LUWERO, Uganda
HEADLINES in the June 8 New Vision newspaper warned, “We are eating our way to the grave’’ and “Obesity rising in rural areas.’’ A third of women in urban Kampala and a quarter of the women in more rural central and southwestern Uganda are overweight or obese, according to 2007 government statistics. It is a major paradox since 50 percent of children in southwestern Uganda are malnourished.
The paradox worries not just Ugandan health experts, but elected officials as well. “Many of my friends used to ride bicycles for transport,’’ said Ronald Ndawula, chairman of Luwero District, an hour’s drive from Kampala. His position is akin to a US governor. “Now I see many of them driving taxis. Many of them now think it’s degrading to ride a bicycle or walk on dusty roads on foot. Now I hear a lot of people having foot problems because of diabetes.
“We initially thought diabetes was a disease of the rich. I used to think that myself. But a lot of the poor don’t go to the doctor. Many of them would rather go to herbalists.’’
Concern has risen all the way to Ugandan President Yoweri Museveni, who said last month, “Just imagine how many people the country loses due to HIV/AIDS, lung cancer due to smoking, poor hygiene, poor nutrition and obesity due to lack of exercises, all these avoidable diseases.’’ The acting head of the Uganda Heart Institute, John Omagino, this month said heart disease will be the nation’s leading killer by 2020. “Many men still look at a potbelly as a badge of pride and success,’’ Omagino has said.
The growing toll is personal for Juliet Sekandi, an epidemiologist at Makerere University School of Public Health in Kampala. “My aunt has lost three of her toes,’’ she said. “She is a high school secretary so she does not lack information. I tried to talk to her, but she waited until her feet were so foul smelling.
“The disease seems so new, people aren’t quite sure what to do. Even if people came to clinics, we can’t stock the medicines because they’re so expensive and we can’t test people properly because we run out of sticks to test the sugar. We end up teaching diet management, which is not really effective.’’
David Guwatudde, the chair of epidemiology and biostatistics at Makerere, said one study in a rural district found that 30 percent of people have hypertension, an area just beginning to experience modernization. “It is a big puzzle to me,’’ Guwatudde said. “Maybe people are getting more salt in their diet. Kids aren’t running around like they used to. It’s adding up.’’
Francis Bajunirwe, a lecturer of community health at Mbarara University, a six-hour drive from Kampala, and Jerome Kabakyenga, the dean of medicine at Mbarara, said Uganda’s relative stability in the last quarter century after violent rule of Idi Amin has opened up Uganda not just to the benefits of Western development, but also to diseases that simultaneously hit the rich and poor with hypertension and diabetes. The educated sit at desks while the rural poor, despite being more active, consume far more Western-style sugars and starches than in decades past.
“Years ago, cooking with oil was a sign of affluence,’’ Kabakyenga said. “It was only for Christmas and Easter and village celebrations. Now it’s every day.’’
Kabakyenga, Bajunirwe, and other health experts I met in a weeklong visit said the everyday fight against the oncoming epidemic will not be easy when a third of Uganda’s budget comes from international donors and the priority of donor health dollars is for HIV/AIDS. “I’m watching all the people my age, in their 30s, getting bigger,’’ said Bajunirwe, who earned his doctorate at Case Western Reserve University in Cleveland. “But we have all these patients who have five urgent needs, and hypertension and diabetes usually is not the most urgent at the moment. We have to find a way to invest to make them urgent or we are going to have a very serious silent epidemic.’’
Derrick Z. Jackson can be reached at jackson@globe.com. 
