tag:theconversation.com,2011:/ca-fr/topics/obesity-in-africa-28613/articlesObesity in Africa – La Conversation2017-12-05T12:05:58Ztag:theconversation.com,2011:article/873912017-12-05T12:05:58Z2017-12-05T12:05:58ZDeveloping countries could get sick before they get rich. Policy can help<figure><img src="https://images.theconversation.com/files/195823/original/file-20171122-6039-1wlbzi3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">As cities in developing countries - like Lagos in Nigeria, pictured here - grow, so do obesity risks.</span> <span class="attribution"><span class="source">Reuters/Akintunde Akinleye</span></span></figcaption></figure><p>Improved <a href="https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6024a4.htm">human well-being</a> is one of the modern era’s greatest triumphs. The age of plenty has also led to an unexpected global health crisis: <a href="https://www.globalnutritionreport.org/files/2017/11/Report_Summary_2017.pdf">two billion people</a> are either overweight or obese. Developed countries have been especially susceptible to unhealthy weight gain, a trend that could be considered the price of abundance. However, developing countries are now facing a similar crisis.</p>
<p>Obesity rates have <a href="https://jamanetwork.com/journals/jama/fullarticle/1832542">plateaued</a> in high income countries but are <a href="https://thediplomat.com/2016/03/confronting-obesity-in-asias-cities/">accelerating</a> elsewhere. The <a href="https://data.unicef.org/wp-content/uploads/2017/06/JME-2017_brochure_June-25.pdf">combined findings</a> of UNICEF, the World Health Organisation and the World Bank showed that in 2016 Asia was home to half the world’s overweight children. One quarter were in Africa. </p>
<p>Residents of developing nation cities are increasingly susceptible to obesity, particularly amid the megatrends of urbanisation, globalisation, and industrialisation of food supply. According to India’s National Institute of Nutrition, over a quarter of urban-dwelling men and nearly half of women <a href="http://www.hindustantimes.com/health/india-s-cities-fighting-twin-issues-malnourished-children-obese-adults/story-4AP2yafjrewYx4qqKccBNJ.html">are overweight</a>.</p>
<p>The majority of the world’s future urbanisation is projected to occur in developing countries, particularly in <a href="http://wcr.unhabitat.org/wp-content/uploads/sites/16/2016/05/WCR-%20Full-Report-2016.pdf">Asia and Africa</a>. As rural dwellers move to urban areas, easy access to cheap and convenient processed foods lures them into unhealthy diets.</p>
<p>This crisis will test the political resolve of governments that have historically focused on ending hunger. These governments must understand that the factors making cities convenient and productive also make their residents prone to obesity. Intelligent, focused policies are needed to effectively manage this emerging crisis.</p>
<h2>Urban lifestyles</h2>
<p>Urbanites enjoy a variety of culinary options, ranging from aisles of processed goods in supermarkets to scores of short-order street vendors. Additionally, international fast food chains are flourishing in developing countries. This is <a href="https://www.nytimes.com/2017/10/02/health/ghana-kfc-obesity.html">shifting dietary habits</a> away from healthier traditional fare and towards fried foods and sugary drinks.</p>
<p>The health risks of such diets are compounded by the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4188656/">sedentary lifestyles</a> of urban dwellers. The most recent Indian nutrition survey <a href="http://www.ninindia.org/NNMB%20Urban%20Nutrition%20Report%20-Brief%20report.pdf">found</a> that city-dwelling men and women work an average of roughly eight hours a day. Most are engaged in sedentary office jobs. Only about one quarter exercise.</p>
<p>People’s leisure time is also being monopolised by passive diversions like television, movies, and video games in the growing number of households <a href="http://www.pewglobal.org/2016/02/22/smartphone-ownership-and-internet-usage-continues-to-climb-in-emerging-economies/">able to afford</a> such technologies.</p>
<p>The alarming implication of these trends is that developing countries may become sick before they get rich. That sickness may, in turn, cripple health systems.</p>
<p>The yearly health care costs in Southeast Asia of obesity-related complications like diabetes and cardiovascular disease are already as high as <a href="https://foodindustry.asia/obesity-costs-southeast-asia-up-to-us10billion-annually">US $10 billion</a>. Obesity among China’s younger generation could cost <a href="https://news.cgtn.com/news/7763544e7a597a6333566d54/share__p.html">US $724 billion</a> in medical treatment by 2030. Such diseases are an added burden on countries already struggling to manage primary health care needs.</p>
<p>Policies related to taxation, urban design, education and awareness and the promotion of localised food systems may help control obesity at a lower cost than eventual medical treatment for an ageing and increasingly overweight population.</p>
<h2>Direct interventions</h2>
<p>Some governments have already experimented with direct interventions to control obesity, such as taxation on unhealthy foods and drinks. The US pioneered the <a href="http://www.channelnewsasia.com/news/asiapacific/commentary-a-tax-on-sugary-drinks-not-enough-on-their-own-to-9258284">soda tax movement</a>. <a href="https://www.reuters.com/article/us-thailand-tax-sugar-usa/thailand-enters-war-on-sugar-with-tax-on-sweetened-beverages-idUSKBN1CP2OC">Thailand</a>, <a href="http://bit.ly/2AIwLMK">Brunei</a>, and <a href="http://www.channelnewsasia.com/news/singapore/7-major-soft-drinks-manufacturers-in-singapore-to-reduce-sugar-9146552">Singapore</a> have adopted similar measures. <a href="http://edition.cnn.com/2017/03/02/health/south-africa-sugar-tax/index.html">South Africa</a> is likely to introduce a sugar tax beginning in April 2018. </p>
<p>Regulatory approaches have not stopped at taxation – or at sugar. In the United Kingdom, <a href="https://www.ft.com/content/dfd3bb80-bc84-11e6-8b45-b8b81dd5d080">advertising rules</a> prohibit the marketing of foods high in fat, salt and sugar to children younger than 16.</p>
<p>The city of Berkeley in California recognises that taxes alone are not enough to address obesity. Proceeds from the city’s sugar tax <a href="http://www.berkeleyvsbigsoda.com/faq">are used</a> to support child nutrition and community health programmes. This underscores the importance of education and awareness.</p>
<p>There is also promise in broader-reaching initiatives. Urban design holds significant power to reshape lifestyle patterns and public health. Improving the attractiveness of public space, the “walkability” of neighbourhoods and the quality of cycling infrastructure can draw residents out of their cars and living rooms. </p>
<p><a href="http://www.sciencedirect.com/science/article/pii/S0091743514003661">A recent study</a> of urban neighbourhoods in Shanghai and Hangzhou found that middle-income residents living in less walkable neighbourhoods had significantly higher Body Mass Indices than both richer and poorer residents who lived in walkable neighbourhoods in urban China.</p>
<p>Finally, healthier lifestyles begin in grocery store aisles. Governments should encourage tighter connections between agricultural production systems, urban grocers and food vendors. Relationships with farmers in areas immediately adjacent to cities, in addition to the promotion of urban gardens, have been <a href="http://seedstock.com/2014/05/27/10-american-cities-lead-the-way-with-urban-agriculture-ordinances/">popular approaches</a> in the US. </p>
<p>Such initiatives can also help urban residents better understand the mechanics of food sourcing. This raises awareness about the relationship between natural foods and healthy lifestyles. Even the preservation of culture around traditional foods can promote healthy alternatives.</p>
<p>Combining controls on unhealthy foods with policies that incentivise healthy eating and active lifestyles constitute a promising response to rising obesity rates. Addressing public health is a policy mandate for developing countries from both an economic and social point of view. To paraphrase the recent <a href="http://www.globalnutritionreport.org/">Global Nutrition Report</a>, addressing obesity is a global imperative for releasing the brakes on development.</p><img src="https://counter.theconversation.com/content/87391/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Governments must understand that the factors making cities convenient and productive also make their residents prone to obesity. They must confront this challenge with intelligent, focused policies.Asit K. Biswas, Distinguished visiting professor, University of GlasgowKris Hartley, Assistant professor, The Education University of Hong KongLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/737762017-04-18T15:19:52Z2017-04-18T15:19:52ZSouth Africa needs more than a sugar tax to get to the bottom of obesity<figure><img src="https://images.theconversation.com/files/164297/original/image-20170406-16660-1apadzq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People are leading more sedentary lifestyles and eating calorie dense foods fuelling obesity.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>South Africa has been wrapped up in public and parliamentary debates on the value of South Africa’s proposed sugar tax. These highlight that the growing obesity epidemic has been fuelled by people consuming high levels of sugar. </p>
<p>Obesity shortens a person’s lifespan and affects their quality of life. It leads to lifestyle diseases that result in among others strokes, blindness, amputations and kidney failure.</p>
<p>Obesity has become a global epidemic with more than <a href="http://www.who.int/mediacentre/factsheets/fs311/en/">600 million adults</a> worldwide classified as obese. The US leads the pack with a 34% obesity prevalence, followed by Mexico (30%) and New Zealand (about 26%). </p>
<p>In Africa, the World Health Organisation reports that South Africa has the highest obesity levels with 26.8% of people classified as obese. Seychelles has a 26.3% obese population while Botswana follows closely with 22.4%.</p>
<p>In South Africa obesity related lifestyle diseases rival HIV/AIDS and TB in terms of their impact. Research shows that chronic diseases result in one death every hour. About 40% of women and 11% of men suffer from obesity in the country. And 25% of teenage girls in rural South Africa are overweight or obese.</p>
<p>But blaming sugar for obesity neglects the many factors that are at play in this complex health issue.</p>
<p>Global studies show there are several other factors responsible for someone developing obesity. These include <a href="http://www.obesity.ulaval.ca/obesity/generalities/genetic.php">genetic links</a>, <a href="http://obesity.ygoy.com/environment-causes-obesity/">lifestyle changes</a>, <a href="http://healthyeating.sfgate.com/caloriedense-vs-nutrientdense-food-5391.html">calorie-dense diets</a>, <a href="https://www.hsph.harvard.edu/nutritionsource/sleep/">sleep deprivation</a> and <a href="https://www.theatlantic.com/health/archive/2015/12/sexual-abuse-victims-obesity/420186/">psychological problems</a>. </p>
<p>South Africa would need to investigate these links as part of its plan to tackle skyrocketing obesity rates. </p>
<h2>Genetic factors</h2>
<p>Scientists have established a genetic basis for obesity but defining the genetic contribution is still a challenge. Bio-medical research has made some headway.</p>
<p>Global <a href="https://academic.oup.com/epirev/article/29/1/49/437222/Genetic-Epidemiology-of-Obesity">research</a> has shown that some populations have a <a href="http://www.nature.com/nrg/journal/v10/n7/full/nrg2594.html">genetic predisposition</a> to obesity. For example, studies show that in the US and Europe, some populations are genetically prone to <a href="https://ghr.nlm.nih.gov/condition/bardet-biedl-syndrome#statistics">Bardet-Biedl syndrome</a>.
People who have this condition have <a href="http://www.webmd.com/children/bardet-biedl-syndrome">disproportionately distributed</a> fat on their abdomens and chests rather than their arms and legs. </p>
<p>Similarly <a href="https://ghr.nlm.nih.gov/condition/prader-willi-syndrome">Prader-Willi syndrome</a> – a complex genetic condition where people develop an insatiable appetite, which leads to chronic overeating and obesity – affects an estimated 1 in 10,000 to 30,000 people worldwide.</p>
<p>But studies into specific conditions in Africa are rare. And more generally, there have been limited genome-wide association studies on African populations. </p>
<h2>Technology and lifestyle changes</h2>
<p>As the world moves toward an information based economy, adults and children have increased the amount of time they spend on mobile phones, watching TV and on computers or tablets – taking sedentary lifestyles to a new level.</p>
<p>For children this shift means they have little time for unstructured play or physical activity – and it directly links to an increase in chronic, non-communicable diseases.</p>
<p>According to a <a href="http://www.milkeninstitute.org/publications/view/531">study</a> by the Milken Institute in the US, every 10% investment in information and communication technology results in a one percent increase in obesity. </p>
<p>In the US, for example, according to research, children spend between <a href="http://www.sciencedirect.com/science/article/pii/S1555415516305050">five and 10 and a half hours daily</a> sedentary watching TV, playing video games and engaging with their iPods, tablets, smartphones and social media. As a result, 17% of the paediatric population in the US are obese. </p>
<h2>Calorie-dense diets</h2>
<p>In addition to technology, <a href="http://ajcn.nutrition.org/content/82/1/265S.full">people’s daily diets</a> have seen massive changes in the past few decades. Energy dense foods have more calories than nutrients. A high intake of empty calorie foods may cause people to gain weight, especially if they take in more calories than they burn. </p>
<p>Many working parents have to make long commutes to work and rely on convenience foods packed with salt, sugar and fat instead of home cooked meals made from fresh ingredients. Many of these products also contain high levels of gluten.</p>
<p>A growing body of research links gluten – a protein found in grains such as wheat – with potentially harmful effects on gut health, inflammation, fat regulation, metabolism and fat storage. </p>
<p>In a <a href="http://www.naturalnews.com/038699_gluten_weight_gain_wheat_belly.html">Brazilian study</a> researchers link gluten to obesity. Researchers <a href="http://www.huffingtonpost.com/dr-mark-hyman/wheat-gluten_b_1274872.html">argue</a> the modern way wheat products are processed means they contain amylopectin and gluten additives that are fattening, inflammatory and addictive. These drive obesity, diabetes, heart disease, cancer and dementia.</p>
<h2>Sleep deprivation</h2>
<p>The prevalence of obesity in the last several decades has been paralleled by a trend of reduced sleep in adults and children. </p>
<p>Worldwide, <a href="http://blogs.webmd.com/sleep-disorders/2010/10/sleep-deprivation-around-the-world.html">85%</a> of people suffer from insomnia. Too little sleep disrupts the normal functioning of our bodies. This includes the hormones that regulate hunger and satiety -– which can result in overeating.</p>
<p>Chronic, even partial sleep loss, <a href="https://www.purelyb.com/be-mindful/get-informed?view=entry&id=297">affects hormones</a> including those which regulate hunger and satiety-related hormones such as ghrelin and leptin. </p>
<p>There’s a close link between how much people sleep and how much they weigh. A group of researchers <a href="http://onlinelibrary.wiley.com/doi/10.1038/oby.2007.118/full">studied</a> about 60,000 women for 16 years, asking them about their weight, sleep habits, diet, and other aspects of their lifestyle. </p>
<p>At the start of the study, none of the women were obese. After 16 years, those who slept five hours or less each night had a 15% higher risk of becoming obese compared to women who slept seven hours each night. </p>
<p><a href="https://www.hsph.harvard.edu/obesity-prevention-source/obesity-causes/sleep-and-obesity/">Studies</a> spanning five continents have looked at the link between sleep duration and obesity in children. Most of these studies have found a <a href="http://pediatrics.aappublications.org/content/pediatrics/133/6/1013.full.pdf">convincing association</a> between too little sleep and increased weight.</p>
<h2>The psychology around obesity</h2>
<p>A <a href="https://www.sciencedaily.com/releases/2014/09/140902092947.htm">meta-analysis</a> carried out on previous childhood sexual trauma studies, which included a total of 112,000 participants has shown that being subjected to abuse during childhood entails a markedly increased risk of developing obesity as an adult.</p>
<p>Such <a href="http://onlinelibrary.wiley.com/doi/10.1111/obr.12216/full">studies</a> have shown that victims of childhood sexual abuse are far more likely to become obese adults.</p>
<p>And <a href="http://www.iowaaces360.org/ace-study.html">new research</a> shows that early trauma is so damaging that it can disrupt a person’s entire psychology and metabolism. This also links to stigma. For example, local researchers found that the stigma attached to HIV/AIDS and weight loss or “thinness” could be fuelling the obesity epidemic among some women. <a href="https://www.hindawi.com/journals/jtm/2009/145891/">Studies in Sub-Saharan Africa</a> have shown that being thin is associated with being HIV positive. </p>
<p>What this adds up to is that if the South African government goes ahead with its plans to implement the sugar tax, it also has a responsibility to fund research into obesity patterns in the country as well as educate consumers and create supportive community environments to assist people to make healthier lifestyle choices.</p><img src="https://counter.theconversation.com/content/73776/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nellie Myburgh receives funding from the Bill and Melinda Gates Foundation. </span></em></p>South Africa has the highest obesity levels in Africa but blaming sugar neglects the many factors at play in this complex health issue.Nellie Myburgh, Senior researcher at the Wits Health Consortium, University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/604802016-06-21T15:05:22Z2016-06-21T15:05:22ZIf food labels aren’t simple, consumers may ignore them<figure><img src="https://images.theconversation.com/files/125906/original/image-20160609-7059-z6no17.jpg?ixlib=rb-1.1.0&rect=119%2C22%2C4528%2C2720&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Consumers gather information about food from a variety of sources including their families, the media and through education. But another way that they can get the information is through food and nutrition labels.</p>
<p>Nutrition labelling refers to the section on food labels that declares nutrient content. This includes a nutrition information table, a list of ingredients, the nutrient content claims made on food labels and any health endorsement logos. </p>
<p>Internationally, there is growing <a href="http://davidhammond.ca/wp-content/uploads/2014/12/2011-Nutrition-Labels-Review-Hammond-JPHN1.pdf">evidence</a> showing the usefulness of nutrition labelling. It has been identified as a population-wide intervention to promote a healthy diet and reduce the burden of non-communicable diseases. </p>
<p>Globally, non-communicable disease account for a large number of deaths. About 13% of deaths are caused by raised blood pressure while 9% are caused by smoking, 6% by raised blood glucose or physical inactivity and 5% by being overweight or obese.</p>
<p>In South Africa, <a href="http://www.hsrc.ac.za/uploads/pageNews/72/SANHANES-launch%20edition%20(online%20version).pdf">research</a> has shown that more than two-thirds of South African women are overweight or obese. South African men are not far behind. </p>
<p><a href="http://davidhammond.ca/wp-content/uploads/2014/12/2011-Nutrition-Labels-Review-Hammond-JPHN1.pdf">Evidence</a> shows a consistent link between the use of nutrition labels and healthier diets.</p>
<p>In recent years, the global trend has been a move towards mandatory nutrition labelling. This includes the nutrition information table, regardless of whether a health or nutrition claim is made on the label. </p>
<p>Developed countries have led the charge, with statutory regulations on nutrition labelling. And South Africa has joined in, updating food labelling regulations in March 2012. </p>
<p>But studies have shown that some South African consumers do not always understand nutrition labels and therefore don’t pay attention to them.</p>
<p>If consumers were educated on the importance of nutrition labelling and how to read and understand the information, they may be more willing and capable of making healthier food choices.</p>
<h2>Food and nutrition labelling</h2>
<p>Food labels are meant to inform consumers and help sell products. They tell consumers about the composition and nature of products to avoid confusion and to protect them against misuses, risks and abuses. </p>
<p>If well designed, nutrition labelling can potentially have a positive influence on a person’s choice of food purchased. This in turn can help the government of a country achieve its public health objectives. </p>
<p>Some research has been done to determine whether consumers in South Africa use and understand nutrition labels. </p>
<p>A number of <a href="http://www.emeraldinsight.com/doi/full/10.1108/BFJ-12-2011-0298">studies</a> show that South Africans have <a href="http://www.researchgate.net/publication/283946753_Consumers_prepurchase_satisfaction_with_the_attributes_and_information_of_food_labels">mixed feelings</a> about food labels as an <a href="http://ac.els-cdn.com/S0963996914002014/1-s2.0-S0963996914002014-main.pdf?_tid=832951f4-36c1-11e6-ba93-00000aab0f01&acdnat=1466411723_c2977a017e4d652b62205a9323605650">information source</a>. Some consumers <a href="http://journals.cambridge.org/download.php?file=%2FPHN%2FPHN16_03%2FS136898001200287Xa.pdf&code=05e24d74fe2e9ff0a239898b8d35813a">do not read labels</a> and are not interested in them. Time constraints stop them and they are either more concerned about the product’s price or they stick to their habitual purchases. Other consumers feel the taste of a product is more important than its nutritional content.</p>
<p>A recent <a href="http://davidhammond.ca/wp-content/uploads/2014/12/2011-Nutrition-Labels-Review-Hammond-JPHN1.pdf">review</a> has found that nutrition labels are perceived as a very credible source of nutrition information and that many consumers use these labels as a guide in the selection of food products.
The use of nutrition labels varies considerably across different sub-groups.</p>
<p>But research shows that some consumers struggle to interpret the nutrition information on labels. They find the different nutrition label formats and the information overload on labels confusing. And they would prefer graphic information such as a logo rather than a traditional nutrition information table. </p>
<h2>Different approaches to nutrition labelling</h2>
<p>Apart from the mandatory nutrition labelling trend, the European Food Information Council notes that another global trend is standardising nutrition content by using front-of-pack labels. </p>
<p>But there is an ongoing debate as to the best front-of-pack labelling approach. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20181813">Research</a> has shown that for front-of-pack labelling to be effective and to avoid consumer confusion, a single, credible and reliable front-of-package nutrition labelling system should be adopted. This will help food manufacturers and retailers, and may assist consumers to make smarter food as well as beverage choices at a glance.</p>
<p>There are four main approaches to <a href="http://www.ehnheart.org/component/downloads/downloads/1380">front-of-pack</a> nutrition labelling:</p>
<ul>
<li><p>single healthy eating symbols/health logos/health endorsement logos; </p></li>
<li><p>traffic light labelling of nutrients, where red, amber and green are used to indicate the levels of key nutrients; </p></li>
<li><p>a hybrid of traffic lights and percentage guideline daily amounts that provides information on these percentages; and</p></li>
<li><p>percent guideline daily amounts, where the percentages for key nutrients in a serving/portion or 100g of food are given.</p></li>
</ul>
<p>Some countries such as Thailand have introduced mandatory front-of-packaging labels, while others – Australia, New Zealand and the US – are considering it. </p>
<p>In South Africa, front-of-packaging labels are not mandatory or standardised. Amendments to the labelling regulations – published for comment in 2014 – include a section on front-of-pack labelling stipulating that it is voluntary. However, if a label is present, it must comply with certain conditions. The Department of Health is still considering the public comments, which could result in further amendments to the regulations. </p>
<p>But there is a need for more simplified labels on both the front and the back of products. </p>
<p>Although the food industry, health professionals and consumers face many changes, challenges and opportunities around food and specifically nutrition labelling, it is the ideal time to promote the use and understanding of nutrition information on labels to consumers.</p><img src="https://counter.theconversation.com/content/60480/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nelene Koen does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>If South African consumers were educated on how to read and understand the information on food labels, they may be more willing and capable of making healthier food choices.Nelene Koen, Lecturer, Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch UniversityLicensed as Creative Commons – attribution, no derivatives.