Curing the obesity epidemic

Individual behaviour and commercial factors fuel this unhealthy state of the nation

IT IS no secret that many South Africans are overweight or obese. The statistics are staggering: 68% of women and 31% of men are either overweight or obese and 13% of children under the age of 5 are overweight – which is double the global average of 6.1%.

Obesity is a major risk factor for a variety of diseases, including diabetes, cardiovascular diseases and cancer to name a few. It is therefore not surprising that there are an estimated 3.5 million diabetics and an additional 5 million pre-diabetics in South Africa.

Obesity also weights the economy. One estimate suggests the South African economy loses more than R700billion per year as a result of obesity-related loss of productivity, absenteeism, presenteeism and medical costs.

A number of factors are associated with the rise in obesity – which illustrates it is a complex phenomenon. These include, at the individual level, shifts in dietary intake with the replacement of home-cooked meals largely comprising unprocessed foods with processed foods purchased from fast food outlets, increased consumption of foods rich in fats, sugar and salt and low in fibre and decreased levels of physical activity with more sedentary lifestyles.

Other contributing factors are the rise of supermarkets as opposed to farmers’ market, fast food outlets as opposed to wholesome homemade meals using fresh ingredients and the marketing of prepared foods which often target children have contributed to the rise of obesity. Most food labels are also not easily understood by consumers – so we often do not know what we are consuming.

South Africa has done well in regulating salt and trans fats and taxing sugar sweetened beverages. Many countries have shown that front-ofpackage labelling and including the number of calories on menus in restaurants and on prepared meals provide consumers with additional information on which to base their choices.

These are supported by the World Obesity Federation, which proposes the following steps to limit the commercial determinants of obesity: restrictions on marketing foods and drinks to children; taxes on sugar-sweetened beverages; front-of-pack labelling; and limiting portion and package sizes. In addition, the federation urges policymakers to create safe spaces for physical activity.

The Department of Health has engaged the food and beverage industries over the years. In 2015, these sectors volunteered to self-regulate 15 issues by 2020. Here are some examples of what they committed to do:

Dairy: Increase the number of products with low or no added sugar.

Snacks, treats, fats, canned fruits and baked goods: Increase awareness of the energy, sugar, total fats, saturated fats and salt. Non-alcoholic beverages:

Increase the range of non-alcoholic beverage options within company portfolios that help consumers in reducing their kilojoule intake. Grains, cereals and bread:

Increase the availability of breakfast cereals with less added sugar.

Quick service restaurant: Provide “better-for-you” choices of food, including non-alcoholic drinks, as part of offering consumers the opportunity to make smarter food choices.

Wholesale and retail: Significantly increase better-for-you options in aisles and check-out areas.

We are yet to formally and independently evaluate the extent to which these sectors have fulfilled their obligations to self-regulate, a cursory review of what is being sold shows little real change. In a recent meeting with these sectors, they again committed to change and to report on what they achieved and what they haven’t.

We have to accept that self-regulation has its limits. The department has legislated in a number of areas. For example, in the case of trans fats in 2011 and salt in 2016. In addition, National Treasury levied a so-called sugar tax on sweetened beverages which came into effect in April 2018.

Clearly, we continue to work with the various sectors to facilitate more rapid self-regulation. We will work with the sectors to further reduce salt use in fast food outlets and restaurants, decrease portion sizes, decreasing sugar in cereals, stop stacking unhealthy snacks in checkout aisles, eliminating adverts of foods with sweetened beverages and promote water instead, promote and sell fruit and vegetables at affordable prices, show the calorie content of prepared food and elimination of advertising of processed foods to children, etc. However, this will need to be complemented with additional regulation.

Work is advanced on front of package labelling with warning labels to show the sugar, salt and fat content for example. Changing the environment as described above is critical to reducing levels of obesity.

However, the individual too should bear some responsibility, including eating right and exercising.

We need a combination of government regulation, responsible action by the food and beverage industries as well as individuals working together to ensure a healthier South Africa.