Overweight and obesity have a greater effect on the nutritional status of the population in The Bahamas than underweight and nutritional deficiencies. Based on the 1994-95 Ministry of Health/CFNI report, among children 4-9 years old, 6.6% were underweight, 12.9% were stunted (a greater proportion of boys than girls) and 5.7% were wasting. In contrast, 14.9% of these children were overweight (the prevalence being the same for boys and girls) (Table 4a). It is not possible to say whether these levels represent an improvement or deterioration in the nutritional status of this particular age group as no data are available for comparison. In the 1988-89 National Health and Nutritional Survey (MOH, CFNI/PAHO, 1991), it was reported that the prevalence of undernutrition (< 5th percentile) among children 5-14 years was 16.7%. At the sub-national level, relatively high prevalence levels of undernutrition were found on Acklins (15.4%) and Crooked Islands (11.9%) among children > 5 years. The highest prevalence of undernutrition (< 3th percentile) was found on the Family Islands (12.3%) among children <5 years; the national prevalence was 7%. In the other regions covered, the prevalence of undernutrition was acceptably low among this age group.
The 1988-89 national survey revealed that the prevalence of overweight (>95th percentile) among the 5-14 year old children, was 6.7%. However, the prevalence among females in New Providence was 16.0%. Among these 5-14 year olds, a relatively low prevalence was seen on Acklins (1.3%), while that seen on Crooked Island (15.8%) was relatively high. The prevalence of overweight (> 97th percentile) among children <5 years, was lowest on the Family Islands (6.4%) and highest on the Crooked Island (16.2%).
The female adolescents appear to be at greater risk for overweight and obesity compared with males (Table 4b). Approximately 20% of the females 15-16 years had a BMI of 24.8 or higher, while 16.2% of the males in the same age group had a BMI of 24.3 or higher. Among females 10-14 years, 17.9% had a BMI of 23.4 or higher, while among males at the same age 5.3% had a BMI of 23.0 or higher. The risk appears greater in the older age group for both males and females. An earlier survey found that, among females 13-17 years, 9.0% were obese, and another 16.7% were overweight. The few studies that reported on adult and elderly nutritional status raise concerns about overweight and obesity, especially in females (Table 4c). Among the adults 15-64 years, 21.3% were obese (significantly more females than males), while another 27.3% were overweight (29.1% males and 25.6% females). Among the elderly, over 65 years, 25.4% of the females and 15.2% of the males were obese.
The only micronutrient deficiency known to be a public health problem in The Bahamas is iron deficiency anaemia. This problem is prevalent in children < 5 years, in adolescents of both sexes and in the elderly, especially in females. The problem is most serious in pregnant women, with 19% of them found to be anaemic (using the low cut-off point of 10g/dl) in 1994. Iron deficiency anaemia is also prevalent in adult males ranging from 14% to 20% on different islands, according to a 1988-89 survey. Mixed results are available on school age children, for which the School Health Programme recorded a low prevalence of 4.5% in 1994 (Hb < 12 g/dl). This low level combines well with the observation that iron intake in school children was sufficient in the majority of the sample used in 1997 by Armstrong-Renwick.
No national surveys on food consumption have been carried out in The Bahamas. However, the available data indicate that the changes in the consumption pattern over the past 20-30 years have led to increased consumption of food from animal (fatty foods), sugar and sugar products, and salt. This coupled with a decrease in the consumption of fruits, vegetables and complex carbohydrates, along with a sedentary lifestyle (including a lack of exercise) may in large part be responsible for the prevalence of obesity and overweight in the country (MOH/MAF, 1998).
Food availability is not, in general, a problem in The Bahamas. However, given the relatively high price for food and the vast differences in average income between its various islands as well as between household incomes per island, the households particularly those on the islands in the lower income range are vulnerable to inadequate food intake. In these lower income groups, food accounts for as much as 62% of household earning potential. The unemployed and most if not all of the illegal immigrants are likely to be the most vulnerable groups with respect to poverty and inadequate food intake.