Dr Dulcy Rakumakoe
Obesity is defined as excessive accumulation of fat that leads to health risks such as cardiovascular diseases, musculoskeletal diseases, high blood pressure and diabetes.
South Africa has a big fat problem, with our children said to be the third-most obese in the world.
Studies say up to 70% of women and a third of men are classified as overweight or obese. In children, one in four girls and one in five boys between the ages of two and 14 are overweight or obese.
Additionally, perceptions of weight and weight loss complicate the issue further. We tend to associate weight loss with negative connotations such as HIV/ Aids. Therefore, even if someone is overweight they fear if they lose weight, it could be interpreted that they are HIV positive. Some people believe being overweight is a sign of affluence and wealth.
With transition in political and socioeconomic conditions, the country has also seen a nutrition transition. The bulk of our population used to be physically active and ate a diet high in fibre and indigenous vegetables, low in animal protein and refined carbohydrates. However, people are now adopting a more western diet, the food has become “faster than us” and is high in unhealthy fats, sugar and salt.
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Hence, we have seen an increase in overweight and obesity over the last 15 years.
Childhood obesity is associated with a higher chance of obesity, premature death and disability in adulthood. But in addition to increased future risks, obese children experience breathing difficulties, increased risk of fractures, hypertension, cardiovascular disease, insulin resistance and diabetes, and psychological effects.
Body mass index (BMI) is a simple index of weight-for-height that is commonly used to differentiate between classifying people as either overweight or obese. It is defined as a person’s weight in kilogrammes divided by the square of his height in metres (kg/m2 ).
When the BMI greater than or equal to 25, the person is overweight – and is obese if the BMI is greater than or equal to 30. This should be considered a rough guide because it may not correspond to the same degree of fatness in different individuals.
The fat that lies just below your skin – the kind you can grab with your hands – is called subcutaneous fat.
In your belly, it’s called visceral fat because it builds up in the spaces between and around your viscera (internal organs). This fat is sneaky and has the most severe health risks, especially diabetes mellitus.
You can have it even if you are not generally overweight. It is the most difficult fat to drop, and diet has been shown to be more effective than exercises that specifically target this area.
Stop the sugary beverages (even fruit juices), rather drink water; fill your plate with non-starchy vegetables; stop processed foods; start strength training a minimum of twice a week because building muscle burns fat; get enough sleep; stand up and move.
The increased intake of energy-dense foods that are high in sugar, and a decrease in physical activity due to the increasingly sedentary nature of people’s lives are largely responsible.
The problem starts in childhood, with less than two-thirds of children participating in weekly physical activity. Children spend more time sitting than playing.
In adults, half of males and almost two thirds of females are physically inactive.
This is the simplest explanation for how sugar (especially fructose) makes you fat.
Glucose is absolutely vital to life and energy and is an integral part of our metabolism. Luckily, our bodies can produce it and we have a constant reservoir of it in the bloodstream. If we don’t get glucose from the diet, our bodies produce what we need out of proteins and fats.
Fructose, however, is very different. This molecule is not a natural part of metabolism and humans do not produce it. In fact, very few cells in the body can make use of it except liver cells. When we eat a lot of sugar, most of the fructose gets metabolised by the liver. There, it gets turned into fat, which is then secreted into the blood and stored.
The increased consumption of unhealthy food and sugars and sweetened soft drinks has been linked to weight gain, as it provides a major and unnecessary source of calories with little or no nutritional value. Recent studies have shown that there is a change in body fat that occurs when changing intake of sugars, and this is because of an alteration in energy balance.
They have also shown that there is a rapid weight gain that occurs after an increased intake of sugars. Current dietary advice published by the World Health Organisation highlights the need for a reduction in sugars intake to 5% of our energy intake to halt the increase in obesity.
Obesity is a major risk factor for diseases such as:
Apart from restricting the sugar we consume, individuals can:
Intervention is required at societal level. Supportive environments and communities are fundamental in shaping people’s choices, making the healthier choice of foods and regular physical activity the easiest choice (accessible, available and affordable), and therefore preventing obesity.
There also needs to be a sustained political commitment and the collaboration of public and private stakeholders because obesity has disastrous consequences on the economy as well.
The food industry can play a significant role in promoting healthy diets by:
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