The pandemic of obesity in South Africa is a result of our ‘Americanised’ food environment and the responsibility should be shifted from individuals to government policies, according to experts. “I hear people saying Burger King is coming to South Africa, it’s fantastic. Krispy Kreme is coming, wonderful,” said Professor Karen Hofman from the University of the Witwatersrand. But, she is quoted in a Health-e News report as saying, in other parts of the world – the ‘western world’ – these outlets are “the lowest of the low” because there is an awareness about how hazardous their products are to human health.
Lynn Moeng, chief director of health promotion, nutrition and oral health at the national Health Department said that South Africa’s weight problem is escalating and that the ambitious government target to reduce obesity by 10% by 2020 will not be met. “Everything that made Americans too fat, they are exporting to us so we can be like them,” she said. Speaking on World Obesity Day (10 October) she said “our economic policies are affecting us” placing big business and trade interests over health priorities.
The report says that, according to Johannesburg-based endocrinologist Dr Sundeep Ruder, South Africa is already the most obese country in sub-Saharan Africa and has the highest prevalence of diabetes on the continent. He said that the true scale of the problem in South Africa is hard to quantify because about half of all people with diabetes have not been diagnosed and research has estimated that rates are going to continue to skyrocket: by 48% by 2040.
“More people (in 2015) died because complications related to diabetes than malaria, tuberculosis and HIV combined,” he said. Despite the fact that the risk factors for conditions like obesity and diabetes, such as diet, physical activity and sleep, are “modifiable” and related to lifestyles they are increasing “at an alarming rate”. “What happens in our bodies is affected by our relationship with the environment,” he said.
The environment most South Africans live in promotes the cheaper, and more accessible, food options that are usually ultra-processed and very high in sugar, salt and fat. “You can talk about gluttony but what is failing us is education… One can of soft drink per day increases your risk of developing diabetes by 15%… The billboards (we see) do not say this,” he said.
The report says these products are often relentlessly marketed to children, which establishes unhealthy food preferences from an early age and which are very difficult to change later on in life. “Children repeatedly exposed to marketing portray unhealthy food as fun, cool, exciting and positive. This ties in with using popular toys and movies in promotional packaging and even to in-school marketing,” said Hofman. “A study we ran in Soweto found that 50% of schools had Coca-Cola signs in their grounds – and this was five years after they said ‘We are no longer marketing to children’.”
She said that industries are targeting and manipulating the most vulnerable populations, including children. For example, the way products are placed in supermarkets is “not random” and products high in sugar are often placed lower on shelves; eye-level for children.
The report says this is why the onus should be placed on government to regulate the environment, rather than placing the blame on individuals for continuing to make unhealthy choices. These regulations include the tax on sugary beverages that began in South Africa in April. But public health experts are encouraging the government to go further and regulate advertising of unhealthy foods aimed at children as well as clamping down on the labelling of packaged foods.
Additionally, research has found that stigmatising individuals for obesity only makes the situation worse. A 2014 study found that obese people who were fat shamed gained up to two more kilograms than those who were not stigmatised for their weight.
And it also found that South African media is the most stigmatising in the world in terms of how it portrays obesity. The country’s online newspapers scored the highest for the negative portrayals of people with obesity together with Italy, Hong Kong and Morocco.
Researchers from the international non-profit World Obesity Federation analysed close to 200 images used in articles about obesity from online newspapers in 15 countries across the globe. More than half (63%) of images used showed overweight or obese people, while 42% showed isolated body parts which researchers consider to be negative imagery.
“The use of these images can reinforce stereotypes about personal responsibility and blame. The images also tended to present people with obesity as miserable, distressed or sad,” the 2018 World Obesity Federation annual report says.
The report says researchers recommend media organisations choose images that portray people with obesity in a more respectful manner – for instance, using a photo of a big person exercising or images that don’t isolate certain parts of their bodies – will help reduce weight stigma.
“Weight stigma in the media reinforces dislike and disrespect for people living with obesity and emphasises ‘personal responsibility’ for the disease,” the study states. “(This) may not only absolve governments and commercial actors of responsibility for their role in creating obesogenic environments but may also lead individuals living with obesity to blame themselves and internalise the stigma about their condition.”