Important note: Information in this article was accurate in 2004. The state of the art may have changed since the publication date.
Sunday Times (Johannesburg) - October 3, 2004
Megan Power
The government will release reworked dietary guidelines for healthy eating, township walking clubs will be established and a major international obesity conference will take place in SA this month.
At the same time, an urgent multi-pronged prevention and management strategy is being developed by the Department of Health in line with the global battle against the bulge.
According to a Health Department study, more than half of SA's women are overweight or obese, with the figure for African women nearly 60%.
Fat intake among Africans has jumped almost 65% since 1940, when records first started being kept. Obesity-related diseases like hypertension and diabetes are spiralling.
More South African adults now die from obesity than from poverty. And researchers say they have encountered another phenomenon: that people associate weight loss with HIV and Aids.
But, says the government, breaking dangerous social and cultural perceptions around fat will be tough. According to research, many black women believe that if fat women lose weight, they are:
*HIV-positive;
*Not being supported properly by their husbands;
*Not as attractive or fertile.
The director of the Department of Health's chronic diseases, disabilities and geriatrics directorate, Dr Elamin Mohamed, said the social and cultural aspects of obesity were a "big challenge" and could not be ignored.
"The new dietary guidelines are just one aspect of a full-blown, multi-sectoral obesity prevention and management strategy being developed ... The earlier we implement this strategy, the better," he said.
The new guidelines contain simple health messages that are food-based (bread, meat and so on) and not nutrient-based (protein, carbohydrate and so on), as in the past.
Dr Thandi Puoane, a lecturer and researcher at the School of Public Health at the University of the Western Cape, said the institution's surveys in the Eastern and Western Cape had revealed that fat was associated with being healthy, and thin with having HIV and Aids.
"The women we speak to say that if they're fat and then lose weight, their communities will say they've got HIV/Aids. Even school kids are telling us this."
Women, especially those who had a "deprived" upbringing but who could now afford meat, wanted to eat it daily, she said, and bought fried meat from street vendors. Even if they wanted to eat low-fat foods, these were often not available in townships.
Black middle-class women were also affected. "It's taken them years to be able to afford cars after having to walk long distances most of their lives. Now we say they should walk more, few are willing to do it."
Puoane, with help from the Sports Science Institute, will launch the first walking club in Khayelitsha this week. If successful, more clubs will be opened in the Western Cape.
"South African women have gone from under-nutrition to over-nutrition," said Dr Krisela Steyn, head of the Medical Research Council's Chronic Diseases of Lifestyle Unit.
"They eat much more than they need, they are not physically active and many of them associate fat with wealth, health and success."
Chairman of the South African Society for the Study of Obesity, Professor Tessa van der Merwe, said obesity among black women was underdiagnosed for years, while the dire consequences went unrecognised. About 60 South Africans are affected by strokes and heart attacks daily and the World Health Organisation predicts that in the next 20 years, obesity-driven diabetes across sub-Saharan Africa will double.
"More people are now dying from obesity than from poverty," said Van der Merwe. "They are as malnourished but at a much higher weight."
Research also shows that undernourished children with stunted growth have an increased risk of becoming obese.
The results of the Department of Health's follow-up study to the first national obesity survey conducted in 1998 will be available only next year.
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