TOWARDS THE REDUCTION OF

OBESITY IN SOUTH AFRICA

WORLD NUTRITION

CAPE TOWN 2016

Presented by TL Moeng Mahlangu.

National Department of Health

PRESENTATION OUTLINE

Rationale for the development of the National strategy for the prevention

and control of obesity.

Prevalence of obesity globally and in SA

Key drivers of obesity

Process of developing the strategy

Stakeholder involvement

Initial Implementation phase

Acknowledgements

Conclusions

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RATIONALE FOR THE DEVELOPMENT OF AN OBESITY STRATEGY FOR SA

• The prevalence of overweight and obesity among children and adults is increasing worldwide, including in SA.

• Obesity in South Africa is ranked fifth as a risk factor for early death and years of life lived with disability or disability-adjusted life years (DALYS).

• South Africa has the highest overweight and obesity rate in Sub-Saharan Africa and the second/third highest in Africa

• Need for a coordinated multi-sectoral approach to the prevention and control of obesity in South Africa

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Key facts: The global picture

• Worldwide obesity has more than doubled since 1980.

• In 2014, more than 1.9 billion adults, 18 years and older, were overweight. Of these over 600 million were obese.

• 39% of adults aged 18 years and over were overweight in 2014, and 13% were obese.

• Most of the world's population live in countries where overweight and obesity kills more people than underweight.

• 41 million children under the age of 5 were overweight or obese in 2014.

• WHO global estimates: 2016

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Numbers of adults overweight, obese and severely obese

2010, 2014 and estimated for 2025

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Obesity in South Africa

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Obesity in South Africa

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Obesity in South Africa & NCDs

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Worldwide, 31·1% (95% CI 30·9–31·2) of adults are physically inactive;

More than 80% of adolescents around the world are not meeting physical activity recommendations.

Hallal et al., Lancet, Published Online July 18, 2012 http://dx.doi.org/10.1016/

Global prevalence of physical inactivity

DRIVERS OF OVERWEIGHT AND OBESITY

Poor early

childhood

feeding practices

Lack of

Knowledge

Insufficient

Physical

ActivityPoor Diet

• Lack of inclusive environment

for physical activity

(infrastructure, safety)

• Lack of community networks to

promote physical activity

• Increased use of technology

(computer games, TV)

• Time-special challenges

(transport, work distance)

• Limited access to

appropriate

information

• Consequences poorly

understood

• Knowledge of energy

content of food

• High coverage of

advertisements of

unhealthy foods

• Early introduction of

complementary feeding

• Poor feeding practices of

low birth weight babies

• Using food as a reward

• Early introduction of

unhealthy food to

children

• Individual and lifestyle factors

• Perceived high cost of healthy

foods

• Environmental influence

• Socialization – culture and

psychosocial

• Portion sizes purchased and in

restaurants

• Easily available ultra-processed

foods

• Purchasing power

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THE DEVELOPMENT PROCESS

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Concept document to facilitate consultation was developed

Consultation with various stakeholders

PURPOSE:

• To review the obesity landscape

• Identify dietary and physical activity patterns

• Consolidate evidence for interventions

• Learn best practices

• Identify barriers and enablers

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Stakeholder consultation: Rationale for the consultation

STAKEHOLDER MAPPING

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DEFINING ROLES OF GOV. DEPARTMENTS

OBESITY

CONTROL

SRSA

Dep of public service

adm

Dep of

Social Development

Trade and industry

Basic Education

Road and transport

Local Gov

DAFF

Enable engagement

with civil servants

Engagement with

food industry

Access to

fresh fruit and

veg and to

local markets

Municipalities

to create

enabling

environments

Promotion of recreational

sports and Physical activity

Create bicycle

lanes

Curriculum review

and promoting

physical activity and

healthy eating

Creating

enabling

environments in

ECD’s

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DEFINING ROLES OF OTHER STAKEHOLDERS

OBESITY

CONTROL

Media

Research bodies

Academia

Development partners

retailers

NGO

Non-alcoholic Beverage

sector

Quick service restaurant

groups

Positive messaging, understanding

the rationale

Monitoring and

provide evidence

to improve

programming

Technical support, Provide

global perspective,

Advocacy and monitoringSocial

mobilization,

increase

community

engagement

Reformulation,

Change

practice,

responsible

marketing

Provide healthier

options and low

cost, portion

control.

Provide healthier

options, reduce

access 15

POLITICAL COMMITMENT

• Developed and approved by Minister of health and MEC from the 9 provinces, co-signed by Ministers of Basic Education, Trade and Industry and Public service admin;

• An MOU for promoting Physical activity exists between DOH and the Sports and Recreation Ministry.

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Obesity strategy :broad goals

This strategy recognizes the need for a comprehensive and

multi-disciplinary approach

Goal1: Create an institutional framework to support inter-sectoral engagement

Goal 2: Create an enabling environment that support availability and accessibility

to healthy food choices in various settings

Goal 3: Increase percentage of the population engaging in physical activity (PA)

Goal 4: Support obesity prevention in early childhood ( 0-12 years)

Goal 5: Communicate with, educate and mobilize communities

Goal 6: Establish a surveillance system and strengthen monitoring, evaluation

and research

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Progress on implementation

• Industry commitment strategy in place: including:

– Product reformulation

– Increase availability of healthier options in menus

– Workplace guide developed and being implemented

– ECD guide almost complete

– Draft regulations on marketing to children to be finalized

• Treasury support with the sugar tax

• Some changes from food industry

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Lifecycle approach is keyThe first 1000 days are relevant to prevent

future incidence:

• This includes education on appropriate

weight gain during pregnancy- For SA it

implies strengthening existing

programmes like BANC. and Mom

connect

•Support for optimal breastfeeding and

appropriate complementary feeding.

Promoting healthy eating and physical

activity in all settings ( ECD’s, Schools,

workplace etc)

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Lessons learned

• Communication is critical in changing behavior

• Focusing on prevention strategies critical, difficult to reverse obesity

• Cultural norms need to be addressed

• An all societal approach is critical

• Engaging industry is a challenge: Need governments to be BOLD, FOCUSSED AND ASSERTIVE

• A social movement to address obesity is needed: INVOLVE CBO’S AND NGO’S and broader civil society

• The UNICEF conceptual framework is relevant even for addressing obesity: The basic causes including trade policies; underlying causes; and immediate causes for a better outcome.

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Acknowledgements• Dr Karen Hoffman from the University of the Witwatersrand’s School of Public Health;

• Dr Celeste Naude from Stellenbosch University’s Centre for Evidence-based Health Care;

• Prof M Senekal from the University of Cape Town’s, Nutrition Department;

• Prof L Skaal from the Limpopo University’s School of Public Health;

• Dr Vicky Lambert of the University of Cape Town’s Sports Science Institute;

• Ms Carina Muller, Education Specialist in the Department of Basic Education;

• World Health Organization (WHO) for their technical support and to Dr Taskeen Khan for co-ordinating the WHO's support.

• Dr L Adonis WHO consultant

• Inputs from various Stakeholders

• Ms Pontsho Sepoloane, Mr Aaron Manyuha From National Depart of Health

• Health Promotion, Nutrition and Non-Communicable Diseases staff ,

• The multi-sectoral nature of the strategy is evidenced by commitment and input from other government departments

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I thank you allwww.doh.gov.za