At the end of my working day in Aruba I come to the conclusion that today I have only seen one patient who was not overweight. I saw a 12-year-old girl with vague abdominal pain and quite overweight who only drinks cola. I saw a one-and-a-half-year-old boy of 18 kilos. An average weight for a 4-year-old. I saw a 50-year-old man with back and knee pain and a fat apron that reaches to his thighs when walking. I saw a grandmother with diabetes and high blood pressure, along with her eight-year-old grandson. The boy is a good weight, but grandmother thinks he is too thin and wants him to be examined by a pediatrician.
I give advice and explanations. Explain the difference between the norm and normal. Make a circle on paper to represent a plate and make four squares: a quarter for carbohydrates such as rice, a quarter for proteins such as chicken, and two quarters for vegetables. I show growth curves. Tables with the sugar content of soft drinks and juices. I inform and advise until I weigh an ounce and at the end of the day I am tired but satisfied.
That satisfied feeling disappears like snow in the Aruban sun when I drive over the island in my car. I see an island the size of Texel, with fast food restaurants on every street corner. I count five Wendy’s, three McDonald’s, two Pizza Hut(s), five KFC’s, three Burger Kings, two Taco Bells, five Dunkin’ Donuts, dozens of local (takeaway) restaurants and food trucks that mostly sell fried snacks. There is really no escaping the unhealthy excess on this island.
‘One happy island’ is the slogan of Aruba, but it is now increasingly called ‘one heavy island’. As many as 80 percent of adult Arubans are overweight, half of whom are obese. About 50 percent of children under the age of 10 are overweight. According to the WHO, Aruban children are among the fattest in the world. This translates into the development of all kinds of chronic conditions such as joint pains, high blood pressure, cancer and diabetes. To give an example: in Aruba more than 16 percent of the population suffers from diabetes (90 percent of which is ‘acquired’ type 2), while the world average is 8 percent. The percentage of women who develop breast cancer is also higher than in the rest of the world. This can be partly explained by excess adipose tissue leading to an increased concentration of estrogens in the body, increasing the risk of breast cancer.
The prices in the supermarket are high. An Aruban told me how in the past boats full of vegetables, fruit and fish arrived from Venezuela in the harbor of Oranjestad. Fresh, cheap and high quality. Since the crisis in Venezuela, that trade has come to a standstill. More than 95 percent of food is now imported, mainly from the Netherlands and the US. Fruit and vegetables brought in by plane are on average 2 to 3 times more expensive than in the Netherlands. This makes it unaffordable for the average Aruban, who lives on a minimum salary (officially 900 euros per month). Although, according to the critics, there is always money for a telephone card.
There are more factors that play a role in the development of obesity on this island. In addition to poverty, stress also plays an important role. Part-time work hardly exists here. Many people even work multiple jobs. The single mother of the aforementioned one-and-a-half-year-old boy has two jobs and has difficulty making ends meet. She comes home exhausted six days a week at eight o’clock in the evening. With a takeaway meal that she eats with her son.
Another cause for obesity is the extent to which food is part of the culture. The Dutch say they love a party. Arubans know what a party is. They celebrate their parties exuberantly with lots of fun and even more food. Even a funeral ends in a real dinner party.
The government is rolling out a national prevention plan. Up to now, this has mainly focused on health education, but there are more spearheads. This is important, because if eight out of ten Arubans are overweight, including many administrators and policy makers, then it is not enough to hold them accountable for behavior and responsibility. Then giving knowledge and health skills is not enough. Then one must look at the environment, the circumstances in which Arubans live (and grow up). Because if they don’t change, the population and the obesity problem will only continue to grow in size.
