A spate of gloomy headlines were published last week in regard to the weight of the nation! While it is cause for great concern that two out of every three South Africans are either overweight or obese, with women most seriously affected, no one seems to be suggesting any solutions to this ever increasing obesity dilemma.
Action, not recriminations please
What we now need is some action to turn around this disastrous situation, so this is an open letter to the Department of Health, the health fraternity, educators and the media in South Africa:
Dear professionals who are involved (or should be involved) with turning the tide of obesity in South Africa, please let us do something about educating our nation about the link between overweight and food intake, and the connection between obesity and all those dread diseases that threaten our people such as high blood pressure, stroke, heart disease, and diabetes.
Recriminations and "shaming" two thirds of the population because they "love junk food" or "believe they are healthy" when they have a BMI of more than 40, is not going to change the situation. Neither will bans, prohibitions (just think of how disastrous Prohibition was in the US), complicated legislation or endless investigative committees. What could just make a difference is nutrition education starting at grassroots level and giving total support to making us a nation that participates in physical activity once more.
Lack of education
Take a leaf out of the advertiser’s book. Everyone constantly demonises fast food advertising, but imagine what would happen if we could spend the same amount of money and time on advertising nutrition messages to the nation in all the different national languages? To embed an idea or a concept in the human consciousness takes endless repetition. The bottlers of cola drinks get it right, so why can’t the nutrition educators? Let’s allocate 10% of the health budget to advertising nutrition messages. And above all, let’s make those nutrition messages positive (see below).
Start them young. If you want to change the mindset of the nation, start with children at pre-primary and primary school to spread the good news about food and healthy diets and how not to gain weight and how being active can save your life.
Use positive communications
The World Health Organisation (WHO) has set out guidelines for formulating nutrition messages such as the Food-Based Dietary Guidelines (FBDGs). I was privileged to help formulate the first FBDGs for South Africa more than a decade ago and the one primary principle we tried to adhere to was to send out positive, non-prescriptive messages to the nation.
Instead of producing 11 FBDGs that all started with "Thou shalt Not eat X or Y or Z", we managed to formulate 10 FBDGs contained positive messages. No one likes to have fingers wagged at them, especially about food, obesity and lack of exercise.
Be culturally sensitive
Empathy and cultural sensitivity are the keys to changing ideas that have been honoured for millennia. If the African culture honours well-nourished, ample people and finds large female figures beautiful, then we need to accept this and work with leaders in the community to find out how to change these perceptions to ones that are less dangerous in the modern world.
Let’s sit down with our community leaders and ask them how they would phrase nutrition and activity messages to their own people to ensure that these people stay healthy and do not suffer from all kinds of diseases of overnutrition.
South Africans are not in "denial" about obesity, they have a different mindset that predisposes them to see the situation differently. The fact that HIV/Aids and TB are all associated with weight loss and emaciated figures, makes it even more difficult to change the idea that "large is lovely". This is one situation where an Eurocentric approach is going to fail totally.
Use existing structures - don’t destroy them
In August, I was appalled to read an article by Graeme Hosken on "Food safety put at risk by cash crunch" on TimesLIVE-mobile. In this article Hosken reported that the Medical Research Council (MRC) had decided to “restructure” because of the fact that its budget had only grown by 3.5% annually for the past four years.
Hosken quotes the President of the MRC, Professor Salim Karim as saying, “We are prioritising the top 10 causes of death and top 10 causes of death and disease”, which means that some of the existing 23 units of the MRC will be axed or merged. The quote goes on to say: "Conditions caused by unsafe food do not make the top 20 list of deaths. Neither does nutrition, although it is an underlying cause of some conditions in the top 10 causes of death,” (Hosken, 2012).
If we look at the top 10 causes of death in South Africa, then all of them, even "Interpersonal violence" and "Road accident injuries" have a nutritional component (in the case of these 2 causes, alcohol abuse plays a major role). For example, People Living with HIV/Aids and TB, as well as patients with "Lower respiratory tract infection" and children with "Diarrhoeal diseases", need a good balanced diet that sustains them and their immune systems against the ravages of these infectious diseases.
The roles played by overweight, obesity and poor diets in "Cerebral vascular disease" (stroke), "Hypertensive heart disease" (high blood pressure and heart disease), "Ischaemic heart disease" (heart disease) and "Diabetes" in South Africa, must be evident and require scientific investigation sooner, rather than later.
If the MRC deliberates the future of research units in terms of statistics then surely they must create an "Obesity Research Unit" as a first priority, because in my book a percentage of 61% is higher than the highest percentage of 31.6% (HIV) listed in the Top 10 Causes of Death. Agreed that most people who are overweight or obese are not going to die immediately from their condition, but the majority will probably develop high blood pressure and stroke, heart disease and heart attacks, and diabetes in the near future, is they are not already suffering from such comorbidities of obesity.
So please keep in mind that overweight and obesity represent the highest percentage of any medical condition in South Africa when you deliberate which MRC units you are going to axe in November and which units you will retain. Also please consider creating a new MRC unit dedicated to researching how to combat obesity and overweight and how to change cultural perceptions in a sensitive way. Keeping the food supply safe and clean may also need a bit of attention.
Unity is strength
Some of us may remember this concept. So I appeal to my colleagues to "Speak with one voice" instead of proposing highly divergent and often risky and unaffordable solutions (e.g. the Atkins diet) for weight loss. Let’s identify affordable slimming diets that are well balanced and present them to the nation without thought of personal gain.
In 1998 the biennial Nutrition Congress was held at Sun City with the theme of "Nutrition in the News". One of the aims of the congress was to place nutrition under the spotlight and engage the media. Well, we have succeeded beyond our wildest dreams. Nowadays nutrition is used by the media to sell newspapers, magazines and TV programmes, but far too often with a negative slant. Tragedies and disasters, gloom and doom, tsunamis and earthquakes make the headlines, as do spiralling obesity and its dire consequences.
I would ask the media to support the drive to change perceptions about obesity, but not by shaming those who are overweight. Let’s have more positive articles about food selection for weight loss and good health and being active. You can do so much good - don’t spoil it for the sake of sensationalism.
Remember dieticians and nutritionists
Finally, I would like to enter a plea that all the government bodies that are, or should be involved, with combatting overweight and obesity, should use the services of the dietetic and nutrition fraternity. Dieticians and nutritionists have studied every aspect of diets, slimming, overweight and all the diseases related to obesity at university and are required to earn Continuing Education Units (CEUs) every year to ensure that their knowledge is up to date. As a group, we have always been at the forefront of nutrition education and the formulation of the FBDGs and that is where we can play a significant role in the future if you allow us to do so.
Please don’t consider making any changes or starting any campaigns to combat obesity, increase physical activity and altering cultural concepts without the help of dietitians and nutritionists.
- (Dr IV van Heerden, DietDoc, October 2012)
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