Durban - While health authorities in South Africa are focused on the HIV and Aids pandemic, another sinister problem is quietly wreaking havoc – obesity.
“We are getting fatter and fatter,” says Suna Kassier bluntly, as she presents a dismal picture of South Africa’s obesity crisis, “and it is going to cost us dearly.”
Obesity is a major risk factor for hypertension stroke, heart disease, diabetes and other illnesses known as chronic diseases of lifestyle. The World Health Organisation estimates that they will account for 80 percent of disease by 2020. They are set to cause seven out of 10 deaths in developing countries.
Kassier, a lecturer and academic co-ordinator at UKZN’s Discipline of Dietetics and Human Nutrition in Pietermaritzburg, was speaking at an event hosted by the South African Sugar Association in Durban recently.
She has also researched obesity among urban black women in the Durban and Pietermaritzburg areas for a PhD.
What is alarming, she says, is that people – from consumers who feast on high-kilojoule foods to health authorities – appear not to be taking it seriously.
Kassier calls the obesity crisis “the elephant in the room” that nobody wants to acknowledge.
And acknowledge it we should. Besides the health risks, obesity-related illnesses involve considerable indirect costs to business through absenteeism and loss of productivity.
So, what is causing us to pack on the kilos?
“There are multiple causes,” says Kassier. “We live in an obesogenic environment. We want a quick fix for everything and tasty food is cheap and readily available. As people move from rural to urban areas and become more affluent, eating fatty sugary take-away meals is easier than cooking from scratch. It is also an indicator of status – people brag about buying takeaways.”
Cheap, tasty and fattening food is everywhere – street vendors sell vetkoek, wors rolls and chips – and we are bombarded by television advertisements that urge us to buy more and eat more.
“People also become less active in urban living. Less physical activity is viewed as progress and walking and physical labour represent hardship.”
Genetics play only a small part and the obesogenic environment is a far greater influence, says Kassier.
Cultural beliefs have a huge effect on obesity, she adds. In her research she found that many black women chose to stay overweight as it was prized in their community.
“When they visit family in rural areas, they are complimented on their weight as it indicates they are doing well. It also indicates that they are healthy and with HIV/Aids being so prevalent, that is a message they want to convey.
“Some women said that while they wanted to eat more healthily and lose weight, they were discouraged by husbands and partners. At family events they felt pressurised to eat and food played a big part in their traditions and religious practices.
“African women were also found to have a larger ideal body size and were more accepting of themselves at higher body weights. They were likely to feel attractive, even when they were dissatisfied with their own weight.
“They felt less pressure from society and from men to be thin.”
Among more affluent sectors of society, overeating can be aggravated by many issues: depression and stress, marital status and transitions, lack of physical activity, self-esteem, socio-economic status, alcohol consumption, smoking and smoking cessation, and more.
Research shows that emotions are linked to eating behaviour. In some people, stress causes overeating, while others have reduced appetite. Loneliness, depression, anger, anxiety, boredom and joy cause increased intake of food in some people. Marriage gets the blame too, as it is commonly associated with weight gain.
Increased physical activity is associated with normal weight, possibly because people who exercise are more likely to stick to a healthy eating plan, says Kassier. Most studies link a high body mass index to reduced physical activity and those most at risk are people in service sector occupations (who have desk jobs), use transportation to get to and from work, have technology at home, spend leisure time passively, spend little time on food preparation and where there is no social support for exercise.
“We need to make the environment conducive to exercise,” says Kassier.
With South Africans’ penchant for eating out, could healthier options in restaurants help stem the tide of obesity?
It looks unlikely says Kassier, as people want to treat themselves when they go to a restaurant.
So what’s the solution?
Kassier says we need to look beyond the numbers on the scale.
“Behaviour modification and the development of a healthy lifestyle is what is needed. Set realistic weight loss goals. It takes time to make sustainable lifestyle changes so do not expect too much too soon.
“Losing weight is challenging and it requires an understanding of the emotional and cultural factors that contribute to overeating. It requires policy changes aimed at creating an environment that promotes physical activity and dietary education in schools, taxing nutrient-poor foods and subsidising fruit and vegetable farming.
“Interventions should be culturally sensitive and include public health campaigns and programmes. There needs to be an industry-supported change in food supply, eating patterns and lifestyle.” - Daily News
* Most overweight people are in denial, a study by Profmed medical scheme revealed on Wednesday.
“Around 78 percent of obese and 52 percent of morbidly (extremely) obese people in South Africa consider themselves to be healthy,” said Graham Anderson from the scheme.
He said South Africa needed to highlight the issue as obesity week was from October 15-19.
“People who are overweight are not only more at risk of a number of serious illnesses, but may also be subject to higher medical insurance premiums,” said Anderson. - Sapa
How widespread is obesity in South Africa?
* 29 percent of men and 56 percent of women are classified overweight or obese.
* 30 percent of women aged 30 to 59 years are obese.
* 58.5 percent of black women are obese, 52 percent of women of mixed ancestry, 49.2 percent of white and 48.9 percent of Indian women.
* 54.5 percent of white men are obese, followed by Indian men (32.7 percent), men of mixed ancestry (31 percent) and African men (25 percent).
* 17 percent of adolescents are overweight and 4.2 percent are obese. Among urban children, aged one to nine years, 17.1 percent are overweight and five percent are obese.