CHANGING SYSTEMS TO REDUCE OBESITY IN SA
March 2025
One of the defining consumer trends of the 21st Century is the pursuit of healthy living. Yet, the World Health Organization (WHO) records that overweight and obesity has more than doubled since the 1990’s, affecting all regions of the world, and particularly South Africa. Our country has the highest obesity rate among all African countries with half of all adults recorded as overweight or obese – this is comprised of 68% of South African women and 38% of men.
This prevalence of overweight and obesity not only affects quality of life for individuals and families, but it is a major contributor to the country’s preventable disease burden that includes diabetes and hypertension. There is enormous potential to reduce healthcare costs in South Africa by enabling healthy lifestyles. Tackling the issue of ever-increasing rates of overweight and obesity, which includes children and teens, has previously focused on individual choices. The simplistic approach has been that if South Africans just eat less, eat healthy and exercise more, the country will turn the tide against overweight and obesity. However, this doesn’t consider that causes of overweight and obesity, a form of malnutrition, are highly complex, and so the rates of overweight and obesity keep rising.
World Obesity Day, which falls on 4 March, is taking the lead in acknowledging that the drivers of obesity and overweight are multi-faceted with its 2025 theme, Changing Systems Healthier Lives. Maria van der Merwe, President of The Association for Dietetics in South Africa (ADSA) explains what this means: “The systems we are referring to are the food, government, health, media and environmental systems, which all have impacts on the increasing risks of obesity. These systems all affect our lives as individuals and there are a range of factors embedded in all these systems that are contributing to the increase of obesity. If we look at the food system and the foods that are available, affordable and desirable, we see that there’s a prevalence of calorie-dense but nutrient-poor foods that are accessible and affordable in certain communities, while healthy food options are scarce or much more expensive. This is a food desert – a failing in the food system that is contributing to malnutrition. We can easily understand that individual choices are not the issue when the actual food system is stacked up against you.
“Furthermore, as we go through our daily lives we are impacted by multiple intersecting systems. So, it doesn’t help if the nursing sister at the day clinic tells a patient to eat more vegetables and exercise if that person is living in a community where fresh vegetables are scarce, and the environment is so unsafe they cannot go outside after work and take a walk in their community. In this common example of multiple systemic barriers to healthy living, the food system, the environment, the healthcare system and the government system are all failing the individual and limiting their hopes of living a healthier life.”
Highlighting the complexity of overweight and obesity are a host of contradictory country statistics. For example, 29% of South African children under 5 years are stunted due to undernutrition, while 23% of children are overweight. Consider also that 69% of obese South African adults live in food-insecure households which is a testimony to surviving on cheap, energy-dense but nutrient-deficient foods.
While it might seem that as individuals, South Africans can’t do much to change these circumstances imposed by systems, Dr Edzani Mphaphuli, Executive Director at the Grow Great Campaign, disagrees. Grow Great aims to mobilise South Africans to halve stunting by 2030.
Dr Mphaphuli identifies 8 key ways that South Africans can use their consumer power to impact on the systems that are compromising health and enabling high rates of overweight and obesity. She says:
- “Consumers must demand systemic change that prioritises public health over corporate profits.
- Consumers need to shift from blaming overweight and obesity on individual choices and instead demand systems that support those in need.
- Consumers must raise their voices to help every mother get financial and nutritional support during the critical first 1000 days of their children’s lives, from conception to their second birthday, which can effectively eliminate early risk factors for obesity, which includes new mothers being unable to breastfeed exclusively for the first six months of life.
- Consumers must demand that food packaging features clear and straightforward nutritional labels, and health warning labels like those on cigarette packages, so that everyone can easily identify unhealthy and healthy food options.
- Consumers must lobby for a ban on misleading advertisements that promote ultra processed, unhealthy foods.
- Consumers must demand that healthy foods are made both affordable and accessible to all.
- Consumers must demand that neighbourhoods are designed with safe and welcoming spaces for exercise, while also advocating for improved living conditions in unsafe environments such as informal settlements, where people face daily hazards like open sewage, broken bottles and crime while walking.
- Consumers must advocate for the creation of environments, policies, and resources that truly support healthier lives for all.”
Better systems and healthier lives lead to a stronger economy
There is much to be gained by empowering South Africans to achieve their aspirations of healthy lifestyles. Reducing obesity-related diseases like diabetes and hypertension will cut healthcare costs; and a healthier population will be more productive, which will be a boost to the economy. On an individual level, access to nutritious, affordable food choices will lead to an improved quality of life for all South Africans.
Liezel Engelbrecht, a Registered Dietitian and the DG Murray Trust’s Innovation Manager for Nutrition Strategy concludes, “We need to realise that more than half of adults in South Africa are overweight or obese. This costs our strained economy over R33 billion per year in public healthcare costs alone. Yet over a quarter of children under five years are stunted, a tell-tale sign of chronic malnutrition. The reality is that these seemingly opposite nutritional outcomes have overlapping drivers on the systemic level, and are often found in the same households, and sometimes even impacting on the same individuals. These two expressions of poor nutrition, along with ‘hidden hunger’ which refers to micronutrient deficiencies, make up the triple burden of malnutrition that haunts our country and is playing a role in preventing human development and economic progress. Addressing this requires government, the public and the private sector to work together to improve the availability, affordability and quality of our food.”