Take the scourge by the horns

Obesity is defined as excessive accumulation of fat in the human body 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 years are overweight or obese. Additionally, perceptions of weight and weight loss complicate the issue further in the country.

We tend to associate weight loss with negative connotations such as HIV/aids; therefore even if someone is overweight they fear that if they lose weight it could be interpreted that they are HIV positive. Some people believe that being overweight is a sign of affluence and wealth.

With political transition, 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 carbs.

Due to increased urbanisation, people are adopting a westernised diet, the food became “faster than us” and is high in bad fats, sugar and salt. Childhood obesity is associated with a higher chance of obesity, premature death and disability in adulthood. Obese children experience breathing difficulties, risk of fractures, hypertension, cardiovascular disease, insulin resistance and diabetes, and psychological effects.

Overweight/Obese

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 kilograms divided by the square of his height in metres (kg/m²). When the BMI is greater than or equal to 25, the person is overweight.

He/ she is obese if the BMI is greater than or equal to 30. This should be considered a rough guide and may not correspond for all individuals.

Central obesity (belly fat)

The fat that lies just below your skin in most of your body – 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, strength training twice a week minimum because building muscle burns fat; get enough sleep because sleep deprivation has been shown to cause weight gain, and avoid long sedentary positions.

Causes of obesity

The cause of obesity and overweight is an energy imbalance between calories consumed and calories used.

The increased intake of energy-dense foods that are high in sugar; and a decrease in physical inactivity due to the increasingly sedentary nature of many forms of work, changing modes of transportation, and increasing urbanisation, are largely responsible for the obesity epidemic.

The problem starts in childhood and continues into adulthood, with less than two-thirds of children participating in weekly physical activity. Our children spend more time sitting than playing.

The role of sugar

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 fatness when changing intake of sugars, and this is because of an alteration in energy balance.

A rapid weight gain occurs after an increased intake of sugars, therefore it seems reasonable to conclude that reduction of sugar intake is cardinal.

Dietary advice by the World Health Organisation highlights the need for a reduction in sugar intake to 5% of our energy intake. It is thought that adherence to the 5% recommended sugar intake would halt the increase in obesity.

Health Consequences

Obesity is a major risk factor for diseases such as:

• Cardiovascular diseases (mainly heart disease and stroke) ɳ Diabetes; musculoskeletal disorders (especially osteoarthritis, a highly disabling and painful disease of the joints);
• Some cancers (endometrial, breast, and colon). 5% recommended sugar intake would halt the increase in obesity.

How do we prevent obesity?

Apart from restricting the sugar we consume, individuals can also:

• Reduce calorie intake from sugary and starchy foods and increase intake from vegetables and proteins. Starchy foods include bread, potatoes, rice, pap, samp, pasta.
• Exercise for half an hour, five times a week (moderate intensity exercise) in the beginning, then increasing intensity and strength training with time depending on tolerability. Try work with an experienced trainer and your physician to prescribe the most relevant regimen for weight loss.Join a counselling or support group. Running clubs have been shown to work really well, especially to keep you motivated.
• There is also a lot of intervention that 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 many 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:

• Reducing the sugar and salt content of processed foods.
• Ensuring that healthy and nutritious choices are available and affordable to all consumers.
• Practicing responsible marketing – especially those aimed at children and teenagers.
• Ensuring the availability of healthy food choices and supporting regular physical activity practice in the workplace.