Super Size South Africa
by Nils van der Linden
Posted Fri, 27 Aug 2004
You’ve probably heard of ‘Super Size Me’ – the movie about the American who ate nothing but McDonalds food for a month. But, beyond his personal ordeal, the film takes a long, hard look at the problem of obesity in the United States.
The statistics it hauls out speak for themselves: “60 percent of all Americans are either overweight or obese; if left unabated, obesity will surpass smoking as the leading cause of preventable death in America.”
But that’s America, a first world nation, where everything’s always bigger. Surely South Africa, a developing country with poverty issues, doesn’t have similar problems. Wrong.
“It’s a worldwide trend”, says Professor Tessa van der Merwe, “and South Africa is following in the world’s footsteps."
“It’s not only a disease of developed countries as was previously thought,” adds the Honourary Secretary of the International Association for the Study of Obesity.
The child factor
She highlights some broad figures for South Africa: one third of the adult male population is overweight, as is one out of every two women. And, the biggest cause for alarm, roughly one fifth of all children.
It can affect us all. Says Krisela Steyn of the Chronic Diseases of Lifestyle unit at the Medical Research Council: “Obesity has no respect for social class. It is equally distributed across South African classes.”
And it’s increasing. According to Mickey Chopra from the School of Public Health at the University of the Western Cape, the increase in obesity is happening the fastest among the poor, especially those in urban areas.
But is obesity really a problem?
In Van der Merwe's opinion, it is one of "mammoth proportions”. Classed as a chronic disease by the World Health Organisation, she emphasises that it is not just a cosmetic issue.
And according to ‘Super Size Me’, obesity has been linked to: hypertension, coronary heart disease, adult onset diabetes, stroke, gall bladder disease, osteoarthritis, sleep apnea, respiratory problems, endometrial, breast, prostate and colon cancers, dyslipidemia, steatohepatitis, insulin resistance, breathlessness, asthma, hyperuricaemia, reproductive hormone abnormalities, polycystic ovarian syndrome, impaired fertility and lower back pain.
And, documents a 2002 report by the World Heart Federation, the most common conditions caused by obesity (heart disease, diabetes-mellitus, high blood pressure and cholesterol) annually contribute to about 17 million deaths around the world.
SA's figures equally alarming
Figures in South Africa are equally alarming, according to the 2003/4 South African Health Review. The annual report on the nation’s health found that, when combined, all chronic non-infectious diseases usually associated with lifestyle (heart disease, strokes, cancer, chronic obstructive pulmonary disease and diabetes) result in 37 percent of deaths.
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Amongst the risk factors for these conditions? Poor diet, lack of exercise, high blood pressure, high cholesterol and obesity.
So, if we know about these dangers why is obesity on the increase?
Basically, the condition is caused by eating more food than what our body needs — compounded by our increasingly sedentary lifestyles. This upsets the balance between our energy intake (through eating) and expenditure (through body processes and physical activities). “We eat more food than we need,” says Steyn, simply.
Energy-conserving genes
Van der Merwe says that over millions of years our genes have been programmed to conserve energy — which was important for survival when food was scarce and humans had to work hard to obtain it. This energy preservation in our body persists, even though food is now readily available.
Although she highlights other factors — such as our stressful society, which can cause a physiological response that increases appetite — the issue of obesity remains primarily one of diet.
Particularly in urban areas, says the South African Health Report, there has been a change from traditional plant-based foods to “high fat, high sugar, energy dense, low fibre foods”.
It adds that these changes have been especially striking over the past few years “particularly with the growth of the fast food industry”.
Chopra points out that South Africa has one of the fastest growing markets for international fast food companies, as well as many home-grown chains. “The increasing levels of obesity have been shown to be linked to changes in diet that has increased markedly in saturated fats especially amongst the poor in urban areas,” he says.
Fast food outlets are advertising their products as modern, urban foods — resulting, he believes, in traditional methods of preparation being seen as less acceptable.
And, says Chopra, the cheapest forms of fast food come in the form of processed hooves and other off-cuts — only edible when fried and heavily salted.
But fast food companies are also guilty of adding sugars and fats for which humans have a biological fondness. With the aggressive marketing campaigns these are but two reasons why we eat fast foods even though we know they’re not healthy.
According to Chopra, there are many others, including the convenience and price: fast food is often more “cost-effective than cooking or other healthier options”.
Faced with such obstacles, what’s the solution to our obesity problem?
Healthy eating habits
Firstly “you have to watch what goes in your mouth”, says Van der Merwe. And how much.
The Nutrition Information Centre of the University of Stellenbosch advocates a diet that’s balanced, varied and features moderate quantities.
“Have a balanced diet — including fruit and vegetables, vitamins and roughage,” echoes Steyn.
And there are food groups to watch out for. “Overall, your diet should control the intake of fat, saturated fat, cholesterol, salt, sugar and alcohol,” according to information supplied by NICUS. “These in excess are known to promote diseases of lifestyle” which include obesity.
Minimise fatty foods, which are high in calories. Even so-called “good fats” — such as those found in nut, canola and olive oils as well as in seafood like salmon — should be taken in moderation. “Any fat, in excess, is deleterious to health, end of story,” says Van der Merwe. Fats shouldn’t exceed 35 percent of your caloric intake, she advises. And this includes less obvious fat — like the butter found in cake and cookies.
The World Heart Federation adds that avoidance of soft drinks, reduced salt intake and limiting alcohol to ‘one drink a day if you are female or two if you are male’ to the list.
The volume of food is also important: “If you eat more than your body expends, you will pick up weight, it’s as simple as that,” says Van der Merwe. Steyn suggests that if you’re already obese the “overall amount of calories taken in should be less than what we need so that the body can burn off some of its energy reserves”.
Exercise
Exercise also plays an important role, causing our bodies to expend more energy, although a bad diet can nullify its effect, says Chopra. Van der Merwe agrees. While exercise is valuable in the long run, you “can’t undo with exercise what you have done with your eating habits”.
“The balance just isn’t in your favour,” she explains. And a problem is that, through misinformation, people often overestimate the amount of calories spent while exercising.
“You would have to walk for seven hours straight to burn off a Super Sized Coke, fry and Big Mac,” offers ‘Super Size Me’.
“Awareness is important,” says Van der Merwe adding that people, especially parents, should be informed about obesity. For example, parents must understand that their obese children won’t ‘just grow out of it’. If a child is currently between 10 and 14 years old and has one obese parent, there’s an 80 percent chance that they will become an obese adult.
Obesity likened to asthma
If your child is obese or if you’re unsure, Van der Merwe recommends taking them to a doctor. She likens obesity to asthma, and say that overweight children should have a checkup. Diabetes that usually develops in obese adults, for example, is now increasingly being seen amongst obese children.
And if you’re an obese adult, a medical check up is even more important to rule out those diseases of lifestyle.
Parents should lead by example, says Steyn, by providing healthy, balanced meals for their children. But if you’re not sure what exactly constitutes a balanced meal, seek nutritional counselling: a professional dietician can work out an eating plan for yourself or your children. And it needn’t be expensive — many schools and community health centres provide the service.
Coupled with the healthy meals is cutting down on fast food. “You simply can’t have takeaways every night,” says Van der Merwe. And, likewise, your kids must be discouraged from demanding the high calorie sugar rush provided by fast food.
Curb fast food advertising
Chopra, whose work was recently published in the British Medical Journal, provides a possible solution to curbing childrens’ demands for junk food: restrictions on fast food companies strategies' targeting kids.
“I would support initiatives that are underway in countries such as the UK where they are seriously contemplating controls on advertising to children, the provision of free gifts and the sponsorship of events aimed at children by fast food companies,” he elaborates.
It’s been suggested that curfews be initiated on British TV so that ads for fast foods and fizzy drinks are limited before certain times when children are more likely to be watching.
According to ‘Super Size Me’, the average American child sees 10 000 TV adverts per year. There’s a scene in the film where a group of five-year-olds are asked to identify images of certain people. The majority can’t identify the likes of George W. Bush or Jesus Christ. All recognise Ronald McDonald.
The lure of free toys
Chopra also reasons that it’s very difficult for parents to resist a child’s demands for the free toys accompanying meals — which retailers are clearly using to target the pre-teen market.
But what about adults? Says Chopra: “We know from research in the UK, US, Europe, and eastern countries like China that health education has a very limited impact.”
This is because “it’s very difficult to change people's eating habits unless deeper changes occur”. These proposed changes: the increased availability of healthy alternatives to fatty junk foods and the curbing of fast food advertising.
Sound harsh? Chopra offers the lessons taught by smoking. Education, in the form of health warnings, didn’t do much to curb the use of cigarettes. Only when their prices increased through heavier taxation and tobacco advertising was curtailed did the numbers of smokers decrease.
Food for thought, indeed.
