The theme for World Obesity Day 2024 is: “Let’s talk about Obesity And…”. It’s clear that the theme is open-ended as an indication to show that obesity is indeed complex and requires a good understanding of the factors that lead up to the point when an individual is said to be overweight or obese. Driven by the World Obesity Federation (WOF), and its membership, this year’s theme aims to fill the gap in educating populations around the world on the factors that influence obesity. The Heart and Stroke Foundation South Africa (HSFSA), aligns with the WOF although it has expanded the 2024 theme to include a life-course approach. The foundation's theme, therefore, is “Let’s talk about obesity over the life course”, and will be commemorated for the month of March. In South Africa, there is a high burden of obesity with almost 65% of women being classified as overweight or obese. There is also an increasing prevalence of childhood obesity. The CEO of the HSFSA, Professor Pamela Naidoo, has emphasized the importance of a strong and impactful campaign for WOD as one of the prevention measures to protect young children and future generations.
In order to address the obesity epidemic, the first step is to acknowledge the intergenerational cycle of obesity. A multifaceted approach is required to reduce the obesity burden. Kinza Hussain, the Foundation’s dietitian states that we need to target families, infants, and children to initiate and promote healthy behaviors. Adolescents are also a special group where health behavior messages should be promoted before this age group becomes reproductively active. Most important are pregnant women who need to optimize their nutritional intake, monitor weight gain and prevent gestational diabetes. The postpartum period needs to be monitored to promote a return to healthy pre-pregnancy weight and facilitate long-term breastfeeding.
It has been well established that obesity entails a strong genetic component. Individuals who have obese parents are more likely to be obese themselves. Of course it is also important to monitor the intersection between environmental and genetic factors. In recent years, attention has shifted to maternal obesity and how obesity has the potential to develop in utero. “Emerging evidence highlights the impact that maternal obesity has on the fetus and this provides not one, but multiple windows of opportunity to mitigate the growing concern obesity is placing on our communities,” says Ms Hussain. Studies have illustrated that fetal exposure to maternal obesity is linked to a higher prevalence of stillbirth and congenital defects. Furthermore, there is an increased risk of non-communicable diseases (NCDs) later in life, including childhood obesity and cardiovascular diseases.
While studies have established that neonatal fat is associated with childhood obesity, opportunities exist for intervention along the health trajectory during childhood. Infant feeding methods have the potential to represent the first point in the postnatal period whereby the impact of being an obese mother can be rectified. Research has illustrated that breastfeeding reduces the risk of childhood and adult obesity. Exclusive breastfeeding, and breastfeeding for extended periods (up to 12 months) demonstrate greater benefits such as the normal development of appetite regulation. The second window of opportunity is the weaning stage. Early introduction of solids (before 4 months) or delaying it beyond 6 months may increase the risk of becoming overweight during childhood, as demonstrated by emerging evidence.
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Prof Naidoo states that the state of obesity is not all “gloom and doom”. The recommended measures can be used to mitigate the chances of developing childhood obesity, but at the same time, the literature does state that the obese child is not predestined to become an obese adult. The childhood years, therefore, are yet another crucial period to address overweight and obesity that may have been programmed in utero. Of significance, studies have also shown that early intervention to reverse excessive weight in childhood removes any residual metabolic risk. Ultimately, the obese child who becomes a lean adult is not at a cardiometabolic disadvantage. This implies that by reducing obesity prevalence over time one can reduce the risk of type- 2 diabetes.
Teenage births and pregnancies are not uncommon in South Africa. Pregnancy is viewed as a teachable period when women are more open to public health messaging and willing to make health behavioral changes. Educating young, pregnant females, about the strategies that can be used to prevent obesity among youth and young children is critically important. As an adult, being obese is more complex than just simply being sedentary and eating incorrectly. These factors can further worsen the condition but are often not the only determinants of it. The best way to understand how a condition can affect someone is by listening to the first-hand experience of individuals experiencing the condition. Obesity has tripled since the year 1975 and it has been found that the bias, stigma, and discrimination faced by individuals living with obesity contribute to increased morbidity or mortality.
Juandre Watson, the Foundation’s Acting Health Promotion Manager, expresses the importance of workplace wellness programmes to combat obesity. Given that most people spend a large part of their time in the workplace and, therefore, eat at least one of their daily meals there, well-planned interventions have been demonstrated to be useful for combating overweight and obesity. These include dietary interventions associated with exercise or educational programs. In addition to such interventions, new and emerging science needs to be explored and implemented in the management of obesity. One such example would be the intriguing relationship between the gut and brain, and its link to obesity. Alterations to the gut microbiota can be a result of unhealthy eating habits and stress which may also result in obesity. This would then entail ensuring the consumption of specific foods and improving mental health to keep the gut healthy.
This WOD and for the entire month of March, join the HSFSA in keeping the conversation going and in understanding the complexity of obesity. Let us all recognize the role we have to play, Let’s talk about obesity and…” and spread the word.
