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Obesity in South Africa: challenges for government and health professionals

Published online by Cambridge University Press:  02 January 2007

H Salome Kruger ,
Thandi Puoane ,
Marjanne Senekal  and
M-Theresa van der Merwe
H Salome Kruger*
Affiliation:
School of Physiology, Nutrition and Consumer Science, North-West University, Potchefstroom, 2520, South Africa
Thandi Puoane
Affiliation:
School of Public Health, University of the Western Cape, Bellville, South Africa
Marjanne Senekal
Affiliation:
Department of Physiological Sciences, University of Stellenbosch, Stellenbosch, South Africa
M-Theresa van der Merwe
Affiliation:
Senior Consultant Physician Endocrinologist, Johannesburg General Hospital, Johannesburg, South Africa
*
*Corresponding author: Email vgehsk@puk.ac.za
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Abstract

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Objectives

To review data on the prevalence, causes and health consequences of obesity in South Africa and propose interventions to prevent and treat obesity and related outcomes.

Methods

Data from existing literature were reviewed with an emphasis on changing eating and activity patterns, cultural factors, perceptions and beliefs, urbanisation and globalisation. Results of studies on the health consequences of obesity in South Africans are also reviewed.

Results

Shifts in dietary intakes and activity patterns to higher fat intakes and lower physical activity are contributing to a higher prevalence of obesity. Few overweight black women view themselves as overweight, and some associate thinness with HIV/AIDS. Glucose and lipid toxicity, associated with insulin resistance, play roles in the pathogenesis of the co-morbid diseases of obesity. Elevated free fatty acids in the black population predispose obese black patients to type 2 diabetes.

Conclusion and recommendations

Obesity prevention and treatment should be based on education, behaviour change, political support, intersectoral collaboration and community participation, local actions, wide inclusion of the population, adequately resourced programmes, infiltration of existing initiatives, evidence-based planning, and proper monitoring and evaluation. Interventions should have the following components: reasonable weight goals, healthful eating, physical activity and behavioural change. Genes and mutations affecting susceptibility to the development of co-morbidities of obesity and vulnerable periods of life for the development of obesity should be prioritised. Prevention should be managed in community services, identification of high-risk patients in primary healthcare services and treatment of co-morbid diseases in hospital services.

Keywords

ObesitySouth AfricaUrbanisationCultural beliefsDietPhysical activityInsulin resistance
Type
Research Article
Information
Public Health Nutrition , Volume 8 , Issue 5 , August 2005 , pp. 491 - 500
Copyright
Copyright © The Authors 2005

References

1International Association for the study of obesity (IASO). IASO Annual Review 2003–2004. London: IASO, 2004.Google Scholar
2Popkin, BM. The nutrition transition in low-income countries: an emerging crisis. Nutrition Reviews 1994; 52(9): 285–95.Google Scholar
3Steyn, NP, Labadarios, MB, Mauder, E, Nel, J, Lombard, C. Secondary anthropometric data analysis of the national food consumption survey in South Africa: the double burden. Nutrition 2005; 21: 4–13.CrossRefGoogle ScholarPubMed
4Mollentze, WF, Moore, AJ, Steyn, AF, Joubert, G, Steyn, K, Oosthuizen, GM. Coronary heart disease risk factors in a rural and urban Orange Free State population. South African Medical Journal 1995; 85(2): 90–6.Google Scholar
5Bourne, LT, Lambert, EV, Steyn, K. Where does the black population of South Africa stand on the nutrition transition?. Public Health Nutrition 2002; 5(1A): 157–62.Google Scholar
6Vorster, HH. The emergence of cardiovascular disease during urbanisation of Africans. Public Health Nutrition 2002; 5(1A): 239–43.CrossRefGoogle ScholarPubMed
7van der Merwe, MT. Obesity in South Africa – the southern tip of a big mountain. Continuing Medical Education 2001; 19: 549–50.Google Scholar
8Steyn, NP, Nel, JH, Tichelaar, HY, Prinsloo, JF, Dhansay, MA, Oelofse, A, et al. Malnutrition in Pedi preschool children, their siblings and caretakers. South African Journal of Clinical Nutrition 1994; 7: 12–8.Google Scholar
9Mvo, Z, Dick, J, Steyn, K. Perceptions of overweight African women about acceptable body size of women and children. Curationis 1999; 22(2): 27–31.Google Scholar
10Walker, ARP, Walker, BF, Manetsi, B, Tsotetsi, NG, Walker, AJ. Obesity in black women in Soweto, South Africa: minimal effects on hypertension, hyperlipidaemia and hyperglycaemia. Journal of the Royal Society of Health 1990; 110(3): 101–3.Google Scholar
11Levitt, NS, Katzenellenbogen, JM, Bradshaw, D, Hoffman, MN, Bonnici, F. The prevalence and risk factors for NIDDM in urban Africans in Cape Town, South Africa. Diabetes Care 1993; 16(4): 601–7.CrossRefGoogle ScholarPubMed
12Levitt, NS, Steyn, K, Lambert, EV, Fourie, JM, Rossouw, K. Modifiable risk factors for type 1 diabetes mellitus in a peri-urban community in South Africa. Diabetic Medicine 1999; 16(11): 946–50.Google Scholar
13Kruger, HS, Venter, CS, Vorster, HH. Obesity in African women in the North West Province, South Africa is associated with an increased risk of non-communicable diseases: the THUSA study. British Journal of Nutrition 2001; 86(6): 733–40.CrossRefGoogle ScholarPubMed
14World Health Organization (WHO). Integrated Management of Cardiovascular Risk. Report of a WHO Meeting, Geneva, 9–12 July 2002 Geneva Non-communicable Diseases and Mental Health Publication WHO. Geneva. WHO 2002.Google Scholar
15Allison, DB, Zannolli, R, Narayan, KMV. The health care costs of obesity in the United States. American Journal of Public Health 1999; 89(8): 1194–9.CrossRefGoogle ScholarPubMed
16World Health Organization (WHO). Obesity: Preventing and Managing the Global Epidemic. Report of a WHO Consultation. WHO Technical Report Series No. 894. Geneva: WHO,2000.Google Scholar
17Vorster, HH, Oosthuizen, W, Jerling, JC, Veldman, FJ, Burger, HM. The Nutritional Status of South Africans. A Review of the Literature from 1975–1996. Durban: Health Systems Trust, 1996.Google Scholar
18Cameron, N, Getz, B. Sex differences in the prevalence of obesity in rural African adolescents. International Journal of Obesity and Related Metabolic Disorders 1997; 21(9): 775–82.CrossRefGoogle ScholarPubMed
19Monyeki, KD, van Lenthe, FJ, Steyn, NP. Obesity: does it occur in African children in a rural community in South Africa?. International Journal of Epidemiology 1999; 28(2): 287–92.Google Scholar
20Cole, TJ, Bellizzi, MC, Flegal, KM, Dietz, WH. Establishing a standard definition for child overweight and obesity worldwide: international survey. British Medical Journal 2000; 320(7244): 1240–3.CrossRefGoogle ScholarPubMed
21 Medical Research Council. Umthente uhlaba usamila: The 1st South African National Youth Risk Behaviour Survey [online]. Pretoria: Department of Health, 2002. Available at http://www.mrc.ac.za/healthpromotion/healthpromotion.htmGoogle Scholar
22Popkin, BM, Richards, MK, Monteiro, CA. Stunting is associated with overweight in children of four nations that are undergoing the nutrition transition. Journal of Nutrition 1996; 126(12): 3009–16.CrossRefGoogle ScholarPubMed
23Jinabhai, CC, Taylor, M, Sullivan, KR. Implications of the prevalence of stunting, overweight and obesity amongst South African primary school children: a possible nutritional transition?. European Journal of Clinical Nutrition 2003; 57(2): 358–65.Google Scholar
24Mukuddem-Petersen, J, Kruger, HS. Association between stunting and overweight among 10–15-y-old children in the North West Province of South Africa: the THUSA BANA Study. International Journal of Obesity and Related Metabolic Disorders 2004; 28(7): 842–51.CrossRefGoogle ScholarPubMed
25Cameron, N, Wright, MM, Griffiths, PL, Norris, SA, Pettifor, JM. Stunting at 2 years in relation to body composition at 9 years in African urban children. Obesity Research 2005; 13(1): 131–6.CrossRefGoogle ScholarPubMed
26Kruger, HS, Margetts, BM, Vorster, HH. Evidence for relatively greater subcutaneous fat deposition in stunted girls in the North West Province, South Africa as compared to non-stunted girls. Nutrition 2004; 20(6): 564–9.CrossRefGoogle ScholarPubMed
27Hoffman, DJ, Sawaya, AL, Verreschi, I, Tucker, KL, Roberts, SB. Why are nutritionally stunted children at increased risk of obesity? Studies of metabolic rate and fat oxidation in shantytown children from Sao Paulo, Brazil. American Journal of Clinical Nutrition 2000; 72(3): 702–7.CrossRefGoogle ScholarPubMed
28Steyn, NP, Senekal, M, Brits, S, Alberts, M, Mashego, T, Nel, JH. Weight and health status of black female students. South African Medical Journal 2000; 90(2): 146–52.Google ScholarPubMed
29Cilliers, J. Impact of a multidimensional weight-management programme on the weight status and associated factors of first-year female students. MSc thesis, Nutrition Science, University of Stellenbosch, South Africa, 2004.Google Scholar
30Senekal, M. Weight fluctuations experienced by female students at university and guidelines for long-term weight management. PhD dissertation, Faculty of Natural Sciences, University of Stellenbosch, South Africa, 1994.Google Scholar
31Puoane, T, Steyn, K, Bradshaw, D, Laubscher, RFourie, J, Lambert, V, et al. Obesity in South Africa: the South African demographic and health survey. Obesity Research 2002; 10(10): 1038–48.CrossRefGoogle ScholarPubMed
32Steyn, K, Bourne, LT, Jooste, PL, Fourie, JL, Rossouw, K, Lombard, C. Anthropometric profile of black population of the Cape Peninsula in South Africa. East African Medical Journal 1998; 75(1): 35–40.Google Scholar
33Benade, AJS, Oelofse, A, Faber, M. Body composition of different ethnic groups in South Africa. Asia Pacific Journal of Clinical Nutrition 1996; 5(4): 226–8.Google Scholar
34Kruger, HS, Venter, CS, Vorster, HH, Margetts, BM. Physical inactivity is the major determinant of obesity in black women in the North West Province, South Africa: the THUSA study. Nutrition 2002; 18(5): 422–7.Google Scholar
35Senekal, M, Steyn, NP, Nel, JH. Factors associated with overweight/obesity in economically active South African populations. Ethnicity & Disease 2003; 13(1): 109–16.Google ScholarPubMed
36MacIntyre, UE, Kruger, HS, Venter, CS, Vorster, HH. Dietary intakes of an African population in different stages of transition in the North West Province, South Africa: the THUSA study. Nutrition Research 2002; 22: 239–56.CrossRefGoogle Scholar
37Khan, MK, Bowman, B. Obesity: a major public health problem. Annual Review of Nutrition 1999; 19: 13–17.CrossRefGoogle Scholar
38Chopra, M, Galbraith, S, Darnton-Hill, I. A global response to a global problem: the epidemic of overnutrition. Bulletin of the World Health Organization 2002; 80(12): 952–8.Google ScholarPubMed
39Vorster, HH, Wissing, MP, Venter, CS, Kruger, HS, Malan, NT, de Ridder, JH, et al. The impact of urbanisation on physical, physiological and mental health of Africans in the North West Province of South Africa: the THUSA study. South African Journal of Science 2000; 96: 505–14.Google Scholar
40May, J, ed. Poverty and Inequality in South Africa: Meeting the Challenge. Cape Town: David Philip Publishers, 2000.Google Scholar
41Ball, K, Mishra, G, Crawford, D. Which aspects of socioeconomic status are related to obesity among men and women?. International Journal of Obesity and Related Metabolic Disorders 2002; 26(4): 559–65.Google Scholar
42Renzaho, AMN. Fat, rich and beautiful: changing socio-cultural paradigms associated with obesity risk, nutritional status and refugee children from sub-Saharan Africa. Health and Place 2004; 10(1): 105–13.CrossRefGoogle ScholarPubMed
43Kumanyika, SK. Special issues regarding obesity in minority populations. Annals of Internal Medicine 1993; 119(7): 650–4.Google Scholar
44Kruger, HS, van Aardt, AM. Obese black women's knowledge of and attitude to weight control. Journal of Family Ecology and Consumer Science 1998; 26(2): 121–30.Google Scholar
45Puoane, T, Fourie, JM, Shapiro, M, Rosling, L, Tshaka, NC, Oelofse, A. [Big is beautiful] – an exploration of urban black women in South Africa. South African Journal of Clinical Nutrition 2005; 18(1): 6–15.CrossRefGoogle Scholar
46Senekal, M, Steyn, NP, Mashego, T-AB, Nel, JH. Evaluation of body shape, eating disorders and weight management related parameters in black female students of rural and urban origins. South African Journal of Psychology 2001; 31: 45–53.CrossRefGoogle Scholar
47Faber, M, Kruger, HS. Dietary intake, perceptions regarding body weight, and attitudes toward weight control of normal weight, overweight, and obese black females in a rural village in South Africa. Ethnicity & Disease 2005; 15(2): 238–45.Google Scholar
48Chopra, M, Puoane, T. Prevention of diabetes throughout an obesogenic world. Diabetes Voice 2003; 48: 24–6.Google Scholar
49Bourne, LT, Langenhoven, ML, Steyn, K, Jooste, PL, Nesamvuni, AE, Loubser, JA. The food and meal pattern in the urban African population of the Cape Peninsula, South Africa: the BRISK study. Central African Journal of Medicine 1994; 40: 140–8.Google ScholarPubMed
50Cress-Williams, L. Food micro-enterprises for food security in an urban slum community in East London: development of an awareness creating programme. MSc thesis, Consumer Science, University of Stellenbosch, South Africa, December, 1998.Google Scholar
51Kruger, HSVenter, CS, Vorster, HH. Physical inactivity as a risk factor for cardiovascular disease in communities undergoing the rural to urban transition: the THUSA study. Cardiovascular Journal of South Africa 2003; 14(1): 16–23.Google ScholarPubMed
52Maia, JAR, Prista, A, Marques, AT. Impact of physical activity and maturation in physical fitness. A path analytic study in youth from Maputo, Mozambique. In: Casagrande, G, Viviane, F, eds. Physical Activity and Health: Physiological, Epidemiological and Behavioural Aspects. Padua: Unipress, 1998; 147–56.Google Scholar
53Wyndham, CH. Mortality from cardiovascular diseases in the various population groups in the Republic of South Africa. South African Medical Journal 1979; 56(24): 1023–30.Google Scholar
54Seftel, HC, Asvat, MS, Joffe, BI, Raal, FJ, Panz, VR, Vermaak, WJ, et al. Selected risk factors for coronary heart disease in male scholars from the major South African population groups. South African Medical Journal 1993; 83(12): 891–7.Google Scholar
55Joffe, BI, Seftel, HC. Diabetes mellitus in the black communities of southern Africa. Journal of Internal Medicine 1994; 235(2): 137–42.CrossRefGoogle ScholarPubMed
56van der Merwe, MT, Crowther, NJ, Schlaphoff, GP, Gray, IP, Joffe, BI, Lonnroth, PN. Evidence for insulin resistance in black women from South Africa. International Journal of Obesity and Related Metabolic Disorders 2000; 24(10): 1340–6.CrossRefGoogle ScholarPubMed
57Omar, MA, Seedat, MA, Motala, AA, Dyer, RB, Becker, P. The prevalence of diabetes mellitus and impaired glucose tolerance in a group of urban South African blacks. South African Medical Journal 1993; 83(9): 641–3.Google Scholar
58Seedat, YK. Race, environment and blood pressure: the South African experience. Journal of Hypertension 1983; 1(1): 7–12.CrossRefGoogle ScholarPubMed
59Nthangeni, G, Steyn, NP, Alberts, M, Steyn, K, Levitt, NS, Laubscher, R, et al. Dietary intake and barriers to dietary compliance in black type 2 diabetic patients attending primary health-care services. Public Health Nutrition 2002; 5(2): 329–38.Google Scholar
60Motala, AA, Pirie, FJ, Gouws, E, Amod, A, Omar, MA. High incidence of type 2 diabetes mellitus in South African Indians: a 10-year follow-up study. Diabetic Medicine 2003; 20(1): 23–30.CrossRefGoogle ScholarPubMed
61Rheeder, P, Stolk, RP, Veenhouwer, JF, Grobbee, DE. The metabolic syndrome in black hypertensive women – waist circumference more strongly related than body mass index. South African Medical Journal 2002; 92(8): 637–41.Google Scholar
62Rotchford, AP, Rotchford, KM. Diabetes in rural South Africa – an assessment of care and complications. South African Medical Journal 2002; 92(7): 536–41.Google Scholar
63Wing, JR, van der Merwe, MT, Joffe, BI, Panz, VR, Seftel, HC. Insulin-mediated glucose disposal in black South Africans with essential hypertension. Quarterly Journal of Medicine 1994; 87(7): 431–6.Google Scholar
64Buthelezi, EP, Van der Merwe, MT, Lönnroth, PN, Gray, IP, Crowther, NJ. Ethnic differences in the responsiveness of adipocyte lipolytic activity to insulin. Obesity Research 2000; 8(2): 171–8.Google Scholar
65van der Merwe, MT, Crowther, NJ, Schlaphoff, GP, Boyd, IH, Gray, IP, Joffe, BI, et al. Lactate and glycerol release from the subcutaneous adipose tissue of obese urban women from South Africa; important metabolic implications. Journal of Clinical Endocrinology and Metabolism 1998; 83(11): 4084–91.Google Scholar
66van der Merwe, MT, Panz, VR, Crowther, NJ, Schlaphoff, GP, Gray, IP, Froguel, P, et al. Free fatty acids and insulin levels – relationship to leptin levels and body composition in various patient groups from South Africa. International Journal of Obesity and Related Metabolic Disorders 1999; 23(9): 909–17.CrossRefGoogle Scholar
67van der Merwe, MT, Schlaphoff, GP, Crowther, NJ, Boyd, IH, Gray, IP, Joffe, BI, et al. Lactate and glycerol release from adipose tissue in lean, obese, and diabetic women from South Africa. Journal of Clinical Endocrinology and Metabolism 2001; 86(7): 3296–303.Google ScholarPubMed
68Punyadeera, C, van der Merwe, MT, Crowther, NJ, Toman, M, Schlaphoff, GP, Gray, IP. Ethnic differences in lipid metabolism in two groups of obese South African women. Journal of Lipid Research 2001; 42(5): 760–7.Google Scholar
69Punyadeera, C, van der Merwe, MT, Crowther, NJ, Toman, M, Immelman, AR, Schlaphoff, GP, et al. Weight-related differences in glucose metabolism and free fatty acid production in two South African population groups. International Journal of Obesity and Related Metabolic Disorders 2001; 25(8): 1196–205.Google Scholar
70Punyadeera, C, Crowther, NJ, van der Merwe, MT, Toman, M, Immelman, AR, Schlaphoff, GP, et al. Metabolic response to a mixed meal in obese and lean women from two South African populations. Obesity Research 2002; 10(12): 1207–16.CrossRefGoogle ScholarPubMed
71van der Merwe, MT, Wing, JR, Celgow, LH, Gray, IP, Lonn, L, Joffe, BI, Lonnroth, PN. Metabolic indices in relation to body composition changes during weight loss on Dexfenfluramine in obese women from two South African ethnic groups. International Journal of Obesity and Related Metabolic Disorders 1996; 20(8): 768–76.Google ScholarPubMed
72Joffe, BI, Panz, VR, Wing, JR, Raal, FJ, Seftel, HC. Pathogenesis of non-insulin-dependent diabetes mellitus in the black population of southern Africa. Lancet 1992; 340(8817): 460–2.Google Scholar
73Kumanyika, S, Jeffery, RW, Morabia, A, Ritenbaugh, C, Antipatis, VJ. Obesity prevention: the case for action. International Journal of Obesity and Related Metabolic Disorders 2002; 26(3): 425–36.Google Scholar
74Thomas, PR, ed. Weighing the Options: Criteria for Evaluating Weight-Management Programs. Washington, DC: National Academy Press, 1995.CrossRefGoogle Scholar
75Senekal, M, Albertse, EC, Momberg, DJ, Groenewald, CJ, Visser, EM. A multidimensional weight-management program for women. Journal of the American Dietetic Association 1999; 99(10): 1257–64.Google Scholar
76Wylie-Rosett, J, Swencionis, C, Ginsberg, M, Cimino, C, Wassertheil-Smoller, S, Caban, A, et al. Computerized weight loss intervention optimizes staff time: the clinical and cost results of a controlled clinical trail conducted in a managed care setting. Journal of the American Dietetic Association 2001; 101(10): 1155–62.Google Scholar
77Department of Health. South African Guidelines for Healthy Eating for Adults and Children Over the Age of Seven. Pretoria: Department of Health, Directorate: Nutrition, 2004.Google Scholar
78Southern African Society for the Study of Obesity (SASSO). Guidelines for the Prevention and Management of Overweight and Obesity in South Africa. Johannesburg: SASSO, 2003.Google Scholar
79National Institutes of Health (NIH). The National Heart, Lung, and Blood Institute expert panel on the identification, evaluation, and treatment of overweight and obesity in adults. Journal of the American Dietetic Association 1998; 98: 1178–91.Google Scholar
80van Baak, M, Saris, WHM. Exercise and obesity. In Kopelman, PG, Stock, MJ, eds. Clinical Obesity. London: Blackwell Science, 1988; 429–68.Google Scholar
81Lean, M. Clinical Handbook of Weight Management. London: Dunitz, 1988.Google Scholar
82Van Gaal, LF, Mertens, IL, de Leeuw, I. Recent and future drugs for the treatment of obesity. In:Björntorp, P, ed. International Textbook of Obesity. Chichester: Wiley & Sons Ltd, 2001; 451–69.CrossRefGoogle Scholar
83Hansen, D, Astrup, A, Toubro, S, Finer, N, Kopelman, P, Hilsted, J, et al. Predictors of weight loss and maintenance during 2 years of treatment by sibutramine in obesity. Results from the European multi-centre STORM trial. International Journal of Obesity and Related Metabolic Disorders 2001; 25(4): 496–501.Google Scholar
84Muls, E, Kolanowski, J, Scheen, A, Van Gaal, L. The effects of orlistat on weight and on serum lipids in obese patients with hypercholesterolemia: a randomized, double-blind, placebo-controlled, multicentre study. International Journal of Obesity and Related Metabolic Disorders 2001; 25(1): 1713–21.CrossRefGoogle ScholarPubMed
85Van Gaal, LF, Rissanen, AM, Scheen, AJ, Ziegler, O, Rossner, S. Effects of the cannabinoid-1 receptor blocker rimonobant on weight reduction and cardiovascular risk factors in overweight patients: 1-year experience from the RIO-Europe study. Lancet 2005; 365(9468): 1389–97.Google Scholar
86Sjostrom, CD, Lissner, L, Wedel, H, Sjostrom, L. Reduction in incidence of diabetes, hypertension and lipid disturbances after intentional weight loss induced by bariatric surgery: the SOS Intervention Study. Obesity Research 1999; 7(5): 477–84.CrossRefGoogle ScholarPubMed
87Kaput, J, Rodriguez, RL. Nutritional genomics: the next frontier in the postgenomic era. Physiological Genomics 2004; 16(2): 166–77.Google Scholar
88Patterson, RE, Eaton, DL, Potter, JD. The genetic revolution: change and challenge for the dietetics profession. Journal of the American Dietetic Association 1999; 99(11): 1412–20.CrossRefGoogle ScholarPubMed