We would like to believe there may be small, simple solutions to big problems, but when is that actually true? The answer is probably, never. Intractable, extreme issues arise out of complexity, and nothing less than a host of multi-dimensional, cross-functional countermeasures issued at the right time and the right place can bring about sustainable transformation.
Obesity, a disease characterized by the interaction of genetic, behavioural, metabolic and environmental factors, embodies a complex matter requiring a comprehensive approach. A quick glance at the South African context (marked with more than 41% of women being obese) highlights that combating obesity in South Africa will require more than a one size fits all approach.
This is why advising people who are obese to just consume fewer calories while burning more energy is not just doomed to fail but damaging to vulnerable people.
Obesity is a health condition beyond overweight that soars past trite platitudes. Research has shown that restricting calories while boosting exercise only makes a paltry 3 to 5% difference to sustainable weight loss and weight management. This is staggering, and it points out that the roots of obesity run deep - in the unseen details of our DNA; in the shadowy intricacies of our individual psychology, and day-to-day, in the banality of our homes, workplaces and communities where bias and shame are uncontested.
World Obesity Day, the 4th of March, is a time to acknowledge the global increase of obesity and its long-term impacts, while providing hope through awareness and education. Having a loved one on the brink, or all the way down the road, causes all involved parties to grapple with bona fide existential fear. Obesity puts one at risk for a host of other medical conditions such as non-communicable diseases, and it is too complex to solve with simple calorie restrictions plus exercise.
Dr Christine Taljaard-Krugell, President for ADSA (The Association for Dietetics in South Africa) says, “Simplifying obesity to one cause could prevent effective treatment. It ignores the various root causes such as biology, food, genetic risk, healthcare access, life events, marketing and sleep. Hence, when tackling obesity as a chronic disease, an evidence-based approach should be followed. Holistic patient care is critical. While cutting back on calories and increasing exercise is a relevant start and lays a foundation for healthy living at a healthy weight, it’s not the be all and end all when you’re aiming for sustainable change. This is a misconception that needs to shift.”
In recognition of World Obesity Day, the National Department of Health has stated that “it welcomes a broader view when it comes to dealing with obesity in South Africa, which is at an all-time high. Obesity is defined as a prevalent, chronic condition that impairs health, increases morbidity, and renders people prone to relapsing.”
Obesity care cannot simply be about diet and exercise advice; it should include intensive nutritional therapy led by registered dietitians, physical activity programmes, pharmacotherapy, as well as psychological, and even surgical interventions. For sustainability, the root drivers of obesity must be dealt with. These may be genetic and/or psychological drivers that will inevitably scupper calorie-restriction and exercise efforts if they persist as underlying causes.
People living with obesity also face bias and stigma that have major impacts on their life goals and aspirations, and therefore, their well-being. Here’s a way that we can all help counter the increasing obesity among SA adults and children: understand the complexity of the issue; don’t assume; don’t judge and don’t give off-the-cuff advice. Interrogate your own explicit and implicit biases. Promote and support holistic, professional patient care. There is a better way.
To find a registered dietitian in your area that can assist in the management of obesity, visit: http://www.adsa.org.za