World pandemic of obesity: the situation in Southern African populations

Among sub-Saharan Africans in general, a generation or so ago, there was very little gain in weight, or in blood pressure, with age. Even at present, in most populations, especially in the indigent masses, obesity prevalence remains very low, at 1–5%. However, in South Africa and some neighbouring countries, Botswana, Namibia and Zimbabwe, with rise in socio-economic status, urbanization, and diminishing physical activity, the proportion affected has increased. Rises, as noted in Cape Town, have been only slight in men, to 8%; but in women much more so, to 34%, ie to a level similar to that of African-American women. Dietarily, energy intake has increased slightly, that from fat from 15–20% to 25–30%. However, there have been falls in dietary fibre intake, to 20–25 g and 15–20 g daily, in rural and urban areas, respectively. Evidence suggests that the health disadvantage of obesity in African women is less than that in white women, and would seem to have little influence on their proneness to hypertension, coronary heart disease and breast cancer. Traditionally, and even currently, sociologically, the disorder carries little opprobrium. As to the future, the prevalence in women may well increase still further. Regarding treatment, unfortunately among African women desirous of losing weight, sustained reducing measures are near impossible; moreover, pharmacological treatment is too costly to implement. Public Health (2001) 115, 368–372.