We need to communicate to kids that their health, not a number on the scale, is what’s important

According to a new report recently released by the World Obesity Federation, obesity will affect more than 250 million kids by 2030. While media outlets and newsfeeds continuously remind us of the rising rates of childhood obesity—which have tripled in the past 20 years—far less attention has been paid to the complex solutions needed to address this problem.

It seems the obvious answer to the rising prevalence of childhood obesity would be to reduce calorie intake and increase physical activity. If calories out exceed calories in then weight loss is inevitable, right? Unfortunately, it’s not that easy. And the hundreds of campaigns and interventions attempting to tackle childhood obesity are a testament of that. Take, for example, the large-scale WAVES study, which after a 12-month intervention across 54 schools, showed no differences between intervention and control schools in terms of improvements in students’ body mass index (BMI). School-based interventions may have little impact on obesity without broader societal and environmental efforts in place.

Initiatives to address childhood obesity may be further compromised by a lack of consideration to the underlying messages they send to children and families. Many approaches targeting obesity are based on the assumption that body weight is within personal control and that individuals have the ability to change their weight. We assume that change won’t occur unless individuals believe they have the power to change. For example, in schools, promoting beliefs about the controllability of intelligence have been shown to increase academic effort. And in the case of emotions, controllability has been associated with more positive emotion regulation.
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Body weight, however, is another story.

Instead of encouraging a mindset motivated to change, messages that perpetuate beliefs that obesity is within personal control can instead increase societal stigma and self-blame. Beyond blatant fat-shaming and pervasive negative portrayals of individuals with larger bodies in the media, seemingly innocuous messages can produce potent stigma. The Late Late Show host, James Cordon, recently described the harmful effects of fat shaming, and how a judgmental gaze intended to restrain eating would be enough to evoke feelings of shame and self-loathing.

By emphasizing behavioral control as a method of weight loss, we are simultaneously (and at times unintentionally) placing blame on individuals who struggle to lose weight. This blame becomes internalized, surfacing as a cascade of emotional, physiological and behavioral problems that can undermine physical and psychological health.

This fact is particularly worrisome given that youth of all body shapes and sizes are vulnerable to weight stigma. Over and above BMI, weight stigma is linked with low self-esteem, body dissatisfaction, suicide ideation, low physical activity levels and depressive symptoms among adolescents. When youth are stigmatized, shamed or teased about their weight, they are more likely to engage in unhealthy eating behaviors, such as binge eating or high calorie consumption, avoid physical activity and gain weight—contributing to a vicious cycle of psychological distress, social withdrawal, unhealthy behaviors and weight gain.

So, it’s time to take a step back and look carefully at the messages being communicated in interventions to address childhood obesity. Fundamentally, messages should emphasize health and health behaviors, rather than body weight. We need to communicate to children that their health, not a number on the scale, is important.
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Reducing blame starts with raising awareness of the complex factors that contribute to body weight and the harmful consequences of weight stigma— in the media, the classroom, on the field, and at home. In addition to education, policies are needed to appropriately address weight-based mistreatment, such as school-based anti-bullying policies that adequately protect students in the face of weight-based bullying. And, finally, just as diversity surrounding other social stigmas, like those based on race/ethnicity or disability status, has proven effective in reducing stigma, increasing exposure to diverse bodies in positive ways will be critical to disrupting the harmful cycle of stigma.

While the issue of childhood obesity is complex public health priority, we must be certain that the messages we send serve to empower and support healthy behaviors among youth irrespective of body weight itself.

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Forward Nyanyiwa Correspondent
“Ko small house yako inani izvozvi?” (Who is with your small house right now?) was a screaming signature message on a number of billboards erected around the country by the Ministry of Health and Child Care in partnership with various HIV and Aids organisations back at the turn of the millennium.

A recent survey around Chitungwiza has revealed that the same message is still inscribed in Harare’s dormitory town’s health institutions and other public corners.

This is in recognition of the impact the infamous “small house” phenomenon has played in the spread of the once deadly scourge in Zimbabwe.

Last week, Cabinet withdrew a clause in the Marriages Amendment Bill that provides for “civil partnerships”, arguing such a union was generally alien to the nation’s cultural and Christian values.

In that vein, it was also construed that the proposed law would sort of legalise “small houses”,  street lingo for extra-marital unions.

Section 40 of the Marriages Amendment Bill provided as follows: “A relationship between a man and a woman who are (a) both over the age of eighteen years; and (b) have lived together without legally being married to each other; and (c) are not within the degrees of affinity or consanguinity as provided in Section 7; and (d) having regard in all the circumstances of their relationship, have a relationship as a couple living together on a genuine domestic basis shall be regarded as being in a civil partnership for the purposes of determining the rights and obligations of the parties on dissolution of the relationship . . .”

Put simply, subsection five of Section 40 has been the contentious one.

One can afford to go and stay with another partner regardless of the fact that he or she is in a standing marriage — quite strange for real.

However, as the nation is deep in debate over the issue, it had not missed its fair share of scrutiny regarding the spread of HIV/ Aids in the country.

Background is key!

Multiple sexual partners have been fingered as the number one cause for the spread of HIV over the years with cases of infidelity also ranking high in that regard.

Whilst there has been other sources one could get infected with the HIV virus, there is a unanimous agreement among this country’s citizenry that multiple sexual partners have been the major cause.

Some may argue that there had been polygamous marriages over the years, which also contributed their fair share to the spread of HIV albeit on a controlled scale, nothing beats the rate at which “small houses” contributed to the rise of HIV infections.

What has made Section 40 in the current proposed Marriages Amendment Bill a bit off the mark is that it was viewed as having “legalised or empowered” the small house.

This time, it was not going to be the man alone seeking a civil partnership outside marriage, married women were also going to benefit.

Zimbabwe has been on the warpath to reach the 2020 World Health Organisation (WHO) 90-90-90 targets and to eradicate Aids in totality by the year 2030.

When the health ministry came up with the “small house” message, it was evident that the pandemic had spiralled out of control and the current Bill was about to do away with the efforts that has been made so far to avoid new infections.

What this simply meant is that anyone can walk out of a marriage, find even a commercial sex worker and start to live together, at the same time going back to the original spouse who might even be in a similar “civil partnership”.

The result will be a network of unprotected sex amongst the all “married” partners hence very high chances of spreading the virus.

By its definition and considering our social fabric as a people, marriage means there is someone superintending over another one.

In this scenario, men would have benefitted a lot by getting their bodies on whoever they deemed to be a wife.

Women would have not only suffered morally, but also in terms of health as their husbands would afford as many civil partnerships as their pockets could afford.

As Foreign Affairs and International Trade Minister Dr Sibusiso Moyo correctly asserted: “It is not a recognised marriage, it was merely out of consideration of fairness that when these people move apart the one who is more economically empowered should not use that power to the detriment of another part  .  . .”

Young girls and women who cannot openly and freely discuss safe sex methods would also have suffered in silence as HIV- infected men prey on them all in the name of marriage.

Cabinet must be applauded for such a timely intervention which would have eroded all the sanctity of marriage, hence exposing all and sundry to HIV and Aids.

Behavioural change has been fingered too as a key element in eliminating Aids and together with the tried and tested “one man, one woman” motto, the nation must now focus on the targets at hand than to start other burning issues.

New HIV and Aids infections have been reported to be going down with a recent UNAIDS 2019 report indicating that infections dropped from 44 000 cases to 38 000 which may lead to a decline in prevalence.

Multiple sexual partners in whatever context remain a key driver of HIV infections and awareness campaigns must continue to be spread in that respect.

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The Joint UN programme on AIDS, commonly known as UNAIDS, is facing one of the worst challenges afflicting the global AIDS response — this time an existential threat questioning its very relevance. The UN Secretary-General, António Guterres, is expected to appoint a new executive director after the departure of Michel Sidibé in May 2019 on the recommendation of the programme coordinating board which manages the organisation. There are strong contenders from Africa and the U.S. in the reckoning among those who have been shortlisted.

A pivotal role

At such a crucial time, it is disturbing to hear voices again questioning the relevance of UNAIDS for the global response.

There are suggestions that AIDS should go back to the World Health Organisation (WHO) where it originally belonged to some 25 years ago. And that the new executive director should be equipped with an exit strategy to wind up the organisation.

Since its establishment in 1994, UNAIDS has been able to successfully mobilise world opinion to mount an exceptional response to an epidemic which has consumed over 20 million lives with still no effective treatment or cure. The UN General Assembly Special Session (UNGASS) 2001 was a game changer with the adoption of a political resolution that itself was exceptional in many ways. The creation of a Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) and the slashing of prices of AIDS drugs by Indian generics have brought treatment within the reach of many countries. Today some 22 million people are under antiretroviral therapy (ART) and preventing mother-to-child transmission of HIV has become an achievable goal by 2020. The organisation has provided leadership to many countries which in 10 years (2001-2010) could halt the epidemic and reverse the trend.

The epidemic is still alive

However, at a time when it should be leading the global response to end AIDS as a public health threat, the organisation has started to falter in its strategy. First came the extremely optimistic messaging blitz that the world was going to see the end of AIDS very soon. This is far from true. Regions such as eastern Europe and Central Asia and West Asia are nowhere near reaching that goal, with many countries such as Russia witnessing a raging epidemic among drug users and men who have sex with men (MSM) communities. With the top leadership in UNAIDS exhorting countries to bring AIDS “out of isolation” and integrate with health systems, the political leadership in many countries have thought that AIDS is no more a challenge.

Second has been the thinking that the AIDS epidemic can simply be treated away by saturating anti retroviral (ARV) coverage. Nothing could be farther from the truth. It is forgotten that AIDS affects the poor, the marginalised and criminalised communities disproportionately as they face challenges in accessing the ‘test and treat’ programmes. The ever increasing number of young people who are joining the ranks of vulnerable populations do not get prevention messages like in the past. National programmes do not any more consider condoms, sexual education and drug harm reduction as central to the prevention of HIV transmission that results from unprotected sex and drug use. Funding for non-governmental organisations and community-based organisations working on prevention has virtually dried up.

Third has been the weakening of country leadership of UNAIDS in many high-prevalence countries. Senior country-level positions are, in many instances, held by people who do not possess the core competence to constructively engage political leadership to undertake legal reforms and provide access to services to marginalised populations.

Weakening activism

But the biggest setback has been the lost voice of vulnerable communities which was the main driving force of AIDS response in the decade after UNGASS. Activism surrounding AIDS has suddenly fizzled out emboldening many countries, especially in Africa, to further stigmatise and discriminate by enacting new laws that criminalise vulnerable sections of society.

To add to its woes, the charges against one of the senior most staff and his exit from the organisation have seriously compromised UNAIDS at a time when the global response needs its leadership the most. The new executive director will have an unenviable task of not just restoring the credibility and relevance of the organisation but strengthening its presence at country level and making it more meaningful to the communities which look to it for leadership. The new executive director has to work relentlessly to place prevention of the epidemic and empowering communities at the centre of global response.

With 1.7 million new infections and one million deaths occurring every year, we can’t afford to drop the ball half way. The commitment to end AIDS by 2030 is ambitious but not impossible to achieve. What we need is a re-energised UNAIDS with a strong and fearless leadership from a person of high integrity and commitment along with a sincere effort to remove the deadwood from the organisation. Any thought of winding it up or giving the mandate back to WHO would be suicidal at this moment.

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Researchers say they have removed HIV from the DNA of mice, an achievement the scientists say could be an early step towards an elusive cure for humans.

The breakthrough, detailed earlier this week in a study credited to more than 30 scientists from Temple University and the University of Nebraska Medical Centre, was made possible by an antiviral drug in combination with the tool called CRISPR that can edit genes.

The researchers eliminated HIV in nine of 23 mice that were modified so their immune systems better mimicked those of humans.

Clinical trials for the gene-editing component of the cure could start as early as next year if the Food and Drug Administration approves them, said Kamel Khalili, one of the study’s senior investigators.

But he and other HIV experts emphasised that there is a big scientific leap from promising results in mice to success in humans.

“We knew what we needed to do, but the technology was unavailable,” Dr Khalili told The Washington Post, saying he and his team had been awaiting a tool like CRISPR to combat a virus that “becomes part of the fabric of our chromosomes”.

With gene editing finally a reality, he said, “the outcome was amazing”.

Once deadly, HIV can now be managed with a treatment called anti-retroviral therapy.

The therapy only keeps the virus in check; without constant medication, the virus will quickly decimate a patient’s ability to fight off sickness.

HIV infects 37 million people worldwide, according to the latest data from the World Health Organisation (WHO), and only about 22 million of those people receive antiretroviral therapy. Nearly one million people died of HIV-related issues in 2017, according to WHO.

Earlier this year, revelations that a second person had seemingly been rid of the virus raised hopes that another patient’s cure 12 years earlier was not a one-off victory.

But scientists cautioned that it was too early to declare the anonymous second patient cured – and that, regardless, the case did not herald a widespread cure for the devastating condition.

Both patients were treated with stem cell transplants, which experts say are risky, bring serious side-effects and would not be preferred for most patients.

Previously, Dr Khalili’s team at Temple had found a way to remove significant amounts of HIV DNA from rats and mice.

But the technique could not completely remove the infection.

So Dr Khalili’s lab joined forces with a University of Nebraska Medical Centre (UNMC) lab attacking the problem in a different way. Together, the scientists combined the gene-editing strategy with a drug designed to beat back HIV.

Howard Gendelman from UNMC said that his team’s experimental drug is engineered to act over a longer time than normal therapies, meaning it can be administered every couple of months instead of every day.

It is also better able to target HIV in the body, he said. It is crucial that gene editing remove every last bit of HIV, he said, and the drug makes that task easier.

“If you can reduce the amount of virus that’s left for CRISPR, the likelihood that the CRISPR will be effective will go up enormously,” he said.

But if Dr Khalili’s team is able to move forward with trials with humans, it will use standard drugs rather than the one developed by UNMC’s lab, since it probably would not be approved yet for use, Dr Khalili said.

Steven Deeks, a professor at the University of California at San Francisco who has worked extensively on HIV, said the use of gene editing to remove HIV from a live animal is a notable step forward.

But he cautioned that using the technique on humans will be far more challenging: scientists will have to grapple with more variations in the virus, more difficulties in delivering the gene-editing technology and the possibility of cutting up human genes while trying to target HIV, he said.

Those are formidable problems, Prof Deeks said, especially with success depending on removing the virus completely.

“For this approach to work, they have to really knock out 100 percent of the genomes – you can’t leave anything behind,” Professor Deeks said. “One of them can reignite the whole process.”

The scientists behind the new study recognise those challenges. Dr Khalili said researchers are in the process of publishing another study on the use of gene editing to target HIV in primates and are hopeful about bringing the solution to human subjects.

But the scientists need to make sure their techniques are safe, he said. They also want to increase their methods’ chances of working from the roughly one-third success rate they saw with mice.

Dr Gendelman said that while modern drugs are good at keeping HIV at bay, a permanent cure would bring big benefits to patients.

Constant drug treatment can contribute to other health complications, he said, and just keeping the pills in your medicine cabinet can invite unwanted scrutiny from family or significant others.

“There’s a tremendous stigma,” he said. “Every time you take those pills you’re reminded that you have HIV.”

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