No abstract.
South African Journal of Clinical Nutrition Vol. 18 (1): 4-

Steyn, NP

English

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SAJCN4April 2005, Vol. 18, No. 1EDITORIAL‘Big is beautiful’ — and unhealthy andconfusing?Obesity in women from developing countries is agrowing phenomenon, even though the rate is stillrelatively low in certain areas, namely South Asia(0.1%), sub-Saharan Africa (2.5%), and the Caribbeanand Latin America (9.6%).1 In North Africa and theMiddle East the prevalence of obesity is already 17.2%,not much lower than the 20.7% found in the USA.Thirty-six per cent of urban black women and 25% ofrural black women in South Africa are obese. In SouthAfrica as a whole, 30% of women are obese.2 Obesity inblack women is a significant health problem in SouthAfrica and paves the way for diseases such as diabetes,hypertension, stroke, and certain cancers, all of whichare prevalent in black women.3The article on obesity in black urban women by Puoaneet al. in this issue of the Journal (p. 6) makes somesalient points regarding the physical and social issuesaround obesity in black women in a township in CapeTown. The most important point is the way blackwomen feel about ideal body size, which is muchflaunted by the media and valued in Western society,and secondly, how they feel about their own body size.Black women find themselves in a dilemma. On the onehand their culture and traditions demand a bigger bodysize as representing health, wealth and dignity in awoman, while on the other hand they are subjected toincreasing pressure from Western norms to conform toan ideal thin figure. Culturally the latter may give riseto being regarded as unhealthy, poor and sick. The fearof social stigma associated with thinness and beingHIV-positive is a very real one, which may encouragethe adoption of overweight as a countermeasure.Similar findings with regard to culture and traditionwere noted in young black female students enteringuniversity for the first time.4 On the one hand it wasfound that there was more realism (accuracy) regardingweight status and body shape (compared with whitefemale students), most probably linked to culturalnorms. On the other hand there were definite signs ofassimilation of Western norms regarding body shapeand perceived ideal weight. Already there wasevidence of low self-esteem associated with beingoverweight, weight reduction efforts, body shapedissatisfaction, disordered eating patterns and dietaryrestraint. Clearly, young black women wereexperiencing similar dietary problems to those of youngwhite women.Few studies in South Africa have examined factorsassociated with weight gain in black women. Hencethe underlying drivers are still largely open tospeculation. One study undertaken in an economicallyactive population identified risk factors for overweightand obesity as being black ethnicity, inactivity, lessthan 7 years of schooling, and at least one overweightparent.5 Others have ascribed the obesity epidemic tothe rural-urban transition, including electrification,reduced physical activity, increased susceptibility toobesity, and increasing availability of energy-densefoods, particularly fat-rich foods and low-fibrecarbohydrates.6 Puoane et al. indicated that the womenthey studied blamed the cheap fatty foods they ateregularly as being responsible for their overweightstatus. The researchers also drew attention to the factthat the participants in the study consumed very largeportion sizes of high-fat foods.Nevertheless, whatever the causes, it must berecognised that the pandemic needs to be halted as amatter of utmost urgency. Furthermore, it is recognisedby many researchers working in the field that theproblem needs to be identified and addressed inchildhood, since overweight children and adolescentsfrequently become overweight and obese adults.7 Todate there have been few community interventionstackling obesity and overweight in children in SouthAfrica, although it is recognised that the school settingwould make an ideal venue for communication of ahealthy diet and physical activity in the ongoingprevention and management of overweight.  Numerousintervention studies in developed countries have shownsmall yet modest success in teaching children to adoptdesirable behaviours aimed at improving lifestyle. Sincestunting has also been shown to be a risk for laterobesity, it stands to reason that programmes addressingunderweight should ensure that factors relating to theprevention of overweight are included. Ideally,interventions should address all aspects of malnutrition.Over the past two decades there has been a significantnumber of international intervention studies aimed atreducing cardiovascular risk factors, including obesityin elementary school children. Some of the most widelypublished of these are the Child and Adolescent Trialfor Cardiovascular Health (CATCH),8 Pathways,9Cardiovascular Health in Children (CHIC),10 HeartSmart,11 Planet Health12 and the San Diego FamilyHealth Project.13 Some of the health benefits derivedfrom these studies in the intervention groups are, interalia, reduced total cholesterol, increased high-densitylipoprotein cholesterol, reduction in percentage bodyfat, increased health knowledge (diet, activity,smoking), increased aerobic power, increased physicalactivity outside school, improved diet with decreasedfat and saturated fat intake, decreased prevalence ofobesity, improved school meals, decreased risk factorsfor obesity, and decreased TV watching time. However,it is important to note that the intervention studiesexamined generally only show one or two of thesepg4-5  5/13/05  2:36 PM  Page 1April 2005, Vol. 18, No. 15SAJCNpositive outcomes and frequently do not showphysiological changes.The majority of successful interventions have targetedmultiple risk behaviours and most have had thefollowing in common: (i) they have targeted children inGrades 3 - 5; (ii) they have used the school setting asthe venue for intervention, which has generally takenplace over 2 - 3 years; (iii) they have used trainedteachers to undertake the intervention during schoolperiods; (iv) they have focused on changing dietarybehavior and increasing physical activity; and (v) theyhave included the families of the participating children.The writing is on the wall. If health educators are goingto arrest and reverse the obesity pandemic in adults,particularly black women, they are going to have tointroduce cost-effective and sustainable healthpromotion interventions in the schools.N P SteynChronic Diseases of Lifestyle UnitMedical Research CouncilTygerberg, W Cape1. Martorell R, Khan LK, Hughes ML, Grummer-Strawn LM. Obesity in women fromdeveloping countries. Eur J Clin Nutr 2000; 54: 247-252.2. Department of Health. South African Demographic and Health Survey 1998. Pretoria:DOH, 2000.3. Reddy P. Chronic Diseases. In: Ijumba P, Day C, Ntuli A, eds.  South African HealthReview 2003/04. Durban: Health Systems Trust, 2004: 175-187.4. Senekal M, Steyn NP, Mashego TA, Nel JH. Evaluation of body shape, eating disordersand weight management related parameters in black female students of rural and urbanorigins. South African Journal of Psychology 2001; 31(1): 45-49.5. Senekal M, Steyn NP, Nel JH. Factors associated with overweight/obesity in economicallyactive South African populations. Ethn Dis 2003; 13: 109-116.6. Temple N, Steyn K, Hoffman M, Levitt NS, Lombard CJ. The epidemic of obesity in SouthAfrica: a study in a disadvantaged community. Ethn Dis 2001; 11: 431-437.7. World Health Organization/Food and Agricultural Organization. Diet, Nutrition and thePrevention of Chronic Diseases. Geneva: WHO, 2003.8. Edmundson E, Parcel GS, Feldman HA, et al. The effects of the child and adolescent trialfor cardiovascular health upon psychosocial determinants of diet and physical activitybehavior. Prev Med 1996; 25: 442-454. 9. Davis SM, Clay T, Smyth M, et al. Pathways curriculum and family interventions topromote healthful eating and physical activity in American Indian schoolchildren. PrevMed 2003; 37: S24-S34. 10. Harrell JS, Gansky SA, McMurray RG, Bangdiwala SI, Frauman AC, Bradley CB.School-based interventions improve heart health in children with multiple cardiovasculardisease risk factors. Pediatrics 1998; 102: 371-380. 11. Arbeit ML, Johnson CC, Mott DS, et al. The Heart Smart cardiovascular school healthpromotion. Prev Med 1992; 21: 18-32.12. Gortmaker SL, Peterson K, Wiecha J, et al. Reducing obesity via a school-basedinterdisciplinary intervention among youth: Planet Health. Arch Pediatr Adolesc Med1999; 153: 409-418. 13. Nader PR, Sallis JF, Patterson TL, et al. A family approach to cardiovascular riskreduction: results from the San Diego Family Health Project. Health Educ Q 1989; 16:229-244.pg4-5 tib  5/14/05  5:39 AM  Page 2

Editorial: \'Big is beautiful\' - and unhealthy and confusing?

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Editorial: \'Big is beautiful\' - and unhealthy and confusing?

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