Last week we completed the 15th article in a series on Diabetes – one of the most important conditions in South Africa affecting the health and well-being of a large part of our population.  Certainly almost everyone in Port Shepstone either is affected personally, or has an affected family member or knows someone with the disease.

 ALSO READ : Turning the Tide – Understanding Diabetes (part 15)

Also last week I announced the forthcoming “Eating for Life Expo” which will be conducted at Southcoast Mall on the 2nd June.  This will be a poster-presentation covering many of the common lifestyle conditions in South Africa manned by passionate volunteers, accompanied by health professionals who can offer more specific lifestyle advice.  Short video clips will also be shown on various relevant topics.  This is a first ever for South Africa, and may be the first of many such interventions around South Africa and beyond.

From this episode, we will be presenting a series of topics which I consider the main drivers of poor health in South Africa, and discussion about what can be done to reverse these through lifestyle interventions.

The Obesity Epidemic

Body Mass Index is a term used to categorise the level of weight, and is calculated according to mass and height.  Underweight is less than 18,4.  Normal is between 18,5 to 24,9.  Overweight is between 25 and 29,9.  Obesity class 1 is between 30 and 34,9; Obesity class 2 is between 35 and 39,9 and Obesity class 3 is above 40.

How serious is the problem in South Africa?

We know that obesity is a global phenomenon, but used to be confined mostly to Western countries.  However with globalisation and particularly with the adoption of dietary practices of the West in so much of the less industrialised world, population mass average is dramatically changing.  It is said that the rate of obesity incidence increase in South Africa is twice what it has been in the USA.

South Africans are now the most obese people in Africa.  (I was recently in Zambia and a cursory observation of the population of Lusaka suggested a lower incidence of obesity in that country.) 

Amongst South African women, 70% have a BMI greater than 25 – making them overweight, and 40% are above 30, which means they are categorised as obese.  According to a survey conducted by the South African Medical Research council, reported in 2017, by the age of 20 more than 50% of SA women were already overweight.  By the age of 45 a staggering 82% were overweight.

Men are not far behind – 35% of men have a BMI greater than 25 (meaning they are overweight).

But what is of grave concern is the increase in weight amongst our children.  25% of girls and 20% of boys between the ages of 2-14 years are overweight.

So what?  Does it really matter? 

Some people may think that this is a consequence of better nutrition and social status.  However, the results of being overweight and obese are far from inconsequential.  There is a strong correlation between obesity and heart disease, high blood pressure, diabetes, strokes, renal disease, cancer, arthritis and early death.  The greater the obesity, the higher the risk.

The correlation exists because the same drivers of obesity are implicated in causation of atherosclerosis, diabetes, high blood pressure, cancer and arthritis.  For instance increased intake of saturated fats and refined foods increases damage to artery walls which causes atherosclerosis and high blood pressure, heart attacks, strokes and kidney failure.  High intake of all dietary fats and refined foods also increased insulin resistance which predisposes to diabetes, but also chronic inflammation and high blood pressure and autoimmune diseases.  High intake of refined foods results in less dietary fibre and greater risk of gastro-intestinal cancers.  The Standard American Diet is also a driver of Alzheimer’s and other dementias.

ALSO READ : Turning the Tide: Cardiovascular Disease – the number two killer in South Africa (3)

Thus effective and healthy interventions to reverse obesity benefit a whole range of chronic diseases.

What are some of the main drivers of obesity in South Africa? 

The following observations are not necessarily based on importance, but all are born out in scientific studies.

1. A dramatic increase in the consumption of meat and other animal products as disposable income increases.  This is confirmed as I interview patients who are concerned about their excess weight.  Traditionally rural people consumed meat mostly at funerals, weddings or special occasions.  But it is common now for people to eat meat at least daily if not more frequently.  Meat/chicken and fish are all rich in fat – a minimum of 23% fat for the lean cuts.  Frying or grilling increases the fat content that much more.  Processed meats can have up to 70% kilojoules in the form of fat. Compare that with fruits and vegetables which have 5-10% fat per mass.
2. Processed foods. To prolong shelf-lief and increase attractiveness, natural foods are processed to remove water and fibre.  They can be dried, bottled, canned or manufactured to alter taste and appearance.  These include breakfast cereals and other grains, breads, drinks and snacks.  In the processing thousands of health-promoting phytochemicals are removed, and additives and preservatives added, which may have adverse effects on our health.
3. Fast foods – including pizzas, fried foods and meats, burgers, fizzy drinks – all foods rich in fats and sugar, and low in fibre and nutrients.
4. Sugar intake has dramatically increased over the years – sugary drinks, snacks, sweets, ice cream, baked goods, sweetened yoghurts and canned goods. Sugar stimulates the pleasure centre in the brain and can cause food addiction – a common contributor to gross obesity.
5. As we put on weight, we tend to become less active thus reducing energy expenditure.  The metabolic rate is increased for up to 3 hours after a physical workout.  But you have to do an enormous amount of exercise to burn up the kilojoules of a single chocolate bar.   The problem comes when people reward themselves with chocolate or a snack when they have exercised!  Of course being a couch potato, and sitting grazing at fatty fast foods mindlessly in front of the TV is the ultimate in a promotor of obesity.

What is the solution?

This will be covered in the next blog.

Plan to come along to the “Eating for Life Expo” on the 2nd June, and tell your friends.

See you there.

Dave Glass

Dr David Glass graduated from UCT in 1975. He spent the next 12 years working at a mission hospital in Lesotho, where much of his work involved health education and interventions to improve health, aside from the normal busy clinical work of an under-resourced mission hospital.

He returned to UCT in 1990 to specialise in obstetrics/gynaecology and then moved to the South Coast where he had the privilege of, amongst other things, ushering 7000 babies into the world. He no longer delivers babies but is still very clinically active in gynaecology.

An old passion, preventive health care, has now replaced the obstetrics side of his work. He is eager to share insights he has gathered over the years on how to prevent and reverse so many of the modern scourges of lifestyle – obesity, diabetes, ischaemic heart disease, high blood pressure, arthritis, common cancers, etc.

He is a family man, with a supportive wife, and two grown children, and four beautiful grandchildren. His hobbies include walking, cycling, vegetable gardening, bird-watching, travelling and writing. He is active in community health outreach and deeply involved in church activities. He enjoys teaching and sharing information.

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