The Road to Heart Disease (2)

Last week we looked in detail at an infographic produced by Physician’s Committee for Responsible Medicine emphasising the factors that play into development of heart disease, beginning already before birth of our children.  Most of this information relates to what happens in the USA.  But South Africans are adopting many of the behaviours of the West, and thus will go down the same pathway to poor cardiac health found in the USA.

 ALSO READ : Turning the Tide – Dealing with the main lifestyle-related conditions in South Africa (Part 10)

Today we will look at the situation in South Africa as presented by a large group of concerned academics who participate in the Healthy Active Kids South Africa Report Card (HAKSA).  The latest version is 2018. You can find this report here.

Healthy Active Kids SA report card 2018

“There is no disputing the benefits of physical activity and active play for the physical health and mental wellbeing of children and adolescents. And there is increasing evidence of the adverse effects of sitting too much and spending too much time on screens. While technology has its place, screen time also takes away from face-to-face interactions between peers, and can impact negatively on the emotional well-being of children. We know that what children and adolescents eat and drink is also critical for good health and maintaining a healthy weight. And these healthy lifestyle behaviours have been shown to have a positive impact on children and adolescents’ cognitive development and school achievement as well.

“The Healthy Active Kids South Africa Report Card presents the most current and best available evidence on physical activity and nutrition of South African children and adolescents, aged between 3-18 years. Grades are given for a range of indicators relating to physical activity and nutrition that tell us how well our children and adolescents are doing in these categories. The HAKSA 2018 Report Card builds on previous evidence from the 2007, 2010, 2014 and 2016 versions, focussing on research that has been published in the last 2 years. This evidence provides the basis on which to guide policy, develop programmes, and strengthen advocacy to create environments that support healthy eating, and opportunities to be more physically active and sit less amongst South African children and adolescents.”  (Introduction to HAKSA 2018.)

The grading system is:

A – succeeding with a large majority of children and youth (81% to 100%);

B – succeeding with well over half of children and youth (61% to 80%);

C – succeeding with about half of children and youth (41% to 60%);

D – succeeding with less than half but some children and youth (21% to 40%);

F – succeeding with very few children and youth (0%-20%) and

INC – inconclusive due to insufficient data.

Physical Activity Indicators – summary

Overall physical activity – C, averaging about an hour of moderate to vigorous activity per day.  The more active have less obesity and have better quality of life as well as better motor skills, and are less likely to use tobacco or marijuana.

Early childhood physical activity is pretty good (A-) – the only inhibitors are crime and security concerns, and obsession with screens like TV’s, tablets and smartphones amongst the more affluent.  Sedentary behaviours like watching screens got an F, because of increasing exposure of children to screen time.  Current guidelines for screen time for children and adolescents are

• School-aged children: less than 2 hours entertainment screen time per day
• Preschool children: less than 1 hour of screen time per day
• Children under 2 years: NO screen time.

Nutrition Indicators – summary

Fruit and vegetable intake as part of the National School Nutrition Programme has not changed and still remains at D.  Snacking, sugar-sweetened beverages (SSB’s), salt, fast food remain F.  Unfortunately the lowest income sector of the community is more likely to consume the unhealthiest food.  For years there has been a policy for schools to grow vegetables to supplement the nutrition scheme, and also provide practical training for children in basic agriculture, but this aspect of nutrition got a D-.  Overweight/obesity is increasing in South African children and adolescents, with the highest risk in 8-10 year olds, and especially amongst girls.  This is now also beginning to manifest amongst girls in rural areas.  This score was D.

What does all this mean for future heart health?

It is well established that lack of activity, a diet high in saturated fats and salt and sugar as found in snack foods and sugar-laden beverages, is strongly associated with risks of cardiovascular disease.  Social connection and family support and loving relationships are also an important marker of heart health.

Judging by the report card we need to be concerned for the future of our South African children.

The best place to start is in our own homes as parents and grandparents.  But we can also advocate for our children in the school system and in our communities – ensuring safe places for the children to play, and adequate supply of fresh fruits and vegetables in the school feeding schemes, and in our local shops. As concerned parents we can push for more healthful options of snacks in the queuing lanes of the supermarkets, as has been done at Woolworths.   We can advocate for healthier food options to be made available at school tuck shops, and work out ways to incentivise children to choose those healthier options.

But the biggest motivator to change is our attitude and behaviour as parents.  If we adopt healthier lifestyle behaviours and then engage with our children about these in conversation we can make a meaningful impact on their future health.  One important lifeskill for both boys and girls is to know how to prepare healthful meals – like cooking oats porridge or vegetables; preparing a healthy salad; cooking healthy and tasteful grains and legumes.

Next week we will present some practical tips on how to reduce the risks of obesity and future diabetes and heart disease in our children.

Here is a challenge to think seriously about how you can reduce the risks of future heart disease in your children.

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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