OPINION | Obesity in South Africa: Every body needs everybody

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This year's World Obesity Day theme was 'Every Body Needs Everybody', because we all have a role to play in supporting and advocating for people living with obesity.

How big is the problem of overweight and obesity in South Africa?

Obesity is a public health problem in South Africa. The results of national surveys show an increase in obesity, particularly among women 45-55 years old, but also among preschool children and adolescents.

Among preschool children we notice that overweight prevalence increased from around 12% to 18% from 2005 to 2012, while obesity remained at a similar level. A low combined overweight and obesity prevalence was reported in earlier studies, but the prevalence increased to above 10% in most studies conducted after 2013.

The overweight and obesity prevalence among primary school showed a small increase since the turn of the century, compared to a marked increase among adolescents.

What are the main drivers of the increase in obesity?

Poor eating habits, such as infrequent family meals, a high consumption of fast foods, sugar-sweetened beverages and energy-dense school tuck shop items play an important role. Among infants, complementary foods with added sugar and fats, as well as sugar sweetened drinks contribute to excessive weight gain.

About 50% of school-going children in South Africa regularly buy food at school and do not carry lunchboxes.

Marketing of processed foods that are high in fat, as well as sugar sweetened beverages appears to be driving the obesity epidemic and has adverse effects on the nutritional status of children. Marketing focus on fast foods, sweetened breakfast cereals, confectionery and soft drinks.

Children are exposed to advertising through TV, radio, product placement in stores, sponsorships to schools and in-school marketing, product packaging, free samples, loyalty programmes, cartoon characters, the internet, and billboards with beverage company logos inside the school premises.

Regulations (R429 of 29 May 2014) relating to the Labelling and Advertising of Foodstuffs prohibit the commercial marketing of food or non-alcoholic beverage to children unless it complies with specific criteria. The monitoring of its implementation is however challenging.

Insufficient physical activity also contributes to the increase in obesity. The most recent (2018) Report Card on Physical Activity for South African Children indicated that less than half of children met the recommended daily amount of 60 minutes of moderate to vigorous physical activity.

The school and early childhood development centre environments do not provide sufficient opportunities to children for exercise and active play. Many adults, particularly in low-income settings, have no access to opportunities for recreational physical activity.

Environment and commercial determinants of obesity include the built and food environment, with lack of space for safe outside recreation, and lack of access to markets and shops for fresh fruit, vegetables, milk products and other unprocessed foods.

Why is obesity a health problem?

Obesity increases the risk to develop chronic diseases, such as type 2 diabetes, high blood pressure and some cancers. Recent studies indicate that obese COVID-19 patients get more complications and they take longer to shed the virus.

The death rate is significantly higher among obese patients than among those with normal weight. Infants and young children with obesity are more likely to have diseases of the respiratory system.

These infants and children are also more likely to become obese adults with chronic diseases. In addition, it is very difficult to change eating and exercise habits established during childhood.

Obese persons have higher asthma risk, obese asthmatic patients have more symptoms and they respond less well to asthma medications. Obesity is associated with lower quality of life due to restrictions in movement. This is particularly important among older people who need assistance when they walk, stand up and perform daily activities.

How can individuals and families be supported to stop this trend of excessive weight gain?

Nutrition interventions must be tailored to the dietary habits and access to food items in each setting. Health education to caregivers about the importance of balancing screen time (TV, computers and cell phones) with time for active play will contribute to decrease sedentary time.

Health professionals should engage caregivers in praise and encouragement for positive health-related behaviour in their children. Wearable devices, such as pedometers, sport watches and cell phone apps to track movement helps older children and adults to monitor long-term activity trends over time.

Text messaging and WhatsApp messages can be used to encourage participation in behaviour change interventions.

Schools are an ideal setting where children can learn about healthy living, including healthy diets and physical activity, but studies showed that educators’ nutrition knowledge and practices are often suboptimal. Teachers need support from health professionals in health promotion programmes.

Research in South Africa revealed that low household income limits access to expensive nutrient-rich foods, such as meats, dairy products and fruit. Children from low-income households tend to eat cheaper salty snacks, cookies and fast foods more frequently than children from high-income households.

These foods are low in key nutrients, but high in fat, sugar and salt. The affordability of fruit, meats and dairy foods in South Africa is an important factor that prevents daily intakes of these important food groups.

Obesity is a complex public health problem and needs to be addressed by a comprehensive multidisciplinary team to support everybody living with obesity in an effort to improve their quality of life.

Salome Kruger is professor at the Centre of Excellence for Nutrition, North-West University, a registered dietitian and ADSA member

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