National Obesity Week: Obesity and its impact on our nation, cost of living and the state

National Obesity Week: Obesity and its impact on our nation, cost of living and the state

Obesity has become a worldwide pandemic in its own right. Not only does excessive weight gain come with a barrage of health issues, but also has severe implications on one’s psychological health. Obesity rates in South Africa have steadily increased over the years, especially in the younger population. This should serve as a notable warning sign for country officials, medical professionals and civilians alike. So, what issues does this pose for the future of the country’s populace in terms of health and well-being? We will be taking a closer look at the consequences of obesity due to a poor diet that is high in sugar and processed carbohydrates, and how this can affect under-resourced communities. 

Notably, In 2016 South Africa was ranked 30th in world obesity with a 28.3% obesity rate, this being the percentage of adults within the population that are considered obese. This statistic is not very far off from the USA’s. The USA has a 36.2% obesity rate as of 2016 and ranks 12th on this list. The stark difference between South Africa and the USA is that South Africa is a developing country and has a relatively larger low-income population. This brings its own issues to the obesity dilemma. 

Unfortunately, under-resourced communities often lack the education and understanding of what a healthy, low carb-whole foods diet entails. Individuals will often turn to foods that are highly processed and dense in carbohydrates such as bread, samp, pap and pastries. These foods are often more readily accessible in their communities and are significantly cheaper than healthier low-carb options. Consumers are often unaware of the large amounts of sugar that are hidden in highly processed and refined foods and will frequently find themselves eating more food than what is necessary because of this. This leads to families consuming meals that contain a substantial amount of calories, sugar and refined carbohydrates, and are low in nutritional value. Sadly, the consumption of these unhealthy processed foods will often lead to obesity and other metabolic health conditions.  

South Africa has a relatively young population with 35% of inhabitants being younger than 18 years old. It has been estimated that at least 13% of South African children under the age of 5 years are overweight or obese and the stats are only predicted to increase further. This means that there exists a likelihood that children will present with impaired glucose tolerance or T2DM at a far younger age. This will put a massive strain on the public health system, as well as being an incredible financial burden for the state.  A study conducted by Erzse et al. in 2019 recorded that 240 000 patients were diagnosed in 2018 with T2DM and were being treated in the public health sector. The total cost to the state is estimated at a whopping ZAR 2.7 billion, and it is projected that there will be 4.5 million patients diagnosed with T2DM within the public health system by 2030. This does not bode well for the country.

A study, that was published in 2020, was conducted to ascertain the prevalence of overweight and obese school children in Cofimvaba, a rural area in the Eastern Cape. The Eastern Cape was chosen as it is the largest and second poorest province in SA. At least 50% of households are food insecure and are located in rural districts. 211 school children, all between the ages of 6-19 years, were selected at random from 5 different public schools within the Cofimvaba area, 109 of which were girls and 102 were boys. It was found that 21.1% girls and 7.8% boys were overweight, and 4.6% girls and 1.0% boys were obese. Although these statistics are not representative of the entire youth population in SA, it is indicative that obesity is ubiquitous in the country’s younger and poverty-stricken population. It was also shown that the prevalence of overweight and obesity was significantly higher in girls than in boys, both by Body Mass Index (BMI) and Mid-Upper Arm Circumference (MUAC). It was shown that MUAC and BMI are closely correlated to one another, and MUAC was shown to be a good predictor for overweight or obesity. Furthermore, MUAC is considered to be a simple, cheap and sensitive screening tool that can be effectively utilised in under-resourced communities. Therefore, the increased obesity amongst children makes us question what children are being fed and if sedentary lifestyles are unconsciously being promoted by parents. 

A possible reason behind the study findings is that the households are located far from grocery stores that stock quality healthy food options, such as unprocessed meats and poultry, good fats, eggs and non-starchy vegetables. Furthermore, the households lack the necessary income to provide the aforementioned whole foods that are part of a healthy diet. The majority of the adult population that was observed in the Eastern Cape had low levels of education, with most having not completed any form of secondary education. This is potentially another contributor to the lack of knowledge surrounding healthy diets. Unfortunately, behaviour is taught at home and most children in such households will continue unhealthy eating habits, which will in turn be passed onto the next generation.

Many adverse health effects have been linked to obesity, particularly T2DM, and being obese increases your chances of developing the condition.  Individuals with T2DM cannot effectively metabolise glucose due to low production of insulin and cells become insulin resistant. Thus, T2DM patients present with high levels of glucose within the blood. Obesity is a chronic condition that directly influences the ideal health state of an individual by stimulating the release of a number of inflammatory mediators, such as TNF-α and interleaukin-6, both of which have been linked to causing a pro-inflammatory and oxidative state within the body. An oxidative state within the body is essentially when there is an imbalance of free radical and antioxidant activity. This constant state can cause unnecessary stress on the cardiovascular system and neurological system. Although oxidation is a natural process within a healthy individual, obesity exacerbates the process and the development of hypertension, atherosclerosis and possible Alzheimer’s will occur in the long-term if not prevented.

Luckily, an LCHF lifestyle has shown multiple advantages in preventing and reversing obesity and the onset of other metabolic disorders. Studies have shown that individuals have been able to curb hunger, as well as maintain normal blood glucose levels, by consuming products that are low in carbohydrates and high in healthy fats. T2DM patients have shown to have greater improvement in the control of blood glucose levels and a decrease in hyperglycemic episodes. Individuals on an LCHF diet often experience reduced body fat percentage, as well as a decline in triglycerides and LDL cholesterol levels and an increase in HDL-cholesterol levels. Additionally, the levels of C-reactive protein, a pro-inflammatory marker, was seen to lower in obese individuals. High C-reactive protein is thought to be associated with heart disease.

To end off, maintaining a healthy LCHF diet, low in sugar and carbohydrates, is essential for supporting a healthy, happy body. Moreover, promoting healthy habits in children at a young age is crucial for preventing unnecessary medical complications later on in their lives. By cementing these fundamentals children will develop into healthy adults that are informed on metabolic issues, such as heart disease, diabetes and neurological disorders, and can prevent this in the next generation. 

Current research conducted by Georgina Pujol-Busquet, a PhD Researcher, has shed some light on how a diet high in sugar, refined carbohydrates and poor quality oils, increases the risk for developing chronic diseases such as obesity, type 2 diabetes and cardiovascular disease. The purposes of the study were to collect health data from a total of 32 participants that were recruited for the study in July 2019. Comparisons were made between the health data before and after the Eat Better South Africa (EBSA) program. It has been specifically noted that individuals from low-income areas are affected more severely than others and woman are among those that are most affected by an unhealthy diet.

EBSA is a non-profit organisation committed to the education of under-resourced community members on the dangers of excessive sugar and carbohydrate consumption. The foundation’s goal is to teach communities to make better food choices through dietary education, meal and budget planning, and general nutritional awareness. You can find out more about EBSA and their affiliates here.  

The Nutrition Network is a wonderful education and networking platform founded by The Noakes Foundation. Specialised training courses have been curated for healthcare professionals across all disciplines to gain knowledge on the latest and most up-to-date science and research in the field of Low Carb Nutrition. The purpose is to equip medical professions with the necessary skills on low-carb nutrition to practically apply it in their fields. The Nutrition Network’s latest training in its elective module series provides a comprehensive and robust guide on the prevention and treatment of obesity. Obesity: Risk & Reversal has been awarded 12 CPD hours.  You can visit the Nutrition Network here to learn more about their programs.

References:

2017, Type 2 diabetes in children: an emerging epidemic. Health24, viewed October 20, 2020, <https://www.health24.com/Medical/Diabetes/Diabetes-children-and-teens/Type-2-diabetes-in-children-an-emerging-epidemic-20120721>

2018, Obesity in children, Diabetus Focus eMag, viewed October 21, 2020 ,  <https://www.diabetessa.org.za/obesity-in-children/>

2019, Early Detection and Referral of Children with Malnutrition, Mother and Child Nutrition, viewed October 21, 2020 , <https://motherchildnutrition.org/early-malnutrition-detection/detection-referral-children-with-acute-malnutrition/interpretation-of-muac-indicators.html>.

Dix, M., 2018, Everything You Should Know About Oxidative Stress, Healthline, viewed October 22, 2020  , <https://www.healthline.com/health/oxidative-stress>.

Ellulu, M.S., Patimah, I., Khaza’ai, H., Rahmat, A. & Abed, Y. (2016). ‘Obesity and inflammation: the linking mechanism and the complications’, US National Library of MedicineNational Institutes of Health, 13(4), pp. 851–863.

Erzse, A., Nicholas Stacey, N, Chola, L., Tugendhaft, A., Freeman, M.  & Hofman, K. (2019). ‘The direct medical cost of type 2 diabetes mellitus in South Africa: a cost of illness study’, Global Health Action, 12, (1).

Kubala, J. , 2018, The LCHF Diet Plan: A Detailed Beginner’s Guide , Healthline, viewed October 22, 2020 , <https://libguides.ioe.ac.uk/c.php?g=482485&p=3299866>.

Millington, A., 2019, South Africa has just been ranked the unhealthiest country on earth, Business Insider South Africa, viewed 20 October, 2020, < https://www.businessinsider.co.za/most-unhealthy-countries-in-the-world-ranked-2019-3>

Otitoola, O., Oldewage-Theron, W. & Egal, A. (2020). ‘Prevalence of overweight and obesity among selected schoolchildren and adolescents in Cofimvaba, South Africa’, South African Journal of Clinical Nutrition.

Thebus, S., 2019, 13% of SA children younger than 5 years old are overweight – report, IOL, viewed October 21, 2020 ,  <https://www.iol.co.za/capeargus/news/13-of-sa-children-younger-than-5-years-old-are-overweight-report-39203247>

About the author:

Shannon Mace has a BSc degree in Human Life Sciences from Stellenbosch University, she majored in biochemistry and physiology. She has a keen interest in metabolic physiology and hopes to further her studies in the subject. Shannon has joined The Noakes Foundation as a researcher, as well as an administrator. She looks forward to helping the foundation promote healthier living and happier lifestyles.