One On One

Q & A – Ntokozo Ngubane

South Africa is faced with a growing problem of obesity with women being the most affected. Recent studies indicate that there is a growing number of children under the age of five now living with the condition. October 15-19 has been designated as Obesity Week in order to raise awareness about the condition and how people can improve their lifestyles and avoid this condition, feared to trigger various health complications. The Weekly’s Martin Makoni asked Ntokozo Ngubane, a registered dietitian at the Heart & Stroke Foundation of South Africa about some of the causes of obesity and how it can affect one’s life. Makoni also asked Ngubane about the situation in South Africa and how people can avoid it. Excerpts:

How would you define obesity in very simple terms?

Obesity is an accumulation of excessive or abnormal fat in the body. It can be fatal as it contributes to the risks of non-communicable diseases such as diabetes, heart disease, stroke, cancer.

What causes obesity?

It can be a number of things. Most of the time it’s the lifestyle. For example, if we don’t exercise. Physical inactivity or a sedentary lifestyle where you just eat without any form of physical activity to burn out the energy. As a result, there is no energy balance. And besides the activity it can be overconsumption or a lack of variety, so you could be eating a lot of fatty foods or high-refined sugary foods. Other factors include genetics, certain medications, and medical conditions like hypothyroidism or polycystic ovarian syndrome which can contribute to weight gain.

What is hypothyroidism and how does it contribute to obesity?

In simple terms, our thyroid gland is responsible for producing hormones that play a role in metabolism, so if it is malfunctioning it may affect your weight. Hypothyroidism is a condition when your thyroid is underactive therefore may lead to weight gain, if the thyroid is overactive then it causes weight loss.

Given the different circumstances you pointed out, is obesity preventable?

Yes, it can be prevented. Even in patients with these medical conditions, the weight still needs to be managed in order to decrease the risk of other conditions i.e. insulin resistance or diabetes. It can be prevented by living a healthy lifestyle, eating a variety of healthy foods and exercising.

Recent studies indicate that South Africa and China could face a spike in the number of children who are obese, what could be the reason for that, where is that coming from?

The numbers are shocking, if you look at statistics from the World Health Organization (WHO), in 2016 there were 41 million children under the age of five who were obese/overweight; almost half of all the overweight children were from Asia and one quarter from Africa.

In South Africa specifically, 13.3 percent of children under five were overweight or obese; the poor feeding practices are contributing to this.

What’s wrong with the feeding practices, are children being fed the wrong food or eating too much?

Ideally, babies should be exclusively breastfed or formula fed for the first six months of life which means the baby gets all the nutrients only from the breastmilk or formula during that period. At six months, solids can be introduced i.e. when you start preparing soft porridge, or butternut for example. When parents introduce solids, they’re encouraged to not add any sugar, salt or fat to the food and to serve it just like that. If sugar, salt, or fat is introduced at that age, the baby grows with that taste preference and may always go for salty, or sugary snacks. Also when parents pack lunch for school, it should be healthy nutritious wholefoods.

So, what should be avoided at that early stage and how easy is it?

Children shouldn’t be drinking sugar-sweetened beverages, they don’t need that extra sugar. Some of the baby foods sold in the shops are high in sugar, parents should rather puree/blend the fresh fruits and vegetables at home. When packing lunch for your children, instead of packing a sugar-sweetened beverage, rather give them milk or water, a fruit instead of a packet of potato chips.

How much would you attribute South Africa’s problem of obesity to genetics as well as man-made causes?

Genetics does contribute to obesity but most of the time it’s our lifestyle. There has been a shift where people are not eating at home more often, we tend to eat our more or buy fast food as they’re convenient. Life get’s busy and hectic and it’s easy to just grab fast food on your way home. Children are also spending less time playing, most of the time they’re either watching TV or on their phones/ipads playing video games. So a sedentary lifestyle is starting at a young age. The only form of exercise for a child is playing and they should be encourage to have less screen time and 60 minutes of physical activity every day.

In adults, how much does alcohol contribute to obesity?

Alcohol does contribute to weight gain and obesity but it also increases your risk for other diseases such as heart diseases, stroke, and diabetes. We don’t recommend that anyone takes alcohol but if you’re drinking then to do so in moderation. The recommendation is 1 drink for women and 2 drinks for men per day.

So, what should people do to avoid the risk of obesity, of course you mentioned cutting on certain things, which isn’t always easy to do, what’s the best way to go about it?

It’s certainly not easy to say because if it was that easy, everyone would be doing it. Exercising is very important. You have to see what works for you and it’s not just about going to the gym because not everyone can afford it or has the time. Ideally, you should have 150 minutes of exercise per week. You can also jog or walk briskly, join a dance class, any form of exercise that you will enjoy and that will work for you. At work take the stairs instead of the elevator, have small exercise targets i.e taking 10 000 steps every day

When it comes to food, try cook at home more often instead of eating out.  Fast foods are high in fats and salt and should be avoided/limited. Pack a lunch to work so you’re not tempted to go buy a ready-prepared fast food meal. Try incorporate fruits and vegetables every day, aiming for five portions daily. Always choose water, and limit intake of sugar-sweetened beverages.

How healthy are those drinks labeled ‘zero sugar’ is there no sugar for real?

I wouldn’t say such drinks are healthy or not healthy. Such drinks simply don’t have the added refined sugar. They are still sweet because they have added an artificial sweetener which doesn’t have calories, which doesn’t have the energy that normal sugar would have. So, such drinks could be a better option to the original ones with sugar, water remains the best option.

How does South Africa’s obesity situation compare with the rest of the world?

Obesity is a major public health concern globally. For South Africa, statistics from 2016 indicate that 68 percent of women and 31 percent of men are obese or overweight. For children younger than five, it’s 13.3 percent. It’s really bad and we should take it seriously because if you are obese, you are putting yourself at risk of other diseases which are deadly but can be prevented. We have the people dying from heart diseases and stroke before the age of 65 which can be regarded as a premature death; but 80% of these diseases can be prevented by living a healthy lifestyle.