How diet, mental health and food choices are fueling South Africa’s obesity crisis – The Mail & Guardian

Eating is no longer just about eating nutrient-dense foods. (Photo by Stefan Sauer/picture Alliance via Getty Images)

Food is a language we all understand.

Along with touch, it is the way we are invited into our physical bodies shortly after our birth.

We are designed to seek nourishment in its many forms – for pleasure, strength, and growth and development. It’s fascinating that this primal, simple fact of life has evolved with modernity and is the cause of much of our well-being.

And while our waistlines are so much larger, our nutritional deficiencies are equally a greater burden of disease.

In the most recent study of South African food intake and nutrition, the Human Sciences Research Council examined 100 variables affecting a cohort of 34,000 people.

It was found that 69% of overweight adults lived in resource-limited households where food choices were nutrient poor. 30% of women of childbearing age suffer from iron deficiency.

More than half of the world’s population suffers from vitamin D deficiency. More than two thirds of women are obese or overweight. KwaZulu-Natal had the highest obesity rate at 39.4%.

At the same time, 4% of women will be diagnosed with anorexia nervosa during their lifetime, and a much larger percentage fall on a spectrum of disordered eating habits and body dysmorphia.

Too much of anything is never a good thing. Your fat cells are metabolically active, and while we all need some subcutaneous fat for warmth and shorter days, as well as a cushion to catch a fall, an excess of fatty tissue contributes to an inflammatory soup that flows through your veins and affects every organ.

Nervous system regulation is now a central concept in popular wellness culture. Everyone thinks about their vagus nerve.

We all know the accelerators and decelerators of the nervous system. Whatever the body unwinds, it also relaxes, and somewhere on this pivot there is a harmonious balance that makes your heart beat faster and your psyche mostly calm.

This occurs, of course, under ideal circumstances or in a mind where psychological maturity and perspective prevail. The mental health crisis, with more than a third of South Africans diagnosed with a common mental health diagnosis during their lifetime, suggests that the serenity of this balance is becoming increasingly elusive.

There are many things that contribute to this great calamity, but a collective response to physical and psychological discomfort is to reach for chips and chocolate.

Since fast and junk foods are the cheapest and easiest to obtain, self-soothing with refined carbohydrates is even easier than self-soothing with alcohol.

I feel like a broken record, persistently talking about the food and advertising industries and how they contribute to this burden of disease.

How often do you see a muscular, vital human body on a billboard enjoying a bowl of organic spinach or munching on a carrot? No, the images idealize alcohol, burgers, chips, sugary drinks and e-cigarettes. They even begin to glorify bodies that carry unhealthy excess fat tissue.

Cultural norms should not shift in favor of diabetics with high blood pressure and heart disease. I know this is a sensitive area. There are so many factors that contribute to body shape, but if we just rewind 50 years and compare, we are actually changing our shape – and not in a healthy way.

It is no coincidence that the other major arms of the capitalist beast feeding this problem include Big Pharma, who come with a side order of antidepressants and a needle full of appetite suppressants. A salve for the diseases our food system spreads.

One of the challenges we face in treating psychiatric disorders is the metabolic side effects associated with most drugs in this armamentarium.

For a patient whose mood symptoms may be related to their body image or an underlying inflammatory problem, the addition of an antipsychotic or antidepressant often results in weight gain.

And what about endocrine disruptors? These molecules can mimic our endogenous hormones and stimulate or block the receptors they act on. According to the Endocrine Society, there are nearly 85,000 man-made chemicals worldwide, and 1,000 or more of them may be endocrine disruptors.

This discovery began with the study of an adverse effect of the drug diethylstilbestrol, which was given to pregnant women to prevent miscarriage. These women’s girls suffered from a rare form of vaginal cancer.

Many connections and associations have been made between conditions such as attention deficit hyperactivity disorder, cancer, and certain chemicals that we are all exposed to through our skin, diet, air, and water.

What makes proving these relationships so difficult are the multiple influences that work together to express a disease profile.

Another factor could be the steroid hormones we are exposed to through our water systems. Studies observing the feminization of aquatic life have raised concerns about the amount of sex hormones excreted through sewers. More and more data is being collected to reveal a new type of pollution that many of us don’t think about.

Designing supremely tasty foods is a career choice that didn’t exist before the pandemic of adult and child obesity. Perfect combinations of unnaturally occurring fat, salt, sugar, crunch, and carbohydrates disrupt our satiety signals and trick our brains into wanting more.

The jury is out on whether we can compare drug addiction to food addiction.

In rodent studies, healthy and cocaine-dependent rodents prefer a sugary drink to a dose of cocaine.

Our brain’s reward system is designed to seek out calories to arm us against leaner times. Hypersensitive foods not only promote an unhealthy body, but also reduce cognitive function, memory and learning – especially in the developing brain.

According to the World Health Organization, the global prevalence of obesity more than doubled between 1990 and 2022. What could have triggered this escalation other than our environment? Twin, family, and adoption studies have estimated the heritability of obesity at 40 to 70%. But it probably accounts for less than 5% of the increase in the current burden of disease.

We also know that less than 5% of other chronic diseases are hereditary, so it seems too convenient to attribute obesity to evolution alone.

We know our genes load the gun, but our environment and choices pull the trigger. We can turn off obesity genes by choosing a lifestyle that supports a healthy body.

When we use our bodies in the ways they were designed for (move, exercise, dance, jump); When we seek out food for the amino acids and fatty acids our bodies need for basic health, we turn off those obesity genes and prevent diseases like high blood pressure, diabetes, depression and cardiovascular disease.

When a body has been obese for a long period of time, losing the accumulated weight becomes almost insurmountable. The body stores fat. Faced with a calorie-restricted diet, the obese body increases its craving for extra calories and slows its metabolism.

The uphill battle of losing weight in a severely overweight body is real and measurable. The discomfort of carrying extra weight on your joints is real and measurable. The impact of obesity on a patient’s quality of life is overwhelming and enormous.

We have a responsibility to our children and our species to stop the engines that feed this insatiable beast. Say no to Coca-Cola and fruit juice. Say no to fried chicken and processed meats. Say no to microwave dinner in front of the TV.

Say “yes” to the abundance and wisdom of the earth. What you put into your body shapes your brain. We cannot afford further dumbing down.

Dr. Skye Scott is a family physician and co-owner of Health with Heart.