While overweight and obesity are on rise in general in South Africa, including among children and youth, the worst affected segment of our population is women. The World Obesity Atlas 2022 predicts that 50% of South African women will be not just overweight, but obese by 2030. This is the highest predicted obesity rate in all of Africa, and a major concern when it comes to women’s health.
Overweight and obesity usher in significant risks of developing non-communicable diseases such as Type 2 diabetes and certain cancers. Obesity is also closely associated with cardiovascular diseases. However, overweight and obesity don’t just take their physical toll, these conditions have a major effect on a patient’s general well-being, mental health, social relationships, and economic opportunities.
According to Prof. Salome Kruger, a Registered Dietitian who also serves as a Professor of Nutrition at the Centre of Excellence for Nutrition at North-West University, the odds are stacked up against South African women and solutions to the obesity crisis are linked to the improvement of conditions for women across the socio-economic and health landscapes. She says, “The challenges that women face regarding obesity are diverse. If we start at the basics, in comparison to men, women have less lean mass and more fat mass from early childhood, and therefore they have a lower metabolic rate. So even if women proportionally eat no more than men, they will gain weight easier. But there are many other challenges that range across income groups, age and even, occupation.”
It is far less safe for women to exercise in their communities
Levels of physical activity between men and women differ. Professor Kruger points out that career women who are the primary carers of school-going children find it much harder to engage in regular physical activity than their male counterparts do, who focus mainly on their career and self-care over home, child and family duties. An unequal burden of child-care and home life maintenance is still prevalent in South Africa with women bearing these responsibilities far more than men do, and therefore simply having less time available to exercise.
Professor Kruger says, “It’s important to also think of these differences in physical activity across socio-economic conditions. Many neighbourhoods in South Africa are simply unsafe for many women to engage in regular, free physical activities such as walking, running, and cycling in their area, which the men are able to do. Therefore, South Africa’s high rates of gender-based violence is a limiting factor when it comes to women’s opportunities to live more healthy lifestyles.”
South African ‘food deserts’ ignite higher rates of obesity
The country’s communities are awash in calorie-dense but nutrient poor food choices. It may seem that there is plenty of food available, a vendor on every corner, but the food is fatty, salty, sugar- and carbo-loaded and often highly processed, which also means laden with food additives. A ‘food desert’ describes an area where there is little to no affordable fresh produce available daily, and the dominant community eating habits include buying cheap vendor and fast foods. Due to access and affordability limitations, more low fibre, high salt, high sugar and high fat foods are consumed, all of which are contributors to overweight and obesity.
Excess weight impacts on women’s fertility
Major aspects of overweight and obesity impact on fertility as well as healthy pregnancy and childbearing. According to ADSA President and Registered Dietitian, Maria van der Merwe, “Obesity disrupts hormones which can impact on regular, healthy ovulation. Menstruation is regulated by a very fine balance of hormones. Overweight and obese women have higher levels of a certain hormone called leptin because adipose or fatty tissue acts as an organ secreting hormones and this reduces fertility and affects insulin resistance in the body. Research shows that the quantity and the distribution of body fat affects the menstrual cycle and reduces ovulation. Therefore, more excess weight, and the more abdominal fat particularly, the greater the risk of fertility challenges. With a BMI (Body Mass Index) of upwards of 29, women are less likely to be able to conceive because they may not ovulate regularly. Therefore, weight is a factor for women who want to start families with ease and have the confidence of a healthy pregnancy journey.”
South African women need to know there are solutions
Dietary change is important, as well as physical activity. Switching to more nutrient dense foods while avoiding high fat and high sugar makes a difference. Being vigilant about sweets, snacks and sugary beverages is essential. Finding ways to incorporate daily physical activity is important. Cooking more at home using fresh produce helps you to avoid takeaway meals that are unbalanced in nutritional value, high in fat and sugar. Including vegetables and fruits in every meal and focusing on whole grains introduces dietary changes that are healthy and delicious. Maria says, “While there are genetic and hormonal aspects at play, it is important to note that ultimately, overweight and obesity occurs when you are consuming more calories than you burn.”
Taking a disease management approach
Overweight and obesity are complex conditions affecting many aspects of life. Maria says, “It’s important for South African women to seek help and get support. This is a multi-factorial condition, so the journey differs and there needs to be an individualised approach. The goal though is the same, let’s support women in increasing their health and wellness across the country and turn back the tide of South African women having the worst outcomes for obesity across the African continent.”