Action against a health crisis costing South Africa R33 billion a year is being crippled by denialism, stigma and prejudice reminiscent of the early days of HIV.
Currently 50% of South Africans are obese or overweight ‒ and as today marks World Obesity Day, experts have warned this figure could rise by 10% if immediate measures are not put in place.
They warn that the misconception that these conditions are “simply about calories in and calories out, and can therefore be solved with willpower, a calorie-restricted diet and exercise” must be debunked.
Scientists and activists want more prevention in place, public opinion leaning more towards science and less profit at the cost of people’s health and easier access to medical interventions.
While sugar is singled out as “enemy number one”, they have lashed out at advertising campaigns to promote sweetened drinks and processed foods.
Professor Karen Hofman, director of Priceless SA (Priority Cost Effective Lessons for Systems Strengthening) based at Wits University's School of Public Health, blames liquid sugar – contained in soft and energy drinks – as a leading cause of obesity.
“Over the last couple of decades sugary beverage companies have seen South Africa and indeed sub-Saharan Africa as the growth market,” she said. “They are pushing their products here because in the Global North, in North America and Europe, people are drinking much less of these things.
“The vector here,” she added, “is not a virus or a mosquito, it is advertising.”
Hofman said one of the best ways of curbing the amount of sugar being consumed was to use a sugar tax.
“Studies into the use of sugar tax has shown that it can reduce consumption by a third.”
A study conducted last September by senior researcher Micheal Boachie, also from Wits, stated that overweight and obesity were costing South Africa’s health system R33bn a year.
“This represents 15.38% of government health expenditure and is equivalent to 0.67% of GDP. Annual per person cost of overweight and obesity is R2 769.”
Obesity is believed to account for 80–85% of the risk of developing Type 2 diabetes and contributes directly to cardiovascular risk factors, hypertension, and sleep disorders.
Boachie said that among the most expensive conditions to manage were diabetes and cardiovascular diseases. Diabetes and hypertension-related conditions are among South Africa’s top ten causes of death, he said.
“Half of all adults in South Africa are overweight (23%) or obese (27%),” said Boachie. “And the World Obesity Federation anticipates an additional 10% increase (37%) in obesity among adults by 2030.”
Nzama Mbalati, the head of programmes at Heala, a coalition of civil society organisations advocating for equitable access to affordable and nutritious food, called for a packet of interventions to curb obesity.
“We believe that the fiscal policy can be used to incentivise and encourage South Africans to reduce sugar consumption and the consumption of ultra-processed foods,” he said.
“We don’t have control over the food that ends up on the table, so regulation is important. What we have also been doing is using the media to build awareness through information and education programmes.”
But one of the problems, according to Mbalati, is that ultra-processed foods are cheap and accessible. Eating fast food is also seen as a status item. He points to the Vhembe district in Limpopo, where diabetes Type 2 is now the leading cause of death, even though many households grow their own vegetables and fruit.
“Many will rather sell the vegetables and fruit and use the money to buy less nutritious food,” he said.
Professor Francois Venter of Wits’ Faculty of Health Sciences said research showed that exercise and dieting only occasionally achieved sustainable weight loss.
“Make no mistake, eating properly and being active is very, very important for good health. But it won’t make you lose weight, except in the very short term, other than in a small percentage of people.
“Weight is like a thermostat; the body is constantly trying to reset to a set weight it considers ‘normal’, often through increasing hunger – and that set point can only go up. Remarkably, and depressingly, the only reliable thing that leads to sustained weight loss is bariatric surgery and currently expensive medications.”
Venter said researchers began to dispense these medications to patients who could afford them, under the watch of an experienced Wits endocrinologist.
“All the medications suppress appetite, thereby fooling the ‘set point’. Some medications are oral, often taken twice daily; some are injectable, either taken daily or weekly, depending on what you can afford or on stock availability.
“They are all very fiddly, most needing the dose to be slowly increased, which requires a health worker nearby. All the medications have minor side effects and need monitoring; serious stuff is rare, although experience with the very new agents is limited.”
Everyone lost weight.
“The clinical trial reports vary – from about 7% to as much as 20% weight loss in just over a year. Regrettably, if you stop the medication, weight steadily comes back, just as what happens with high blood pressure and diabetes medication, so people with obesity may be on some form of these drugs permanently.”
Venter, who has extensive experience working with HIV, remarked: “It feels like we are back to HIV in the year 2000: we have a condition affecting millions of South Africans that has stigma and prejudice attached to it. We have a complex therapy that is hopelessly and unjustifiably unaffordable.
“And we have medical aids that won’t pay for it, and governments with no plans for it. Yet again, activist organisations like the Heala coalition and Priceless-SA are wading in to take on the sugar and food industries, which don’t want labels on what you are eating.”
Maria van der Merwe, president of Adsa (Association for Dietetics in South Africa) said the continued rise in the number of people who are overweight or obese, “despite constant public health messaging to raise risk awareness, points to the fact that we need to move beyond the persistent misperceptions and stigmas to focus on scientific research results. Obesity is a medical condition that results from complex, converging factors, of which many are out of the control of a person living with obesity,” said Van der Merwe.
“It’s time to debunk myths that these conditions are simply about calories in and calories out, and can therefore be solved with willpower, a calorie-restricted diet and exercise. It’s time to talk about the impacts of social shaming and the lack of acceptance of the diversity of human bodies. These are powerful conversations that we need to have as a nation where overweight and obesity are threatening the health and well-being of a staggering half of our population.”
The Independent on Saturday