by Surafel K Gebreselassie

We are four old classmates seated in a popular Ethiopian restaurant in the Washington DC metro area, home to the largest Ethiopian community outside of Ethiopia. The restaurant was packed. It was a Saturday evening. I was thrilled to find Bedele beer, the first beer I had, which started brewing just when I came of age. That was a pleasant change from Abba Jifar’s tej ( homemade honey wine), King of the Gibe Kingdom of Jimma.

We were four skinny boys then, in our early 20s. We are a different animal today.

Once the plate of kitfo (raw marinated beef), gored gored (raw beef cut up in to cubes), tibs (chopped up and roasted beef) arrived hot from the oven, we attacked it furiously.

“You have lost weight. Haven’t you?”

I was a bit surprised. I thought at first my friends didn’t recognize my weight loss.

Yes I did.

“That is impressive, how much did you lose? “

I would say about twenty two pounds but still have ways to go.

“Twenty two pounds!”

“Isn’t that like 10 kilograms? “

“How did you do it?”

I scanned the restaurant with my eyes. The chatty obese guys seated next to us had lowered their voices as if expecting to hear what I had to say. I stood up, stretched and walked to the toilet to wash my hands sneaking in between the tables.

It was rare to see plates of vegetables.

Almost everyone was eating some combination of beef, lamb or chicken.

Almost every table had one or two people who looked obese or overweight.

It wasn’t a surprise. By 2030 the global estimates of people with overweight reaches to a staggering 2.16 billion, and 1.12 billion will be obese (1) but this is not limited to developed countries. Overweight and obesity are becoming major health issues in low income countries with urbanization contributing to some degree although that pattern is changing with obesity increasingly seen in poor rural areas as well. In the developing world alone there are over 115 million people suffering from obesity related problems such as hypertension, type 2 diabetes, stroke, cancer, heart diseases. It is predicted that by 2030 the African region will see a doubling of heart disease related deaths (2). A recent systematic review also thought us that obesity was more prevalent in Africans who migrated to Western countries (2). For examples, there is a published report about increasing rate of obesity among Ethiopian women living in Israel (3). In this study, compared to
their arrival weight, after 14 years of average living time in Israel, 42% became overweight including 11% who became obese.

Ethiopian immigrants to the US, like ethnic Ethiopians in Israel, undergo several changes not the least of which is adapting to local dietary patterns and lifestyles. A diet rich in teff, whole grains and legumes is replaced by rich amounts of meat, sugar, dairy products and fats. Add to that high sugar soft drinks which are readily available; less calorie expenditure with the relative sedentary Western life. This is spiced up by the traditional Ethiopian foods in many ethnic restaurants particularly in cities with major Ethiopian population. The net effect is imbalance of calorie intake versus expenditure. The change in the Ethiopian immigrants in Israel who developed overweight and obesity that parallels that of the general Israel population (3) could hold true in the Ethiopian immigrant community in the US and Western Europe although that needs to be studied.

The server had brought Ethiopian coffee for each of us when I made it back to my seat.

“So how did you lose?”

It reminded me of my pot belly. Central obesity is even more dangerous. I learned that in medical school but never paid enough attention to myself until recently. I started by changing simple routines. I stopped adding sugar to my coffee and tea. I stopped extra calories from soft drinks and juices that I used to grab every time I opened the fridge. At least two to three times per week I tried to do some exercise be it walking or jogging. I tried to take stairs as much as I can in my work place. The individual changes I did at first didn’t seem much but the sum effect was a remarkable weight loss and feeling of well being. I still kept the visits to local Ethiopian restaurants because they are gateways to Ethiopia, but started mixing vegetables and fruits. It worked for me but not everything works for everyone. For example some people with arthritis may find it difficult to exercise so each individual has to tailor what works best.

Before I had a chance to listen what they had to say, we started the fight to pay the whole bill first, reminding me of how generous we are to each other and to others, something we still kept as immigrants even as we became fatter.

References:

1) Popkin DM, Adair LS, Ng SW. Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev 2012 Jan;70(1):3-21

2) Adeboye B, Bermano G, Rolland C. Obesity and its healthimpat in Africa: a systematic review. Cardiovascular J Afr. 2012 Oct; 23(9); 512-21.

3) Regev-Tobias H, Reifen R, Endevett R, et al. Dietary acculturation and increasing rates of obesity in Ethiopian women living in Israel. Nutrition. 2012 Jan ; 28(1):30-4.