Health

Comment: Obese SA has to get a move on

Mario Greyling

There is a simple way to combat chronic lifestyle diseases, and that is to eat properly and exercise.

Obesity is a prevalent, and potentially deadly, problem in South Africa. (Jean-Sebastien Evrard/ AFP)

South Africans must get moving – literally – to combat obesity, the hidden killer and unspoken instigator of chronic diseases of lifestyle, which are among the biggest causes of death worldwide and a fact of life for more than 70% of women over the age of 35 in our country.

Chronic diseases account for up to 40% of adult deaths in South Africa, where most people have at least one modifiable risk factor for chronic disease. If left untreated, chronic conditions such as ischemic heart disease, type 2 diabetes and hypertension can bring on potentially fatal conditions at any time. But the paradox of the chronic disease burden is that it can be lifted if we tackle obesity.

Our nation’s dire weight problem was highlighted in the Mail & Guardian on May 29 this year. In the article, “SA’s the fattest sub-Saharan African nation”, it was stated: “South Africa has the highest overweight and obesity rate in sub-Saharan Africa: seven out of 10 women and four out of 10 men have significantly more body fat than what is deemed healthy, according to a ground-breaking new study published in the medical journal, the Lancet.”

Solution
But there is a practical, low-cost solution. Physical activity and the right nutrition are required to tackle it. According to a Medical Research Council (MRC) report, Chronic Diseases of Lifestyle in South Africa 1995-2005, a lack of physical activity “is associated with at least a 1.5- to twofold higher risk” of such chronic diseases. Just 30 minutes of moderate to vigorous physical activity a day could keep them at bay.

“The associated risk of inactivity,” the report states, “is similar in magnitude to many other well-known risk factors, such as overweight, smoking, hyperlipidaemia (when the concentration of cholesterol in your blood is too high), and low fruit and vegetable intake.”

Of grave concern, too, is that, because of a prevalence of inactivity among children and teenagers, the risk of obesity goes beyond adults.

The health department and the research council’s South African national youth risk behaviour survey in 2002 found that a third of teens between 13 and 19 years of age took part in “insufficient or no moderate to vigorous activity weekly” and that “more than 25% of the youth surveyed reported watching more than three hours of television per day”.

Childhood obesity is likely to continue into adulthood, becoming a lifelong struggle. Once again, women are particularly at risk, with those who have dealt with the condition during adolescence being eight times more likely to take it with them into their adulthood.

Prescribing exercise 
The importance of daily physical activity to combat obesity and the link between this and protection against chronic diseases of lifestyle is not new or unsupported. In 1995, the United States surgeon general reported “on the existing evidence base concerning physical activity and health, positioning inactivity as a national public health challenge”. In 2004, the World Health Assembly signed off on the World Health Organisation global strategy on diet, physical activity and health, which focused on the prevention and control of chronic diseases.

Why then is it so overlooked in South Africa? Could it really be that simple to tackle?

In the US, there is an interesting shift taking place – medical practitioners are prescribing exercise. Physical activity is considered to be one of the key health behaviours. There is a clear dose-related response, measured in duration and calories. Closer to home, research has revealed that Momentum’s physically active members claim up to 28% less than those who are not active. With medical costs rising, the proactive use of medical cover makes budgeting sense, as the norm in medical savings accounts is for these to run dry in the early part of a year.

Preventative vs curative 
There is a broader motivation for the “wellness case for physical activity” as just 17% of South Africans have medical cover. Between 2000 and 2012, of those with medical aid,  37% was spent on hospitals, 23% on specialists, 16% on medication and 7% on GPs. Only a limited amount of medical aid spend goes on preventative measures, with an overwhelming 74% going on curative treatment.

The need to prioritise physical activity is not technically difficult. It is not as taxing as brain surgery but it is just as much a life-or-death scenario. It is also scientifically backed by research, as explained in one of the chapters of the MRC report: “The role of physical activity in the prevention and management of overweight and obesity is linked, in part, to the impact of physical activity on energy expenditure, body composition and substrate oxidation and metabolism … As such, physical activity has the potential to be a powerful agent of change in the prevention and management of overweight and obesity.”

The battle against obesity, and in turn against it fuelling chronic conditions, calls for physical wellness to be a way of life. All this asks of us is to choose our activity, get moving, and keep moving. Whether it is walking, which calls for a commitment to dusting off trainers early every morning, or taking the bicycle further out of the garage than when the car is being washed, what is important is that everyone becomes more active.

Exercise is free
The fact is that this can be free (gym memberships are not the only way to get exercise) and freeing simultaneously. People can gain more energy, better concentration and an improved physique through physical activity.

Healthcare is every­body’s responsibility, and there is a cheap way for everybody to take the first step in becoming accountable – to themselves, their family, their community and their country.

As an economy that straddles polar-opposite developed and developing world dynamics, the fight against obesity and, in turn, chronic diseases of lifestyle are not just a challenge. They provide an opportunity for us to set the pace for a nation of wellness-conscious, physically active people.

The beauty of this is that exercise can come at no cost. The flip side is that the cost of not exercising has a price tag that will, undoubtedly, be way too high for those who give in to obesity.

Dr Mario Greyling is head of group wellness at Momentum Multiply

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