Experts are gravely concerned about the rising prevalence of obesity in South Africa, which increases the country's disease burden in terms of diabetes and heart disease.
More than 29% of South African men and 56% of South African women are classified as overweight or obese, according to a technical report released by the Medical Research Council (MRC) in 2006. This is higher than the figures reported in other African countries, particularly in women. Nearly 30% of South African women aged between 30 and 59 years are obese.
In a sample of 7 726 South African women aged 15-95 years old, black women had the highest prevalence of overweight and obesity (58,5%), followed by women of mixed ancestry (52%), white women (49,2%) and then Indian women (48,9%).
The obesity problem is costing the country a lot of money. It is estimated that direct costs may be as high as 6,8% of healthcare costs. Indirect costs, such as work days lost, visits to doctors, impaired quality of life and premature deaths, are also becoming more and more problematic.
In another report, this time by the MRC's Chronic Diseases of Lifestyle Unit (2006), lead author Dr Nelia Steyn and others make suggestions in terms of policies and strategies that would address the burden of chronic disease in this country. Most of the strategies are aimed at children. Some of the most important recommendations include:
1. Fiscal policies and levies
There is a need for fiscal policies that would influence the food supply to ensure that the population has access to safe and affordable foods. This will help to discourage the intake of high fat/sugar products.
Another option would be for the government to introduce small levies on certain high fat/sugar foods. These could include items such as soft drinks and crisps.
2. School-based intervention programmes
Schools, which are a very important channel in terms of health-promotion activities, should be targeted.
By targeting children through school-based programmes, health-related beliefs and behaviours are influenced early in the "health career" before they are established as adult patterns.
The authors of the MRC report highlight a recent statement by the American Heart Association in this regard. It is recommended that all schools should implement:
- evidence-based, comprehensive, age-appropriate curricula about heart health, and methods for improving health behaviours, and the reduction of heart-disease risk;
- age-appropriate and culturally sensitive curricula on changing students' patterns of dietary intake, physical activity, and smoking behaviours.
3. Food labelling and claims
Food labelling is currently under revision by the Department of Health and new regulations are expected soon. These new regulations are more informative than the present ones and will provide consumers with detailed nutrition information.
"However, consumers need to be educated about these regulations and how to select 'healthy' foods accordingly," writes the MRC research team. "The Nutrition Directorate of the Department of Health together with the Directorate of Food Control will need to plan and implement specific strategies to do this."
4. Marketing and advertising standards
To date, there have been no regulations regarding the marketing of energy-dense foods to children.
In the MRC report, the hope is voiced that in the near future there will be bans on advertising of energy-dense, high-fat and high-sugar foods on television to young children, particularly since this has been shown to be an effective way of persuading children to make undesirable and unhealthy choices.
5. Policies aimed at improving the environment
The authors suggest that action should be taken to modify the environment in such a way that it will enhance and promote physical activity and healthy eating patterns in schools, the workplace and the community.
This should include limiting children's exposure to vending machines, for example. And food items which are included in the primary school meal programme should be healthy.
In terms of physical activity, it is important to ensure that children have safe and adequate space at school and in the community to play sport and games.
6. Nutrition health logos
In South Africa, the Heart Foundation and the Cancer Association put their stamp of approval on certain food products that adhere to specified health claims and nutrition standards.
"This trend should be encouraged by the Department of Health in an effort to persuade the food industry of the benefits of producing healthier food and meal options," the MRC researchers say.
7. Nutrition education programmes
The researchers note that food-based dietary guidelines initiated by the Nutrition Directorate should be given priority as a tool of nutrition education. This should be incorporated in primary healthcare programmes and in the school curricula.
"Since these guidelines also cater for over-nutrition and promote healthy eating habits for all South Africans, they need to be implemented by all departments and district health authorities, with the important emphasis on avoiding both over- and under-nutrition," the MRC researchers say.
Furthermore, it has been found that health professionals working at primary-care level have an inadequate knowledge about nutrition and lifestyle modification regarding non-communicable diseases. Therefore, their basic training needs to be updated in this regard. – (Carine van Rooyen, Health24)
South Africans are eating more fat