There is no end to the things that make Lucy happy--movies, ice cream, books; socialising, shopping and music.
But they are also a source of pain. Before she goes for a movie, she worries if the seats will be large enough to accommodate her. Shopping is agonising because it is difficult to buy clothes that can fit.
“I was always a big girl since I was a child. Now I’m 39 years old, I’m quite confident in my body but I also have never been happy,” she said.
She’s classified as obese, at 110 kilogrammes, with a body mass index (BMI) of 30.
The BMI is a combination of a person’s height and weight and forms a measure that can help predict their risk of developing diseases. Lucy last week was of the many overweight and obese women who turned up at the Kenyatta National Hospital’s weight loss clinic.
It is called a bariatric camp, an operation in which a surgeon reduces the size of the stomach to reduce food intake less because patients feel less full, eventually leading to weight loss.
The clinic was restarted last week by Dr Kennedy Ondede, KNH’s director of surgical services.
“This is unique for the country because we are taking a truly multidisciplinary approach whereby the client is seen by many specialists,” Ondede told the Star.
Although Kenyans are stalked by hunger, there’s evidence of a growing obesity crisis.
Most affected are educated women. The Kenya Demographic Health Survey (KDHS) 2022 indicates that among women with at least secondary education, 50 per cent of women, aged 20 to 49, are either obese or overweight.
It worsens as disposable income grows. At least six in every 10 women of the same age in the highest wealth quintile are obese, compared to one in five women in the lowest wealth quintile.
The KDHS report shows only 19 per cent of men (20 to 49 years) are obese or overweight.
Dr Ondede said people struggling with weight risk developing other complications such as sleep apnea. “This is a condition in which breathing stops and starts while you sleep,” he explained.
But that’s the least of it. He said there are various classes of obesity from class one to class four, the highest.
Dr Ondede said obesity and overweight are associated with many diseases which make them a huge public health concern for Kenya.
Many clients are keen to know if they qualify for the surgery. “I’m ready for whatever the doctor might recommend,” Lucy said.
Dr Miriti Kiraitu, a specialist gastrointestinal and bariatric surgeon at the clinic, explains, “Body Mass Index is the one that really tells us whether a person is overweight or obese.
"And the normal BMI is between 20 and 25. Between 25 and 30 is overweight. Above that is obesity.”
He explained the population of truly obese people with a BMI of above 30 is between five to 10 per cent.
According to the World Health Organization, obesity is also associated with some cancers, including endometrial, breast, ovarian, prostate, liver, gallbladder, kidney and colon.
The risk of these non-communicable diseases increases even when a person is only slightly overweight and grows more serious as the body mass index climbs.
“So there is a huge economic cost to obesity. And because quite a number of people are sick, they are not able to perform their normal duties, they miss work. So in a very direct way, obesity contributes to economic loss and also social dysfunction,” Miriti said.
Because of that, we want to help people lose their weight so that we prevent some of those diseases. That will translate into better personal health and, of course, family and community health.
Who qualifies for bariatric surgery?
Not everyone. Dr Ondede led the first bariatric surgery in Kenya in 2019. The client had been diagnosed with class III obesity.
Dr Ondede said a client must be evaluated by seven specialists to be approved for bariatric surgery.
They include a psychologist, nutritionist, physiotherapist, endocrinologist, cardiologist, pulmonologist and surgeon.
“We ensure patients reap maximum benefit from this process,” he said.
Most clients do not qualify for surgery because their weight can be controlled through other means such as diet, Dr Ondede said.
“Without any diseases, diabetes or hypertension, the best approach is lifestyle change. You need to take a proper diet and engage in regular physical activity," Dr Miriti said.
"As far as diet is concerned, we advise that you reduce the intake of carbohydrates and increase the intake of protein and vegetables.
"As far as exercise is concerned, the medical recommendation is that we should exercise doing moderate physical activity at least 300 minutes a week," he explained.
“For BMI above 30, that’s where the other interventions become important. But it has to be emphasised that nutrition and physical activity are essentially the cornerstone, the foundation of any weight loss programme.”
The few that qualify for surgery have three options.
They can opt for gastric bypass surgery, where the surgeon divides the stomach to make a smaller stomach pouch, restricting how much you can eat.
The new pouch is then attached to a lower part of the intestines, bypassing the rest of the stomach and first part of the intestines.
The sleeve gastrectomy is the most common type of bariatric surgery in Kenya. The surgeon cuts a portion of the stomach, reducing its size by approximately 80 per cent.
The removed portion is the primary area where the hunger hormone is made.
There is also laparoscopic gastric banding. Here, no organs are cut. An adjustable band is placed around the top portion of the stomach, creating a smaller stomach pouch so you eat less and feel full sooner. Weight loss is slightly slower with this method.
Dr Miriti said bariatric surgery costs around Sh900,000 in private hospitals.
“Most of the cost goes to the consumables utilised during the surgery. The surgeon’s fee is minimal,” he explains.
“So at Kenyatta [KNH] there is a big effort to make it accessible because we have partnered with some companies to provide some of the instruments at a subsidised cost.
"And today, we are seeing a number of people coming to Kenyatta, that’s why we have this camp. Next month, we shall have a big surgical camp at this hospital to provide this service at an affordable level for most Kenyans.”
The surgery costs Sh500,000 at KNH.
Insurance companies in Kenya do not cover obesity treatment, listing it as a cosmetic procedure.
However, the National Health Insurance Fund defrays some hospital costs for its clients.
Dr Miriti said obesity is a disease and its management is not cosmetic. Managing it also has huge benefits that come through improved health.
“We are engaging them in obesity surgery. We want to implore our local insurance companies to begin to cover weight loss surgery. The NHIF has been exceptional.”
At the clinic, many clients are young. In the past, the medics said, most clients were evenly distributed between the ages 20 and 65.
But currently, many adolescents are, which Dr Miriti blames on a westernised, high-calorie diet and sedentary lifestyle.
Lucy does not qualify for surgery. “That means I will be supported through other ways that will help me shed weight, she said. And buy those pretty dresses and slip into movie seats.