Overweight (weight for age) appears to be a bigger, and growing, problem than undernutrition among pre-school children in Dominica. Clinic data presented in the report on Obesity Prevention and Control Strategies in the Caribbean 1990 - 2000, showed an overall decrease in the level of undernutrition (weight for age) among children 0-5 years (attending clinic) over the period 1990-1999. The prevalence (among children attending clinic) of undernutrition decreased from 1.9% in 1990 to 0.9% in 1999, peaking at 2.3% in 1995. In contrast, the prevalence of overweight increased from 6.0% to 9.7% over the same period, peaking at 9.9% in 1995 among the same age group.
A micronutrient study carried out in 1996 by PAHO/CFNI, reporting on the weight for height status among children 1-4 years, indicated that 17.0% of the children were wasted while 7.2% were overweight. A significantly higher proportion of females were wasted compared with males, while interestingly a higher proportion of males were overweight compared with females. The prevalence of overweight and undernutrition vary greatly at the health district level. The children from Castle Bruce show the highest prevalence of wasting (30.0%), while those from Marigot have the lowest overweight prevalence (0.0%) (PAHO/CFNI, 1997).
While no single study of anthropometric measurements of adolescents is available, data from the food consumption study (1996) showed a 17.9% prevalence of obesity among the population aged 15 years and older, and 30.0% overweight, implying that the prevalence of obesity and overweight is high among adults as well as adolescents in Dominica.
Iron is the main micronutrient deficiency of public health concern in Dominica. The prevalence was 34.4% among children 1-4 years, 30.7% among those 5-16 years and 35.1% among pregnant women. Among the 1-4 years age group, a significantly higher proportion of one year old children are iron deficient compared with the older children. There are marked variations at the health district level (among 1-4 years age group); Castle Bruce reported the highest deficiency (55.6%) and Portsmouth the lowest (30.0%) (PAHO/CFNI, 1997). A higher proportion (37.3%) of children 5-10 years is deficient in iron compared with children 11-16 years (22.8%). Among pregnant women, a higher proportion (50.0%) of those below 20 years of age is iron deficient compared with those older (32.5%).
The national survey on food consumption pattern and lifestyle completed in 1996, along with other sub-national surveys reveal that the average intake per person was 1749 calories, which appears to be an underestimation. The consumption of foods from animals and fat/oils (especially as part of condiments) is high among Dominicans. In fact, high status is accorded to the consumption of foods from animals (Maglorie and Prevost, 2000). The contribution of fat to dietary energy supply (DES) has increased between 1964-65 (19.5%) and 1998-2000 (24.2%), peaking at 24.9% in 1989-91 (FAOSTAT, 2002), and may be linked to the high prevalence of obesity and overweight in the population. The increasing demand that chronic diseases, diabetes and hypertension in particular, are placing on the health services may be a direct result of the high prevalence of obesity and overweight.
Despite the fact that 27.0% of the Dominican households live below the poverty line (based on the latest available figures), undernutrition is not as great a problem as is overweight. The poor and the unemployed are, however, still at risk for inadequate dietary intake, although the high level of poverty does not manifest itself in the expected levels of undernutrition.