural areas 29.7% of energy.

Obesogenic Environment
One cause of obesity and overweight is an energy imbalance between calories consumed and calories expended. Globally, there has been: an increased intake of energy-dense foods that are high in fat, salt and sugars but low in vitamins, minerals and highly processed foods and fatty diets in Kenya have been attributed to the marked "nutritional transition" [2] which occurred over the past 400 years since the colonial times [2]. This moved the whole population from the traditional and indigenous foods that are associated with health benefits [2] Culture In Kenya, and Africa at large, some socio-cultural beliefs view obesity and overweight as an admired trait. It is seen as a sign of prestige and wealth [3] There is a lack of strong and outward looking social networks which have been shown to be protective of health [2] Health Care Depending on whether the health care system is well structured, it is then involved in improving health and leading to either prosperity or an individual response to health and function.
Hsia et al [4] in a study to access to health care in Sub-Saharan Africa recognised the critical "infrastructure gaps" that obstruct the health systems. Okeyo et al [5] speculated that overweight and obesity, with their related disease conditions will constitute a major threat to the economically productive adults causing a huge health-care burden soon in developing countries.

1.
Interdisciplinary perspective at various societal levels, [6][7][8][9] involving, research, education, direct management in primary health care is required to improve the obesity situation in Kenya. This could be achieved by involving the incorporation of food and nutrition studies into different areas such as the primary school curriculum, which might affect a shift of behaviours, attitudes, culture, values and beliefs to benefit the community at large [9,10].

2.
Incentives for healthy eating habits [8] should be developed to nationally encourage consumption of traditional foods and the consumption of high fat modern food in moderation.

3.
The promotion of strategies to increase the level [10][11][12] of physical activity in the urban population both at local and national levels.

4.
Improved surveillance and monitoring [8][9][10] of the population's health and well-being is essential. This may be achieved by the Kenyan government improving the infrastructure in the country.

Conclusion
There is an increase in obesity especially in the urban settings in Kenya. This has been attributed to the rural to urban migration due to better employment opportunities and improved health care. However, due to the sedentary lifestyles, decreased amount of exercise and consumption of high-calorie dense foods, obesity develops.