04 October 2010

Fat nation: why are we in denial?

A recent national health survey has found that South Africans are in denial over their weight. DietDoc searches for answers.


A while ago, we discussed the results of a national health survey undertaken by GlaxoSmithKline (GSK) that came up with the shocking finding that South Africans are “the third fattest nation in the world” (Skade, 2010). In addition to the gloomy statistics indicating that 61% of adults are overweight, obese, or morbidly obese, the study also found that most of these people are in denial and regard themselves as ‘healthy’.

Psychological Findings

The study showed that of the 2 out of 3 South Africans who are overweight, obese or morbidly obese: 

  • 78% are of the opinion that they are ‘somewhat healthy or very healthy’
  • 52% of morbidly obese subjects think they are ‘somewhat healthy or very healthy’
  • 42% are not concerned about their health
  • Only 47% acknowledge that exercise and physical fitness is critical to health and achieving a normal weight

(Health24, 2010) 

These startling results seem to indicate that the South African population is in a state of denial and that we have a totally unrealistic approach to our own status of overweight or obesity.

Are we a nation of ostriches who bury our heads in the sand and refuse to face the facts? Perhaps, but I do think that other factors, besides denial, are playing a role in this scenario.

The ‘Fat is Healthy’ Perception

The perception that "Fat is Healthy" is deeply ingrained in the national psyche of our nation. On the one hand, indigenous black South Africans were exposed to millennia of recurring cycles of food shortages and famine. Thinness was, and is often still regarded as a sign of starvation, lack of food and poverty. Families that were physically well endowed and plump, were obviously well-off, had sufficient food and were "healthy".

On the other hand, the HIV/AIDS pandemic sweeping Southern Africa also contributes to this skewed perception that anyone who is thin, may be ill and suffering from HIV/AIDS, which was know as "Slim Disease" for many years. Now that antiretrovirals (AVRs) are being provided more readily, emaciated HIV/AIDS patients tend to develop the so-called ‘lipodystrophy syndrome’ that causes a redistribution of fat in the body. Thus patients receiving AVR treatment are no longer thin and skeletal, but rounded and may even give an impression of being "fat".

It is, therefore, not surprising that a high percentage of respondents in the GSK Study equated being overweight or fat with being "healthy".


According to psychology textbooks, rationalisation ("making excuses") is a defence mechanism that people use to logically defend illogical behaviours. The process can either be a conscious reaction to shield the person against being ridiculed by others, or in most cases an unconscious reaction to internal feelings of guilt (DSM-IV, 2000). As anyone who carries extra weight well knows, the general public and even the majority of health professionals, regard overweight and obese patients as ‘stupid, lazy, and lacking in moral fibre’. No wonder people who suffer from obesity consciously rationalise their situation and defend themselves by stating that they are "healthy".

It is also well know that overweight engenders serious feelings of guilt, so that it is not surprising that South Africans with a weight problem subconsciously rationalise their condition and comfort themselves by believing that they are not on a downward path to ill health.

It is time that health professionals and the public in general stop stigmatising their fellow South Africans because of weight issues. If we could start treating overweight and obese people with dignity instead of derision, it would go a long way to assisting them to come to grips with their problem and to acknowledge that they need to do something to lose weight instead of rationalising their situation.

Further skewed perceptions

The GSK Study also found that 65% of the people who were interviewed believed that healthy food is more expensive and thus often unobtainable to those who need it most, than unhealthy food. In some cases, this is unfortunately true. Food manufacturers tend to price foods designed to reduce weight, higher than standard foods. Fat-free, artificially sweetened products usually cost more than the full-fat equivalent which is sweetened with sugar.

In addition, the GSK Study found that only 33% of the interviewed subjects actually used food labels to determine if the food they buy, is low in fat and energy or high in dietary fibre and protective nutrients (Health24, 2010). What we don’t know, is how many people who buy food in South Africa don’t understand the statements made on labels because of lack of reading skills and/or language barriers.

These perceptions and problems associated with the selection of a healthy diet need to be changed. Hopefully the new South African labelling regulations will help to remove some of the barriers to understanding food label information. In addition, we urgently need a national nutrition education campaign to teach all our people more about healthy eating and exercise.

Such a campaign should include advice on how to read food labels and how to select less fattening foods on a restricted budget.

The positive approach

When I was involved with the compilation of the Food-Based Dietary Guidelines (FBDG) according to the directives of the WHO, one of the instructions that struck me as being immensely sensible was that the WHO said that these FBDG should have a positive basis. Instead of telling people what not to eat, the instructions encouraged us to rather tell people what foods they should eat and what benefits they would reap from using these foods.

I believe that we should also apply the positive approach to the dilemma of obesity in South Africa. Instead of always using threats and messages of doom to scare people into weightloss and exercise, the nutrition fraternity should rather convey what wonderful benefits are associated with losing weight and doing exercise.

Here are two weight-related messages:

“If you don’t lose weight and start exercising you will die a horrid death!’

“If you lose some weight and exercise every day, you will increase your energy levels and look gorgeous!”

Which message would you rather hear? and which message would you rather react to? Somehow, I think the 2nd message may achieve better results.

I hope that if a national nutrition education campaign is ever launched, that it will use a positive approach and not resort to scare tactics!

 - (Dr Ingrid van Heerden, DietDoc, October 2010) 


(DSM-IV (2000). Diagnostic & Statistical Manual of Psychiatric Disorders. Edition IV. American Psychiatric Association. Arlington, USA; Skade T. SA the third fattest nation in the world. Pretoria News, 9 September 2010, p3; Health24 (2010). Fat South Africans in denial. 9 Sept 2010.)

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