Durban — Experts are urging the government to take steps to curb the country’s growing obesity crisis, linked to non-communicable diseases (NCDs), which account for three of the top four causes of death nationally.
The Healthy Living Alliance (Heala) says urgent action is needed as deaths from NCDs in the country increased by almost 60% between 1997 and 2018.
A group of scientists have called it a “calamitous threat” to the lives of South Africans and likened it to the HIV epidemic in the 1990s.
Heala acting CEO Nzama Mbalati said research showed that about one in eight South African children were overweight, double the global average.
He urged the government to stringently regulate the food environment to limit the consumption of unhealthy food.
“Taxation is one of the practical and effective ways of addressing overconsumption of an unhealthy product,” he said.
Mbalati said since the sugar tax was implemented, it had only increased minimally in 2018, 2019 and 2020, adding that it should be adjusted annually, like taxes on alcohol and tobacco were.
He called for the Health Promotion Levy (HPL) on select sugar-sweetened beverages to be increased from its current 11% to 20% while unhealthy food should also have “front-of-package warning labels” to help consumers make better choices.
Mbalati said the food industry spent billions annually on marketing geared towards children, and sweets were easily accessible: “They are in the aisle where you pay so it’s not easy to avoid.”
Mbalati said the most important issue was to ensure that healthy food was cheaper and that the taxes and levies on unhealthy foods were collected.
National Department of Health spokesman Foster Mohale said reducing obesity required a multi-sectoral approach and reducing sugar intake was a key factor.
“Since the inception of the sugar tax, no new studies have been conducted to determine the prevalence of obesity. However, studies conducted post implementation confirmed a decline in the consumption of sugar sweetened beverages. Nationally, urban household purchases of taxable beverages by volume fell by 51% and there was a 29% decrease in sugar intake.”
He also cautioned about the coexistence of obesity and undernutrition, known as the double burden of malnutrition (DMB) which happens when people’s diets are energy-dense but nutrient-poor.
“This means they may be getting an excess of calories, often from ultra-processed and high-calorie foods which may lack essential nutrients like vitamins and minerals. Undernutrition is not just about the quantity of food but also the quality. Even if individuals consume high calories leading to obesity, they may still be deficient in essential vitamins and minerals crucial for overall health. This deficiency can contribute to undernutrition despite excess calorie intake,” said Mohale.
He said from 1994 to 2012, South Africa had an overall increase in energy intake.
“In particular, the consumption of processed and packaged food, such as sugary drinks, sauces, dressings and condiments, and sweet and savoury snacks had the most drastic increase (>50%). The consumption of energy-dense but nutrient-poor foods can contribute to obesity and undernutrition. Consumption of a balanced and nutrient-rich diet is needed.”
He said clinics and hospitals could provide nutrition assessment, education, counselling and support.
The World Obesity Atlas 2022 predicts that 50% of South African women will be not just overweight, but obese by 2030, the highest predicted rate on the continent.
According to MedicalBrief, a group of scientists writing in the SA Medical Journal called on the country to pay attention to the matter because “as with the HIV epidemic in the 1990s, we’re facing a calamitous threat to the health of the population that has been ignored for too long”.
They said weight-related diseases had eclipsed TB and HIV as leading causes of morbidity and mortality. Type 2 diabetes, stroke and heart disease, conditions all directly linked to obesity, accounted for three of the top four causes of death nationally and incur massive health system costs.
Maria van der Merwe, registered dietitian and president of the Association for Dietetics in South Africa, said obesity was a disease which needed medical intervention.
“When we talk about obesity, we talk about the disease and it means treatment. Overweight we can manage with a bit of discipline and lifestyle changes, but the moment you are at a body mass index (BMI) above 30, it is a clinical disease and we need to treat that disease.”
She said there were stock-outs of obesity management drugs for those who needed them because it was wrongly prescribed as a quick fix for weight loss. Obesity medication had to be used for life, she said.
“It’s not something you have to use for three weeks, drop the weight and carry on. So if a person with obesity is getting support, therapy, doctor intervention, physical intervention in terms of body movement to add to their medication, that is the full package they would probably have for the rest of their life. We're not looking at miraculous loss of body weight, we’re really looking at achieving a weight that’s sufficient to reduce the medical risk and that can be sustained. So unfortunately, the treatment (drugs) in my view is being abused.”
She said obesity also led to hormonal imbalances in women which could disrupt or stop ovulation.
Van der Merwe said new research showed that a 5% weight loss achieved “significant biochemical and overall health benefits” if that loss was sustained for six months. “So let’s say you weigh 100kg: a 5-10kg loss is sufficient to support changes in your body to reduce your disease risk.”
Wikus Engelbrecht, the communications director of ProVeg South Africa, said that while many experts focused on BMI, this did not take other factors into account like muscle mass, age, ethnicity, pregnancy, and body composition.
“It should also be stressed that the term does not consider mental health issues and weight management problems in relation to certain medication use, and that eating disorders also have the highest mortality rate of all psychiatric illnesses.”
Englelbrecht said good health was possible at different weight ranges and BMI was only one biometric in a complex mesh of medical indicators.
“In one study, researchers found that average BMI was lowest among vegans, while average BMI was highest among the meat-eaters. It shows an association between diet type and weight.”
Independent on Saturday