Getting right to the heart of obesity and the risks involved

SEPTEMBER is Heart Awareness Month in South Africa and the theme is “power your life”. The aim is to highlight how small positive changes to unhealthy behaviours can empower South Africans to live free from heart disease. Obesity is one consequence of an unhealthy lifestyle we have the power to change.

Heart disease is the number one cause of death worldwide, and the burden is increasingly shifting to low- and middle-income countries.

South Africa has not escaped this trend, and in 2015 diseases of the cardiovascular system and diabetes claimed 106 000 lives in South Africa.

A third of these deaths occurred between the ages of 45 to 64, making them almost entirely preventable. The impact of obesity on heart diseases is often underestimated. Some even argue that not all who are overweight will be adversely affected by their extra weight – the so called “obesity paradox” or “fat-but-fit” phenomenon.

While it is true that not all overweight people are affected equally by high blood pressure and abnormal cholesterol levels, these conditions become increasingly more common with duration and severity of obesity.

Obesity is also a direct independent risk factor for heart disease even in the absence of these conditions. When obesity eventually leads to diabetes, this increases the risk of heart disease and stroke two to fourfold.

South Africa’s obesity prevalence is approximately 40% in females and 12% in males. Yet these figures underestimate the true scale of the problem as they are based on body mass index, which does not account for body fat distribution. Body fat around the abdomen is a far greater predictor of cardiovascular disease and diabetes.

In the national SA National Health and Nutrition Examination Survey study, nearly 40% of males and over 80% of females aged 45-64 years had a waist circumference indicating excessive abdominal fat.

Globally the rise of obesity can be attributed to a socio-economic transition and changes to eating patterns and physical inactivity. An “obesogenic” environment makes it easy to become overweight, and requires evasive action to stay lean.

South Africa’s history of inequality has resulted in a large portion of the population relying on a monotonous diet often devoid of nutrient-rich foods.

Over the last few decades, a modern diet has rapidly become more accessible, but mainly as cheap highly-processed energydense, nutrient-poor foods.

Individuals who grew up with food shortages are further biologically predisposed to weight gain and diabetes when subsequently exposed to an ad-libitum food supply.

As a consequence, obesity figures are set to rise.

To battle obesity, the contributing factors need to be addressed holistically. On an individual level this requires improved education and awareness, early detection of obesity particularly in children, and treatment services for existing obesity – which is largely absent.

Population-level change is important to make healthier choices affordable, accessible, and desirable.

The much-debated sugar tax is a good example of how policy can start to stem the obesogenic tide. Similarly, legislation to limit advertising of unhealthy foods may seem draconian, but can shape better eating habits among children.

Such attempts to change the obesogenic environment can only be successful with collaboration from all sectors.

The Heart and Stroke Foundation SA advocates for a healthier environment and encourages individuals to change unhealthy behaviours.

During Heart Awareness Month the foundation calls on individuals to have their weight and waist circumference measured for free, together with their blood pressure, blood cholesterol and blood glucose levels*.

The foundation further calls on individuals, civil society and the corporate sector to join the fight against an environment that encourages obesity.

Even small changes can make a powerful difference – funding a community exercise initiative, banning a vending machine outside a hospital ward or swopping a daily packet of crisps for a fruit.

*Free testing is available nationwide until October 15. See www.heartfoundation.co.za for more details.

Eksteen MSc RD, for the Heart and Stroke Foundation South Africa.