Obesity in South Africa – a BIG problem

We have a bit of a problem…

I was astonished to read in an article written at the end of 2015 that ’…South Africa has the highest obesity rate in Sub-Saharan Africa, with 61% of the population being overweight or obese…’ [1]. Sixty-one percent of South Africans are overweight or obese! This means that  almost one third of our population is at risk of developing negative health problems including:

  • Heart disease
  • Type 2 diabetes
  • High cholesterol
  • Cancer
  • Liver disease
  • Sleep problems
  • Respiratory problems
  • Arthritis
  • Inflammation
  • Other complications related to chronic lifestyle disease

A typical ‘Western’ diet and overall lifestyle has made its way into the lives of South Africans of all races and cultures, and it is a problem that won’t be going away quickly.  As suggested by Dr Dominique Stott, this epidemic is primarily due to South Africans “…eating too much and exercising too little” [1]. This conventional wisdom suggests that we gain weight because we eat more calories of food (energy in) than we expend during exercise and daily metabolic activity (energy out) [2].  Although partly true, I believe that this way of thinking misses a few very important pieces of the greater puzzle. The types of foods that we choose to prepare and eat on a daily basis are arguably as important as how much of them we consume. What we choose to consume, along with other factors such as genetic makeup, impacts the way in which our bodies choose to use and store fat. Compared with data collected in 1994, the South African population of today consumes more meat, fats and vegetable oils, sugar-sweetened beverages, sauces and condiments, sweet and savoury and snacks, and far fewer vegetables [3]. In addition to this we are consuming more processed, ready-to-eat, convenience products and fast foods on a daily basis due to factors such as convenience, availability, or low cost.

In his talk ‘Processed food: an experiment that failed’, Dr Robert Lustig explains the main differences between processed food and real food [4].  Processed foods contain too much:

  • Trans-fats
  • Branched chain amino acids (found in corn-fed animal products)
  • Omega-6 fatty acids (found in plant oils)
  • Additives
  • Emulsifiers
  • Salt
  • Sugar

…and contain too little:

  • Fibre
  • Omega-3 fatty acids (found in wild fish)
  • Micronutrients (include vitamins, minerals, and phytonutrients)

In this same talk Dr Lustig goes on to explain that “…a calorie is not a calorie…not all calories are processed in the same way…”. But how does this make sense? Here are a few examples to help you understand [5]:

  • Fibre in food assists in delaying the absorption of calories into the bloodstream. When you eat 160 calories of almonds, only 130 calories are absorbed, and the absorption of those 130 calories takes place over a longer period of time, thus preventing erratic spikes in blood sugar levels.
  • Protein metabolism requires twice the amount of energy compared with carbohydrate metabolism. Processing protein thus wastes more energy, whilst also increasing satiety more, compared with consuming carbohydrates.
  • Although fat releases nine calories per gram when metabolised, not all fats, and thus also their calories, are equal. Omega-3 fatty acids have been attributed to lowering heart disease risk and lowering of blood triglyceride levels, whilst omega-6 and trans fats have been shown to increase inflammation, damage arteries, and increase heart attack risk.
  • Sugar, found in many processed foods, is made up of glucose and fructose. Despite being worth the same number of calories, neither of these compounds are metabolised in the same way, nor do they have identical effects on the human body.

One very important point that Dr Stott mentions is the following: “Unless people change their lifestyles, this is not something that is going to change. And if they don’t do anything about it, we are going to end up in South Africa with a real health crisis on our hands” [1].  South Africans need to take responsibility of their own health by changing their lifestyles and their food choices. Choosing to prepare a nutritious dinner of roast chicken using fresh ingredients and plenty of vegetables is a better choice for one’s family than purchasing a KFC bucket with fried chips and fizzy cool drinks.  Even if the same number of calories worth of the latter meal is eaten as the more nutritious meal, the way in which the body will metabolise the fried chicken, chips, and sugar-sweetened drink will differ significantly from how it will process the roast chicken with fresh vegetables.

Although suggesting better food choices, increasing nutrition education, and promoting regular physical activity is a good start, I believe that combatting this problem in South Africa will require more than making these suggestions at a grassroots level.  Although roast chicken with fresh vegetables is a healthier dinner option for any family, compared with fried chicken and chips, the latter option is unfortunately more affordable for most families in our country, where 30% of the labour force is unemployed, and many families are earning on average R60613 annually. In addition to this, some cultures see ‘big’ as being beautiful, having a belly represents wealth and success, and being overweight or obese is not necessarily seen as a problem. So many different factors influence the dietary and lifestyle choices that we as South Africans make, but at what expense?

What do you think about this epidemic that is taking the world by storm? Where is change needed? Who are the big players that need to work together to make a difference?

References

[1] Anonymous. South Africans – the fattest of them all [Internet]. South Africa: Health24. 2015 Nov 18 [cited 2016 Jun 19]. Available from: http://www.health24.com/Fitness/News/south-africans-the-fattest-of-them-all-20151117.

[2] Attia P. Do calories matter? [Internet]. The Eating Academy. 2012 Feb 29 [cited 2016 Jun 19]. Available from: http://eatingacademy.com/nutrition/do-calories-matter.

[3] Ronquest-Ross L, Vink N, Sigge GO. Food consumption changes in South Africa since 1994. S Afr J Sci. 2015 Sep 25;11(9):1-12.

[4] Eat Food Forum. Processed food: an experiment that failed. 2015 Jun 2. Available from: https://www.youtube.com/watch?v=h-8Sbem4G3s

[5] Lustig R. Still Believe ‘A Calorie is a Calorie’?. Huffington Post. USA. [Internet]. 2013 Apr 29. [cited 2016 Jun 19]. Available from: http://www.huffingtonpost.com/robert-lustig-md/sugar-toxic_b_2759564.html.  

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