- Being overweight and obese are steadily increasing in South Africa.
- Partly responsible for this are the highly processed foods we eat.
- Foods high in energy, sugar and salt and of low nutritional value are often more affordable and available than raw, fresh, whole foods.
Standing in line in the supermarket, I like looking around and observing the contents of other shoppers' trolleys.
I am a dietitian and arguably more aware of food choices than the average consumer, so this habit makes sense. I don’t judge, but I like to observe consumers to establish what we're up against if we want to address the level of obesity in our country.
My work involves regular visits to informal and rural areas. Again, I observe as I drive. Buying food in these settings does not involve shopping trolleys and large supermarkets, so my attention is drawn to the informal traders along the road and the products they sell.
I also notice the spaza shops, where branded name boards draw attention to what is on offer inside. Suburban, air-conditioned supermarkets and megastores are far removed from vendor stalls, but these outlets have a lot in common. Retailers, formal or informal, play a significant role in the food we buy and consume. However, it also works the other way round – what we buy influences what retailers offer for sale.
'A complexity of individual and structural factors'
Food systems are complex with all the actors and interactions along the food value chain. Ultimately they determine which food items are available to consumers, where they can be bought, at what price, and in what form and packaging. Highly processed foods, often high in energy, sugar and salt and of low nutritional value, are often more affordable and readily available than raw, fresh, whole foods, resulting in processed foods being the staples in many diets.
Overweight and obesity are steadily increasing in South Africa, driven by a complexity of individual and structural factors. The situation involves more than numbers and proportions, though. While some obese individuals may not like the image they see in the mirror and try to address it, others may look in the same image and be very happy with what they see.
Body image and the definition of obesity differ among individuals, communities, cultures and even generations. However, the widely accepted views that obesity can be controlled and that "eating less and doing more" will shed those extra kilograms, contribute to weight discrimination and stigma, with a negative impact on obese individuals.
A vicious cycle
Bodyweight is more than a number on the scale, or the image reflected in the mirror. Several complex and intertwined factors, often outside of the control of the individual, impact body weight. This includes biology and genetics, access to health care, life events and mental health, and migration and urbanisation.
In addition, the retail settings mentioned above, including food marketing, food affordability and availability, strongly affect the food we buy and consume.
The connection between obesity and the onset of non-communicable diseases such as type 2 diabetes and heart disease is well established. Obesity impacts individual productivity and household income, which again has an impact on what foods are bought and consumed. It's a vicious cycle – obesity due to the consumption of energy-dense foods with low nutritional value. This impacts income potential, necessitating the purchase of cheap foods, which tend to be highly processed foods with high energy density and low nutritional value.
We have to remember that the roots of obesity run deep and that solutions to the escalating issue are complex. Tackling obesity, at the individual, household, community and national levels, will require a multi-dimensional approach.
Transformation 'long overdue'
Nutrition information and education are key to consumers’ understanding of how the food we eat impacts our health. This knowledge can increase the demand for foods that are part of a healthy eating plan. However, as long as these foods are not affordable and available, it is unlikely that consumer behaviour will change.
We casually refer to consumers' "food choices". But we may fail to take into account that consumers are driven by affordability, availability, and the demands created through targeted marketing by corporate giants.
The transformation of our food system is long overdue, and it is time to address obesity and change the trajectory of our country’s health. It is time for the spectrum of stakeholders – like the corporate and industry players, government departments, the healthcare and education systems – to commit to change.
The theme for World Obesity Day on Friday, 4 March 2022 is "Everybody needs to act to make healthier choices easier."
*Maria van der Merwe is a registered dietitian and ADSA (The Assocation for Dietetics in South Africa) president.