Obesity in SA: where will it end?

The most recent statistics from the SA Medical Research Council showed that 70% of adult women over the age of 35 were overweight or obese and that black women were exposed to the greatest risk, with 33% being obese.

Dread consequences

These figures are frightening because they are predictors of the burden of lifestyle diseases such as type 2 diabetes, hypertension, strokes, certain types of cancer and heart disease that our country will have to cope with in years to come.

Already South African statistics relating to these so-called non-communicable diseases are soaring, particularly in our black population which until recently rarely developed such illnesses. I can distinctly remember listening to a lecture in the 1980s by Dr ARP Walker, a pioneer of nutrition science in South Africa, issuing a warning to the scientific and medical communities that South Africa was going to face a "mountain of type 2 diabetes". The audience were incredulous, but how right Dr Walker has proved to be.

Possible causes

There are so many different factors that are contributing to this tsunami of overweight and obesity that it is difficult to know where to start when addressing the problem.

1) Urbanisation and westernisation:

• The changeover from a high-fibre, low-fat traditional diet to a diet rich in fat and processed carbohydrates, including sifted, white maize meal, and liquid sugars, such as cold drinks, squashes and even fruit juices
• The breakup of the family and loss of traditional values including sitting down to eat meals as a family instead of eating high-kJ street food and fast or convenience food
• Lack of physical activity which may affect women more than men and explain why only 6% of black men are obese compared to 33% of black women
• Exposure to hormone disruptors in our polluted water supply which have oestrogenic properties and may fuel insulin resistance and obesity
• The thrifty gene theory which suggests that when a population that has been conditioned by millennia of food shortages to store energy as efficiently as possible and not to use such fat stores unless faced by dire starvation, is exposed to the cornucopia of an unbalanced western diet, these fat storage genes go into overdrive and a once successful survival strategy becomes a fatal liability

2) Poverty and lack of education

• Populations living under the breadline (and up to 12 Million South Africans do just that) (Joemat-Pettersson, 2013), tend to buy the cheapest food with the highest energy value to satisfy their hunger. The loaf of white bread and a litre of cola drink which so many people buy every day to fuel their bodies and keep hunger at bay, are typical examples of poverty food purchases. Going to bed hungry will make anyone reach for cheap food no matter how potentially dangerous it may be.
• The propagation of vegetable gardens is one of the most worthwhile endeavours that can be used to provide vital nutrients such as vitamins and minerals to unbalanced, monotonous diets. The basic principles of vegetable gardening should be part of the school curriculum from Grade 1.
• Simple, basic nutrition facts should also be made compulsory learning and it may help if teachers were allowed to attend courses that increases their knowledge of how to select healthy foods and spend money wisely to ensure that every cent buys the maximum amount of nutrition. Cooperation between the Departments of Education and Health should be encouraged. For example, the dietitians employed by the Department of Health could train educators to spread the message of healthy nutrition at affordable prices to all your learners.
• Education on the prevention of teenage pregnancies and healthy pregnancy nutrition per se, may also reduce the obesity burden because according to the Barker hypothesis (Barker & Osmond, 1986), when undernourished or malnourished women give birth to underweight babies, these children are much more susceptible to obesity and diseases of western lifestyle than normal weight babies. Thus the vicious cycle is eternally perpetuated from one generation to the next. Only education has the potential to stop this cycle.

A ray of hope

Lerato Moloi, the researcher at the SA Institute of Race Relations who published the report with the startling statistics on obesity, particularly relating to female obesity, in this country, for once acknowledged that we should not “blame the obese”. I regard this as a ray of hope.

The knee jerk reaction from the press, the government and the non-obese is to point fingers at both those members of the public who struggle with their weight and food companies. In the case of the government, a report such as the above mentioned one will usually result in more laws to ban certain foods or food components.

As the US of A found in the early years of the last century, legislation such as the prohibition of the sale of alcohol, is not the solution and may even lead to greater evils (e.g. organised crime, drug peddling, production of illegal and potentially dangerous liquor in illicit operations, etc).

The South African obesity problem will not be solved overnight. The USA and the UK, despite all their vast resources, have not made much headway in the past two decades to slow the obesity epidemic in their own countries, so South Africa with its thinly spread resources may also find it difficult to stop this kJ-driven tsunami.

It will take great leadership and empathy, cooperation between government departments and all organisations dealing with nutrition, prioritisation of poverty eradication and nutrition/ physical fitness education, to stop the progress of obesity. We can only hope that such initiatives will be in time to save the health and lives of our citizens.

(Photo of overweight man from Shutterstock)

40% of SA women are overweight
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In 2012 SA obesity rate was already reaching epidemic proportions

(References: Barker DJ, Osmond C (1986). Infant mortality, childhood nutrition, and ischaemic heart disease in England and Wales.; Child K (2013). Obesity in SA tips the scales. The Times, 6 February 2013, p.5; . One in four SA women obese; Joemat-Pettersson T (2013). Ensuring food security of everyone. The Pretoria News, 6 February 2013, p. 10)