Obesity: a ticking time bomb in South Africa – HSF South Africa

National Obesity Week 15 to 19 October 2017

In South Africa National Obesity Week follows World Obesity Day on the 11th October. Obesity will continue to increase in South Africa unless changes are made at an individual, familial, community and policy level. The HSFSA also supports government’s efforts to regulate the food industry as one of the strategies to reduce and halt overweight and obesity.

Obesity is defined as a state of having too much body fat, to the extent that it negatively affects health. Whilst obesity has afflicted a small portion of most societies for centuries, only in the last half century has it drastically increased. Obesity is now one of the biggest global health problems of the 21st century. Whilst the prevalence of obesity is levelling off in high-income countries, rates continue to increase in low and middle-income countries, including in South Africa. Half of South Africans aged 15 years and older are categorized as being overweight and 40% of women as obese.

South Africa’s double burden

South Africa is still plagued by undernutrition as high unemployment levels and inflation continues to drive food insecurity. Ironically, undernutrition and overnutrition have become part of the same problem, the one fueling the other. The seemingly opposite conditions are found in the same communities and even within the same households. A low household income results in a monotonous diet based on refined starch, little protein, poor diversity of fruit and vegetables, and salt as the main taste enhancer. With urbanization many traditional vegetables and legumes which provided some good nutrition are readily replaced by cheap processed meat, crisps, deep fried foods, and sugary snacks and drinks. Food choices are mostly driven by price and accessibility. “Bad access to good food and good access to bad food” – says local participants from a report into hidden hunger 1. In one study where researchers compared prices in rural food stores, healthier food choices cost on average 70% more 2. Changes in food consumption patterns confirm that South Africans are eating more kilojoules, more sugary beverages, more processed and packaged food, and fewer vegetables 3.

This poor dietary pattern becomes deficient in many vitamins, minerals and fibre – yet remains sufficient in energy. “In fact, hyperpalatable foods high in added sugar, fat and salt easily provide a surplus of energy. Combined with low activity levels, this is the perfect recipe for obesity” says Gabriel Eksteen, Nutrition Manager at the Heart and Stroke Foundation SA.

Poverty and undernutrition also have an indirect biological impact on obesity. Poor nutrition during pregnancy, infancy or childhood changes metabolism in preparation of a life of food shortages. When a child is subsequently exposed to a surplus energy from a modern diet, obesity and diabetes is more likely than in well-nourished peers. Equally, infants born to obese

mothers are biologically predisposed to becoming obese themselves – with 70% of South African women overweight, the ripple effect can be immense.

Rising middle-class

In South Africa undernutrition also coexists with over-indulgence, further fueling obesity. The rising middle-class who can afford more nutritious food is also unfortunately increasing their portion sizes and adding luxury items high in fat and sugar such as take-outs and sugary drinks. Parents and caregivers who expose their children to a sedentary lifestyle and poor eating habits place them at risk for becoming obese. Childhood obesity is a powerful predictor of adult obesity.

Obesity is weighing down South African progress

South Africa continues to experience urbanization, an increasingly unhealthy modern food supply, and reduced levels of physical activity. Given this trend, obesity is predicted to steadily increase. The World Obesity Forum estimates that nearly 4 million South African school children will be overweight or obese by 2025. The 2016 Global Burden of Disease study reports that although South Africans are gradually living longer, but a greater proportion of life is spent suffering from chronic diseases 4. Unless we act now, the health consequences of obesity will overburden the health care system and decreased productivity will stifle economic progress.

Act now

South Africans need to work together to fight obesity. The Heart and Stroke Foundation SA calls on all role players, including government, the corporate sector, civil society, and the food sector, to act decisively to bring about change. The World Health Organization and the World Obesity Forum both recommend systemic changes to battle obesity. This includes promoting intake of healthy foods and physical activity, preventing obesity pre-emptively during pregnancy and in early childhood, and improving access to weight management services. Environmental changes to improve access to affordable healthy food and opportunities to be physically active is important, whether at school, at work or in communities. Policies to tax unhealthy food and initiatives to subsidize healthier choices are also recommended and cost-effective. Finally, there should be continued pressure on food manufacturers to limit marketing of unhealthy foods and reformulate products.

Professor Pamela Naidoo, CEO of the HSFSA, states that “South Africa is a complex country with glaring inequalities. Obesity, which poses a major risk factor for the onset of many medical conditions, is but one consequence of the inequalities we face. Consequently, the HSFSA is determined to help multi-stakeholder initiatives to reduce obesity and drive advocacy towards this goal.”


1) Hidden hunger in South Africa, OXFAM, 2012

2) Temple et al, Nutrition, 2011

3) Ronquest-Ross et al, South African Journal of Science, 2015

4) Global Burden of Disease Study, Lancet, 2017

Youth With Type 2 Diabetes Often Face Complications – HealthDay






By Serena Gordon
HealthDay Reporter

Young people with type 2 diabetes are much more likely to show signs of complications from the blood sugar disease than those who have type 1 diabetes, a new study shows.

While the researchers found that about three in four teens and young adults with type 2 diabetes had at least one complication, only one in three with type 1 diabetes did.


“The one big difference in the kids with type 1 and type 2 was obesity. When we controlled the data for obesity, there was no longer an excess of complications for type 2 diabetes,” explained lead author Dr. Dana Dabelea. She’s a professor of epidemiology and pediatrics at the Colorado School of Public Health, in Aurora.

The one bright spot in the findings was that the complications were mostly in the “early or subclinical” stages, Dabelea added.

That means there’s still time to reverse the damage, she explained.

Both types of diabetes have been on the rise, according to the researchers. The obesity epidemic has played a significant role in the increase in type 2 diabetes in both adults and children.

People with type 2 diabetes first develop insulin resistanceInsulin is a hormone that helps the body use sugars from food as fuel. When the body is insulin-resistant, it doesn’t use insulin efficiently. Because insulin isn’t helping sugar into cells to be used as energy, sugar stays in the bloodstream, causing blood sugar levels to rise.

In response, the pancreas — the organ that makes insulin — produces more and more insulin to try to bring blood sugar levels down. Eventually, the pancreas can’t keep up with the demand, and type 2 diabetes develops.

There are a number of medicines available for adults with type 2 diabetes, Dabelea said, but treatment is more limited in young people with type 2 diabetes. They can make lifestyle changes and take insulin and the drug metformin, which makes the body more sensitive to insulin.

Type 1 diabetes is an autoimmune disease. Weight doesn’t play a role in causing type 1 diabetes. Instead, the body’s immune system mistakenly attacks the insulin-producing cells in the pancreas. So many cells are destroyed that the pancreas makes little to no insulin.

To survive, people with type 1 diabetes must take multiple daily insulin injections or receive insulin through a tiny catheter placed underneath the skin that attaches to an insulin pump. But, unlike people with type 2 diabetes, their bodies can efficiently use insulin.

The study included more than 1,700 young people with type 1 diabetes and nearly 300 with type 2 diabetes. They were treated in five different locations in the United States between 2002 and 2015.

The average age of the those with type 1 diabetes was 18, and three-quarters were white. For those with type 2 diabetes, the average age was about 22, and only about one-quarter were white, according to the report.

Both groups had diabetes for about eight years. Their blood sugar levels were similar, the study showed.

The researchers found that almost 20 percent of the type 2 group had early signs of possible kidney disease, as did 6 percent of those with type 1 diabetes.

Dr. William Cefalu, chief science, medical and mission officer for the American Diabetes Association (ADA), pointed out that a number of factors can affect test results for early kidney disease, and this study only looked at one test.

The study also found that 9 percent of those with type 2 diabetes had early signs of eye disease, as did nearly 6 percent of the type 1 group.

Arterial stiffness was seen in 47 percent of those with type 2 diabetes and less than 12 percent with type 1 diabetes. Twenty-two percent of those with type 2 diabetes and 10 percent of those with type 1 diabetes had high blood pressure.

Dabelea said those two complications were the most concerning, because they may not be as reversible with good disease management as the other complications.

Factors other than obesity may play a role in the differences between the two groups of patients, the researchers noted. For example, type 2 may be a more aggressive disease in children. It’s also possible that the limited treatment options for type 2 diabetes affected the rate of complications.

Dabelea also noted that kids with type 2 diabetes were a more diverse population. They may have come from economically disadvantaged families with less access to health care.

Cefalu said he wasn’t “really surprised by the study’s findings, but the statistics are startling, given that these are youth and adolescents.”

He said parents and physicians should see this study as “a call to action to have a heightened awareness that complications are present at a high rate.”

Blood sugar management can help stave off these complications. Losing weight is helpful for kids with type 2 diabetes, and regular physical activity can make a big difference. Make sure your child’s blood pressure is being measured, and that their kidney health is tested, Cefalu added.

Also, get your child’s eyes checked by an ophthalmologist, Cefalu suggested. For kids with type 2 diabetes, annual eye exams should begin right after diagnosis. For those with type 1 diabetes, eye exams are recommended starting five years after diagnosis, according to the ADA.

Cefalu also noted that parents and providers need to keep in mind that there are treatments available for diabetes complications.

The findings were published Feb. 28 in the Journal of the American Medical Association.
Copyright © 2017 HealthDay. All rights reserved.

SOURCES: Dana Dabelea, M.D., Ph.D., professor, epidemiology and pediatrics, Colorado School of Public Health, Aurora; William Cefalu, M.D., chief science, medical and mission officer, American Diabetes Association; Feb. 28, 2017, Journal of the American Medical Association