According to the South Africa Demographic and Health Survey 2016 Key Indicators Report (https://www.statssa.gov.za/publications/Report%2003-00-09/Report%2003-00-092016.pdf), 68% of women, 31% of men and 13% of children in South Africa are overweight or obese.

What is obesity?

Obesity is a chronic disease that goes beyond being overweight and is accompanied by adverse health effects. It is classified as a Body Mass Index (BMI) of 30 kg/m2 or higher when the body fat percentage is much greater than lean body mass. BMI is the index of weight in relation to height. Waist circumference is also larger, usually more than 88 cm in women and 102 cm in men. Cardiovascular disease risk factors such as high cholesterol, high blood pressure and diabetes may also be present.

The list of health risks associated with obesity is long. It includes diabetes, heart disease, kidney stones, osteoarthritis, respiratory problems, sleep apnea, etc. 

What causes obesity? Can it be inherited?

The causes of obesity are much more complex than simply overeating, physical inactivity and as some stereotypes point to, laziness. Obesity is not some personal failure. Usually, there is not just one, but rather a combination of interactions between behavioural, cultural, environmental, genetic, metabolic, psychological and socioeconomic factors.

Can obesity be inherited?

Genetics can predispose one to obesity but is not a single cause.  When people speak about “inherited weight”, keep in mind that the diet and lifestyle of families are usually the same, which can also have an effect.  Social factors and food insecurity can definitely play a role as here as well.  Then there is a saying: “Genes may load the gun, but diet pulls the trigger” – Dr Michael Greger.  So even though one can be genetically predisposed, the gene expression is almost always triggered by our environment, which refers to diet and physical activity and is affected by many factors.

Our environment is bombarded with ultra-processed foods that are quick, cheap and heavily advertised.  I mean think about it, have you ever seen an advertisement simply for fruits, vegetables or legumes? No, because there isn’t really any money to gain from that.

Our environment is also saturated with the promotion of unsustainable diet plans, weight loss products, rules and restrictions that give us false hope of easy weight loss in a short time.  These fad diets only leave us with crushed hope, emotional ties to food and a slower metabolism.

At what stage in life should we begin to watch what we eat as a means to prevent obesity?

We should strive to eat as well as we possibly can at every stage of life. But diet is especially crucial starting with pregnancy.  There are interactions between the mother’s nutritional status and the genes of the fetus.  The ages of 5 – 7 years, and the adolescent years are also critical for the prevention of obesity in adulthood.  The number of fat cells increases until the age of 6 years, and the size of them increases after 6 years.  These are also times of important growth and development.

As parents or caregivers, we are the single most important influence on our children’s food choices AND the establishment of their identity. So whether you mean it as a compliment, or an insult or just an observation, the best way to comment on your child’s weight, is to not. Your comment might really hurt them, damage their relationship with food and possibly give them a lifetime of healing to do.⁠⁠ Rather grasp the amazing privilege you have to be a role model when it comes to laying foundations for lifelong healthy habits.

How should obesity be treated?

There is no one-size-fits-all treatment. Rather, an individualized and holistic approach is crucial.  The treatment goes beyond just eating less and exercising more. Yes, a very important part of treatment is adopting a nutrient-dense diet and increasing physical activity.  However, treatment is multidimensional and requires chronic care as relapse is a possibility for many individuals. 

Consider working with a multidimensional health care team, looking at setting realistic goals and identifying psychological, behavioural and biological barriers. Individuals living with obesity can also be coached in methods like intuitive eating, recognizing hunger and fullness cues, recipe adaptations, menu planning, hydration, sleep hygiene, stress management, self-acceptance, etc.

The focus of this year’s World Obesity Day that took place on the 4th of March, was Every Body Needs Everybody.  The aim was to increase awareness that as a society we all have a role to play in creating a healthier environment as well as supporting those living with obesity.

As a nation, we can look into advocacy opportunities.  This can include equipping those who work with youth, including their parents, to discuss healthy habits and increase awareness.  Schools and workplaces can support a healthy lifestyle by providing nutrient-dense meals and snacks, as well as opportunities for physical activity.  Medical aids can look into providing cover for obesity prevention as well as multidisciplinary intervention.  The marketing of foodstuff should also be addressed.  Another crucial goal would be to change the way society views people living with obesity.  To break the stigma and to speak into weight discrimination.  Thus, as a society, we need to work together and provide support, and strategies towards the common goal of addressing the deep roots of obesity. 

Why are plant-based foods highly recommended in the treatment and management of obesity?

Plant-based foods provide many health benefits such as protecting against nutritional deficiencies and diseases like type 2 diabetes, obesity, hypertension and high cholesterol. The key to these amazing benefits is the fibre and phytochemicals found in fruits, vegetables, legumes, whole grains, nuts, seeds, herbs and spices. 

Phytochemicals are plant chemicals that contribute to the taste, smell and vibrant colours of plant foods and have antioxidant activity. They are also anti-inflammatory and can enhance immunity. Fibre is the pillar of plant-based foods and improves gut health, balances blood sugar levels, lowers cholesterol and stimulates the immune system.

Another contributing factor is that eating mainly whole plant foods essentially crowds out and minimizes foods that are high in saturated fat, like animal products, and processed foods high in energy, but low in nutritional value.

What diet is best to follow to treat and/or prevent obesity?

Let’s first look at the word “diet”.  Diet is not something you “go on” to lose weight and then once the weight is lost you “go off” it.  The definition means lifestyle, or what we eat every day. 

There are two prerequisites for a healthy diet according to the World Health Organization.  Firstly, a healthy diet should protect you from malnutrition in all its forms, including undernutrition, overnutrition and micronutrient deficiencies.  Meaning the diet should be nutritionally adequate.  Secondly, it should reduce your risk for chronic lifestyle diseases such as type 2 diabetes, heart disease, stroke and some cancers.

There is no one-size-fits-all perfect diet.  But all good diets have this in common; they emphasize whole, plant-based foods including fruits, vegetables, legumes, whole grains, nuts, seeds, herbs and spices.  When these foods are the focus of one’s diet, and the not-so-nutritious foods are consumed in moderation, it does not negatively affect our health because there is balance.  It is what we eat every day that matters.

I would recommend whole plant foods.  Not only do they provide the health benefits mentioned above, but they help with maintaining healthy body weight.  A diet that emphasizes these foods are rich in fibre and contain little added fat or sugar.  Because of this, fewer calories are delivered per bite in comparison to eating patterns that are high in energy, sugar and fat, but low in nutrients. 

These minimally processed fibre-rich foods also add bulk to the diet, keeping you full and satisfied for longer, which can then naturally lower your overall intake. 

There are many ways to eat healthily and to increase physical activity.  Each person should find what works for them and what they enjoy!    

Resources:

Escott-Stump, S., 2015. Nutrition Diagnoses-Related Care. 8th ed. Philadelphia: Wolter Kluwer.

Greger, M., 2019. How Not To Diet: The Groundbreaking Science of Healthy, Permanent Weight loss. New York: Flatiron Books.

Whitney, E. & Rolfes, S., 2011. Understanding Nutrition. 12th ed. Belmont, CA: Wadsworth.

World Health Organization, 2020. Healthy diet. [Online]
Available at: https://www.who.int/news-room/fact-sheets/detail/healthy-diet

World Obesity Day 4 March 2021 Everybody Needs Everybody, 2021. World Obesity Day 4 March 2021 Everybody Needs Everybody. [Online]
Available at: https://www.worldobesityday.org/public
[Accessed 7 October 2021].

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