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From Malnutrition to Obesity?


From the news of women using dried cow dung in Kwazulu Natal for menstrual periods to South Africa topping the charts  on the obese scale, most South Africans are perplexed in a country which boasts of the best economy in Africa and perhaps the most efficient health system in sub Saharan Africa. Whereas South Africa has one of the enviable health systems globally, the rise in obesity amongst the population is a cause of concern not only for health professionals but for the citizenry as well. In January 2014 The Overseas Development Institute published results that showed that obesity had quadrupled to nearly one billion in developing nations  since 1980.But why focus obesity? How best can nations address the growing pandemic which is increasingly becoming a threat to enjoyment of quality life in Africa?

Africa has of late gradually developed into a centre of consistent civil conflict, malnutrition, poverty, hunger, rising non communicable disease burden and lately a shocking infirmity of obesity, meaning the obesity crisis now touches all corners of the world and promulgating future healthcare costs. According to The Lancet the prevalence of overweight or obesity among boys rose from 8.1% to 12.9% and the prevalence among girls grew from 8.4% to 13.4%.All over the world the passage of time was marked by bigger waistlines. Successive cohorts seemed to be gaining weight at all ages including childhood and adolescence. Amazingly all this is taking place on a continent known for serious food insecurities, poverty and child malnutrition.

Obesity has been related to western nations which have highly refined foods and fast food outlets at almost every street corner however besides diet, lack of physical activity has been blamed for overweight and obesity. In Africa the westernization of diets and lifestyles has taken grip on the African populace with a rising middle income group. The growth of most African economies has come with a heavy burden on health related outcomes particularly the rising non communicable disease paradigm.  The problem is further perpetuated by lack of comprehensive and clear policy on health risk factors responsible for non communicable disease, overweight and obesity.

In South Africa, government policy on creating sustainable livelihoods for people in townships and urban poor has seen a rise in shopping malls which are mostly “littered” with fast food outlets and at times lack much needed gyms and recreational facilities. Whereas recreational facilities are present even in the most meagre areas, most South Africans still find more comfort in junk food than on the playing field for simple exercises such as jogging. South Africa is one of the few countries in Africa with a clear policy on health risk factors responsible for overweight and obesity. Over the past years body mass indexes for South Africans has increased leading further to a high prevalence of obesity and overweight besides the policy, a development which has baffled health professionals and policy makers. However underlying the health policy are heath behaviours which need to be understood and construed as part of policy implementation. Obesity in itself is a accumulation of a number of unhealthy behaviours or practices which have been present over a long period of time, understanding these behaviours is imperative to addressing current obesity challenges.



A branch which is slowly developing to initiate efficient behavioral change strategies is behavioural health economics. The branch answers questions such as: Why do people make what seem to be irrational choices? Can we understand real life decisions about health better? What should policy makers do about it? Should health be considered as a brand? Without understanding why people act or why they pursue different health behaviours, it is a mammoth task for governments in Africa and globally to address the rising challenge of obesity. For example we understand that a significant number of working South Africans prefer meals prepared at fast food outlets and consume them at least 7 to 10 times each week; however we also need to know why they prefer such food compared to homemade meals. How do we motivate people to do the right thing and stay healthy? The Obama administration and other European countries including UK have employed the services of health behavioural economists to address health problems arising from behaviours. The opportunity to blend in such services has never been greater in Africa than it is now.

Although Africa has over the years been a haven to malnourished children and severe hunger; we are slowly moving into the obese category and to address this growing trend, mix of different strategies should be used by policy makers and health professionals. Addressing these problems through remedial services should not be part of our policy as seen over the years, the need to strengthen health promotion and preventative medicine initiatives is important in addressing arising health problems at infancy stage. Over the past years research has proven that people will not stop smoking merely when the cigarette pack has caution on the effects of smoking, neither will people stop drinking because of the same. Physical inactivity, diets, smoking and alcohol are the four main factors responsible for obesity in Africa however how much do we know about what leads people to engage in these “heinous” acts of “abomination” to the human body? Are policy makers doing enough to halt the growing pandemic of obesity? Is there enough health information to assist the African healthcare consumer to make informed health decisions?

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