SA goes large

Almost half of adult South Africans are too fat. The health risks are huge: heart-related illness, often triggered by obesity, is the second-biggest killer in the country.

Black women are the most susceptible to health-defying weight problems, closely followed by white men. But fat cuts across all social classes. Our children are getting bigger too—thanks to increasingly sedentary lifestyles—and the nation’s police force is not entirely fighting fit.’

We are a fat nation, and getting fatter as we get richer, take less exercise and gain greater access to fast and ready-made meals.

Simultaneously South Africa is struggling with the classic diseases of a developing country—above all the ugly sisters of HIV and tuberculosis. But the infectious diseases get attention, distracting from the chronic lifestyle-related illnesses more often associated with developed nations such as diabetes, hypertension, cardiovascular disease and high cholesterol levels.

Gary Fetter, a Johannesburg doctor specialising in the surgical treatment of obesity, says that overweight and obesity are problems affecting all socio-economic and race groups in South Africa. But the levels of fatness in this country do vary by gender and race. The most affected group are women—approximately 75% of black women, 42% of white women and 37% of Asian women are estimated to be overweight or obese. Among men, whites are most likely to be overweight or obese at 56%, followed by black men at 49% and then Asian men at 35%.

By the World Health Organisation’s reckoning in 1998, 45% of all South Africans over the age of 15 were overweight or obese. Most medical professionals agree anecdotally this 10-year-old figure has almost certainly increased. The most common assessment of fatness or thinness is the Body Mass Index (BMI), a single figure calculated using an individual’s weight and height.

Overweight is a BMI of between 25 and 30, obese is greater than 30, and morbidly obese is over 40. The BMI as a standalone figure is useful, but not always reflective of how healthy or fat a person is. A fit, muscular person may have a high BMI because muscle weighs more than fat. Conversely, a couch potato with very little muscle could have a deceptively low BMI for the same reason.

Even for people with more natural padding against the winter cold, the distribution of fat plays a role. While an apple a day is said to keep the doctor away, an apple-shaped figure may instead lead to more frequent visits to the doctor and possibly an early grave. Far healthier is the stereotyped curvaceous female: big bum and hips, small waist. A waist of more than 80cm for a woman or 94cm for a man is a danger sign, especially if combined with a high BMI.

Fatness carries with it a multitude of health problems: diabetes, hypertension, heightened cholesterol and other fats, increased risk of heart attacks and strokes, bad circulation, leg cramps, impotence - the list goes on.

Dr Martin Mpe, a Pretoria cardiologist, says almost 200 South Africans die daily from heart-related issues. It is the second-biggest cause of death in South Africa after HIV-related illnesses.

Hypertension—defined as a blood pressure of 140/90mmHG—causes no side effects in 99% of its victims, said Mpe. This makes it particularly dangerous. “You feel nothing until the day you drop dead.”

Medication to combat high blood pressure, diabetes and the other problems at least partially associated with being overweight is a thriving business worldwide. But, as Mpe puts it: “The main doctor is the one walking into the doctor’s rooms.” In other words, prevention or management of the illness is in the patient’s own hands.

Obesity leads to high blood pressure and expansion of the heart, damaging other organs and causing arteries to harden and scar. An increase in fat also increases resistance to insulin, leading to type II diabetes. A combination of high blood pressure and diabetes gives an exponential, not an additive risk of early death, says Mpe: a dangerous cocktail of illnesses where the risk of death multiplies.

The financial implications of being overweight from a healthcare perspective are shown by the enthusiasm by some employers and medical schemes to encourage members to move to a healthier—read thinner—lifestyle. Discovery Health, for example, has a wellness programme that encourages members to exercise and eat healthily with incentives such as offering discounts on fresh vegetables at a major supermarket chain.

Losing weight requires a combination of less incoming energy with more outgoing energy—less food and more exercise. Burning 2 500 kcal (kilocalories) a week in exercise should drop your risk of early death by 43%. Exercising, even just walking, increases blood flow through the body, opening up blood vessels and leading to a decrease in blood pressure.

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