OP-ED

Obesity crisis threatens South Africa’s health system

By Johanna Ralston 19 September 2019
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No South African should be malnourished – whether overweight or undernourished – because they are too poor to eat healthy food, says the writer.

More than half of all South Africans are now classified as medically overweight or obese, and this has serious implications for the health system.

As urban centres continue to grow across Africa, South Africa vies for bragging rights as the continent’s economic powerhouse. But in terms of the number of people who are overweight or obese, there is one clear winner: South Africa.

According to the most recent World Health Organisation data, more than half of adults in the country are overweight or obese: more than a 10% increase in the last 25 years. In South Africa, undernutrition remains a major challenge, with rates far exceeding those expected, given its economic status. The impact on health systems, not just in South Africa, but globally, is unsustainable.

The government has been a pioneer in adopting a countrywide soda tax and this is a step forward. But without a programme to educate the South African public on the effects of obesity or a comprehensive national study which lays down a marker on the magnitude of the problem, it will not be enough to turn the tide.

Although the economy turned a corner in 2002, it currently finds itself much closer to the World Bank defined lower-middle income threshold than it does to high-income countries like the US and the UK. This is instructive in understanding how South Africa came to have such high levels of undernutrition and obesity.

As countries have developed economically, there has been a dramatic increase in the prevalence of obesity, especially in children. This happens primarily due to two factors.

First, access to unhealthy foods which are cheaper and more readily available than healthy food.

Second, an environment that creates barriers to physical activity, both in and out of work. This is frequently the case in the transition from rural to urban living, a phenomenon all too visible in South Africa where more than 64% of the population now live in cities.

South Africa also retains a characteristic typical of many developing countries: high exposure, especially among the poor, to undernutrition in the first years of life, followed by environments where unhealthy food choices are often the only choices, and where active work and transport have been replaced by sedentary labour, reliance on vehicles, and few places to safely and easily exercise.

A child with obesity often grows into an adult with obesity, a major risk factor for the world’s biggest killers, including cancer, diabetes and heart disease. The impact on the economy is also great, as productive years of life for working individuals is reduced, and the economy impacted by the costs of disability and absenteeism.

It is clear that the narrative around obesity must evolve to recognise the complex drivers of this disease. Primary healthcare workers must be the frontline of tackling obesity and must be properly trained to provide compassionate care. Better training in the health system, recognition of bias among providers as well as the public, and acknowledgement of obesity as a multifaceted disease are all strategies to improve how obesity is addressed in health systems.

There are proven and cost-effective public health measures that can have a major impact on tackling the obesity epidemic. In the earliest years, such priorities should include the promotion of exclusive breastfeeding for the first six months of life, not smoking while pregnant, increased birth spacing of children and ensuring women in pregnancy have access to quality nutrition.

Individuals of all ages should have access to health systems that can address their challenges, with obesity prevention, management and treatment integrated into Universal Health Coverage as an essential health service. Arming individuals with better information to make purchasing choices can be accomplished through front-of-pack nutrition labelling.

No South African should be malnourished – whether overweight or undernourished – because they are too poor to eat healthy food. A cross-government approach would ensure a more integrated strategy to tackle the obesity epidemic. President Cyril Ramaphosa has championed exercise as a part of healthy living and local government leaders also have a significant role to play in supporting the kinds of environments that will bend the curve on obesity.

The upcoming UN High-level Meeting on Universal Health Coverage, which will take place in New York next week, is an opportunity for South Africa’s political leaders to renew their commitment to reducing childhood obesity and highlight their regional leadership. It has not yet committed to doing so but there remains time for South Africa to demonstrate not only its status as an economic powerhouse but also its leadership in the fight against obesity. DM

Johanna Ralston is CEO of the World Obesity Federation and a fellow at the Geneva Centre for Security Policy. She serves on the WHO Civil Society Working Group for NCDs (non-communicable diseases).

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