How nutrition, mental health and food choices fuel South Africa’s obesity crisis
Food is a language we all understand.
Along with touch, it is the way we are invited into our physical bodies moments after we are born.
We are designed to seek nourishment in its many forms — for pleasure, fortitude and growth and development. It’s fascinating that this primal, simple fact of life has evolved with modernity to be the root of much of our well-being undoing.
And while our waistlines are so much wider, our nutrient deficiencies are equally a heavier burden of disease.
In the most recent investigation into food intake and nutrition of South Africans, the Human Sciences Research Council looked at 100 variables affecting a cohort of 34 000 people.
It found that 69% of obese adults lived in resource-constrained households where food choices were devoid of nutrients. 30% of women of reproductive age are iron deficient.
More than half of the global population is vitamin D deficient. More than two thirds of women are either obese or overweight. KwaZulu-Natal had the highest incidence of obesity, at 39.4%.
At the same time, 4% of women will be diagnosed as anorexic in their lifetimes, and a much larger percentage will fall on a spectrum of disordered eating habits and body dysmorphia.
Too much of anything is never a good thing. Your fat cells are metabolically active, and while we all need some subcutaneous fat for warmth and scarcer days, and a cushion to break a fall, an excess of adipose tissue contributes to an inflammatory soup coursing through your veins and affecting your every organ.
Nervous system regulation is a central concept in popular wellness culture today. Everyone is contemplating their vagus nerve.
We are all familiar with the accelerators and decelerators of the nervous system. What the body winds up, it also winds down and somewhere on that fulcrum is a harmonious balance that keeps your heart beating and your psyche mostly serene.
This, of course, is in ideal circumstances or in a mind where psychic maturity and perspective reign. The mental health crisis, with more than a third of South Africans having been diagnosed with a common mental health diagnosis in their lifetime, suggests that the serenity of this balance is becoming more elusive.
There are many pieces that contribute to this great undoing, but a collective response to physical and psychological dis-ease is reaching for crisps and a chocolate.
With fast and junk food being the cheapest and easiest to get, self-soothing with refined carbohydrates is even easier than self-soothing with alcohol.
I feel like a broken record perseverating about the food and advertising industry and how they feed into this burden of disease.
How often do you see a billboard of a muscular, vibrant human body enjoying a bowl of organic spinach or munching on a carrot? No, the images idealise alcohol, burgers, chips, sugary drinks and vapes. They are even beginning to glamourise bodies that carry unhealthy extra adipose tissue.
Cultural norms should not be shifting towards diabetic bodies with hypertension and heart disease. I know this is sensitive ground. There are so many factors that contribute to body shape, but if we rewind just 50 years and compare, we really are shape-shifting — and not in a healthy way.
It’s no accident that the other big arms of the capitalist beast feeding this problem include Big Pharma, who are there with a side order of antidepressants and a needle full of appetite suppression. A salve for the ills spread by our food system.
One of the challenges we face when treating psychiatric disease is the metabolic adverse effects associated with most of the drugs in this armoury.
For a patient whose mood symptoms might be linked to their body image or an underlying inflammatory problem, adding an antipsychotic or an antidepressant will often result in weight gain.
And what about endocrine disruptors? These molecules can mimic our endogenous hormones and stimulate or block the receptors that they act on. According to the Endocrine Society, there are nearly 85 000 human-made chemicals in the world, and 1 000 or more of these could be endocrine disruptors.
This discovery began when studying an adverse effect of the drug diethylstilbestrol, which was administered to pregnant women to prevent miscarriage. The girl children of these women suffered from a rare form of vaginal cancer.
Many links and associations have been drawn between conditions such as attention deficit hyperactivity disorder, cancer and certain chemicals that we are all exposed to through skin, diet, air and water.
What makes these associations so difficult to prove is the multifaceted influences that conspire to make a disease profile express itself.
Another contributor may be the steroid hormones we are exposed to through our water systems. Studies observing the feminisation of aquatic life have raised concerns about the levels of sex hormones excreted through sewerage. More and more data is being gathered to expose a new kind of pollution that many of us don’t think about.
Designing hyperpalatable foods is a career choice that didn’t exist before the pandemic of adult and child obesity. Perfect combinations of unnaturally occurring fat, salt, sugar, crunch and carbs are messing with our satiety signals and tricking our brains into needing more.
The jury is out on whether we can compare drug addiction to food addiction.
In rodent experiments, healthy and cocaine-addicted rodents will choose a sugary drink over a cocaine dose.
Our brain’s reward system is designed to seek out calories to fortify us against leaner times. Hyperpalatable food not only cultivates unhealthy bodies, but also reduces cognitive function, memory and learning — most notably in the developing brain.
According to the World Health Organisation, the worldwide prevalence of obesity more than doubled from 1990 to 2022. Other than our environment, what could have precipitated this escalation? Twin, family and adoption studies have estimated the heritability of obesity to be 40% to 70%. But it probably accounts for less than 5% of the increase in the current burden of disease.
We also know that less than 5% of other chronic diseases are heritable, so it feels too convenient to blame obesity on evolution alone.
We know that our genes load the gun, but our environments and choices pull the trigger. We can switch off obesogenic genes by choosing lifestyles that support healthy bodies.
When we use our bodies in the way that they were designed to be used (moving, exerting, dancing, leaping); when we seek nutrition for the amino acids and fatty acids that our bodies need for fundamental health, then we switch these obesogenic genes off and we stave off diseases such as hypertension, diabetes, depression and cardiovascular disease.
Once a body has been obese for a prolonged period of time, it becomes almost insurmountable to lose the accumulated weight. The body holds on to fat. In the face of a reduced caloric diet, an obese body will increase its desire for extra calories and slow its metabolic rate.
The uphill battle against weight loss for a very overweight body is real and measurable. The discomfort of carrying extra weight on your joints is real and measurable. The effect of obesity on a patient’s quality of life is overbearing and mammoth.
We have a responsibility to our children and our species to halt the engines that feed this insatiable beast. Say no to Coca-Cola and fruit juice. Say no to deep-fried chicken and processed meat. Say no to microwave dinners in front of a television.
Say yes to the Earth’s bounty and wisdom. What you feed your body designs your brain. We can’t afford any further dumbing down.
Dr Skye Scott is a family GP and co-owner of Health with Heart.