Cape Town - Nutrition Week is being celebrated here in a country in which diabetes and hypertension are among the top causes of death. Everyone from health ministers and doctors to researchers and teachers are encouraging people to embrace a healthy lifestyle. So why are people not doing it?
“It just costs too much,” says Hazel Apples.
Apples, 55, a domestic worker and child minder from Ottery, earns R3 000 a month. Her unemployed 21-year-old daughter lives with her and her husband, along with two brothers.
Apples says she was skinny until her 30s, when she had the last of three children. “I look in the mirror and what I see isn’t normal,” she says.
For now, her blood pressure is fine and she is not diabetic. Even though she doesn’t indulge in much junk food, Apples says she can’t afford the high cost of health foods.
“For us it’s not so much about what’s healthy, it’s about what we can afford,” says Apples.
Her monthly budget for meat ranges from R300 to R500. She buys meat from butcheries instead of from the supermarket as it’s cheaper.
For R80, she buys meat that can be divided into three packets. Each one will make a stew or curry. She also buys cheap meaty bones which add flavour to soups.
Sometimes she buys whole chickens, other times pieces. She can’t afford to pay R30 for three healthier chicken breasts, she says.
In her household, nothing goes to waste. She makes a pot of food using chicken organs which costs R10 a packet. A packet of chicken necks also costs R10, and she uses this to make a curry or pot of soup.
Apples spends an average of R400 on vegetables, which she buys from a vegetable horse cart.
The vegetables – including potatoes, pumpkins, butternut and onions – go a long way to filling her pots. She admits there are times when some of it must be thrown away because it spoils.
Her other groceries include cooking oil, white rice and white bread. She stocks up on polony, yellow cheddar, cheese spread and fishpaste for sandwiches.
Apples gasps at the idea of paying R100 for two litres of olive oil. Cooking oil costs about R30 for two litres.
Apples says that for breakfast, her family eat sandwiches with a fried egg. For lunch, they eat left-overs from the night before. If not, her daughter makes hot chips and eggs.
At work, Apples sometimes eats her employers’ left-overs, which consist largely of curries. Her other lunch option is a peanut butter and jam sandwich, or cheese spreads.
In the evening, they make many stews, curries, potjiekos or dishes such as frikkadels.
Dr Julia Goedecke, senior scientist at the Medical Research Council, says Apples’s diet is very high in fat and carbohydrates. This boils down to a high calorie intake, and without exercise, will inevitably lead to weight gain.
“The main thing I have found is people eat high volumes of high-energy food, with very little nutritional value,” says Goedecke.
She suggested the Apples family add more variety to their diet. Instead of eating bread for breakfast, Goedecke suggests they introduce oats, which are higher in fibre and will keep them full for longer.
While sandwiches make good snacks, the family should switch from white bread to wholegrain. She also suggests dropping the jam from the sandwich.
Goedecke recommends substituting cooking oil with canola oil. It’s a bit more expensive than cooking oil, but half the price of olive oil.
Andisiwe*, 33, lives with her sister in Nyanga. She earns an average of R1 500 a month doing piece work. She spends R325 a month on a hamper comprising 10kg of white sugar, 10kg of maize meal, 7kg of potatoes and 10kg of white cake flour used for baking bread.
She spends a another R150 every two weeks on intestines, pork and pork skin. She braais the offal or pork and eats it with pap most days.
“Vegetables are a luxury. We only eat them on Sundays,” she says . On Sundays, she spends about R25 on carrots, spinach and other vegetables to go with lunch.
Andisiwe admits she doesn’t exercise. The last time she went for tests, her blood pressure and blood glucose were normal. But she was warned that she needed to do something about her weight before she becomes ill.
Goedecke says even on the tightest of budgets, vegetables should make up the bulk of the meal and portion sizes must be decreased.
“It’s related to food insecurity. When there is food available, people tend to over-eat,” says Goedecke.
She stresses that together with better eating habits, people must get used to the idea of exercise.
The minimum daily recommendation is 30 minutes of moderate exercise.
While going for long leisurely walks daily does contribute, it is only considered a moderate workout when the person breaks a mild sweat.
Earlier this month, the health department unveiled it’s non- communicable disease strategy, aimed at reducing lifestyle diseases over the next five years.
According to the department, most risk factors for non-communicable diseases – such as diabetes and hypertension – can be reduced by eating nutrient-rich, fibre-rich foods and green leafy vegetables, but they have to be affordable.
The plan does acknowledge that healthy foods cost between 10 percent and 60 percent more than unhealthy foods, putting it out of the financial reach of many South Africans.
Apples says: “Eating healthy is too expensive. If healthy food is made cheaper, then I would buy it.”
* Andisiwe’s real name was withheld at her request.
* Diabetes: Of all those with diabetes in South Africa, 85 percent to 90 percent of cases are type 2. Most are overweight and do little or no exercise. Diabetes can lead to blindness, increase the risk for suffering a heart attack, stroke, and kidney failure. Weight loss can reduce glucose levels.
* The World Health Organisation predicts diabetes will become the seventh leading cause of death by 2030. Cardio-vascular disease is responsible for 50 percent to 80 percent of deaths in people with diabetes. Eighty percent of diabetes deaths occur in low- and middle-income countries. In developing countries, the average age of sufferers is 35 to 64. - Cape Argus