South Africa has some of the highest levels of obesity in the world, together with exceptionally high rates of poverty. These two issues are linked in a vicious, attritional cycle.
At first glance it appears counter-intuitive to consider that poverty and obesity could be associated. The fact is that poverty is intimately correlated to several non-communicable diseases. Numerous international studies have shown how obesity and its morbid fellow travellers, hypertension and diabetes, stalk the health of the poorest and most marginalised sectors of society.
As a developing nation, with increasing urbanisation, South Africa provides an exemplary case of the paradox of obesity amongst poverty. So how does this apparent contradiction exist and perpetuate?
When most people consider the effect of poverty, the initial image is of an emaciated, stunted figure, perhaps with a tell-tale red tint in her hair. While this is the most visible impact on children, research shows us that the long-term impacts of poverty are even more profound and menacing.
Poorly nourished infants have been found to be predisposed to obesity in later life. This occurs by interference with the genetic programming of the body, mainly in utero. If a mother does not receive adequate nutrition, the lot of her baby can become forever compromised. This is how the tragedy of poverty is perpetuated, inter-generationally. This occurs directly through malnutrition, as well as through other rather more sinister mechanisms.
The next fact is that our image of an emaciated figure is not necessarily linked to famine. Much global poverty exists alongside plenty. In South Africa we produce sufficient good quality food to feed everyone in the country. However the economic reality of poverty condemns almost half our population to the reality of daily hunger, food insecurity and inadequate nutrition.
While it is paradoxical that poverty and obesity exist hand in hand, so too is the reality that the obese poor tend to be under- or mal-nourished. How can this be?
This is because the poor eat the poorest food.
A useful point of departure is to consider our modern methods of food production. Most of our food is grown using industrial agricultural practices. Our food is far removed from the natural diet that nurtured our evolution. Today we fertilise the soil with chemical compounds, extracted from fossil fuels and mines. Apart from these chemical nutrients, the soil on most modern farms is barren and sterile. Industrial agriculture treats soil as a mere medium to which chemicals and water are added in order to grow crops.
Natural, healthy soil contains anything between 5 million and a billion bacteria, fungi and all kinds of microbes, per teaspoon of soil. These work synergistically to release nutrients from the earth and make them available to plants. But by first exhausting the soil through abusive farming practices and then attempting to correct this abuse by adding fertilisers, herbicides and pesticides, we effectively sterilise this phenomenal productivity, at our cost.
One of the first consequences is that industrially grown food is, from the outset lower in minerals, vitamins and other important nutrients like flavinoids, than food grown in rich, healthy soils. The nutrient value of our food has dropped consistently over the past half-century.
Secondly, most industrial foods carry residual levels of these chemicals and pesticides, many which are known endocrine disruptors. Endocrine or hormone disruptors are closely associated with serious negative health impacts, including obesity, diabetes and hypertension. This chemical exposure is known as our body burden.
So here we effectively have a double whammy. The poor eat food which predisposes them to poor health, on top of another, existing predisposition, genetically caused by malnutrition in the uterus or as infants.
Another clue lies in how food is treated and processed after harvest. Most staple crops – maize, wheat and rice – are purified and stripped of much of their nutrient value during processing. Germ, bran and oils are removed to enhance shelf life. While minerals and vitamins may be added to correct this imbalance, these can never equate to their natural counterparts.
Consequently, the cheapest staple foods lack all but the most basic nutritional requirements. Most food contains only refined carbohydrates and chemically stripped oils. The vetkoek diet. So the poor consume white flour, maize meal, polished rice, highly processed vegetable oils, with no real nutritional value. This empty food does no more than fill the stomach – it has calories but no nutrients, a recipe for obesity.
Just as modern food is produced through artifice, so the product inevitably becomes artificial.
If protein is consumed it is usually cheap, processed soya, which is not readily digested and which contains several anti-nutrients that in turn block absorption of important minerals like iron, calcium and zinc. If meat is consumed it too is cheap and nasty – polony, battery chicken and feedlot livestock with its high levels of bad omega 3 fats, increasing hypertension risks.
To compound these corporeal insults, high levels of toxic preservatives like nitrates and nitrites, both known carcinogens, or preservatives like sulphur dioxide - linked to respiratory problems are added to industrial foods. Taste enhancers are added to dilute the blandness; chemicals like monosodium glutamate, aspartame and other artificial flavourants and colourants each add insult to injury. And don’t forget the sugar, which many want to classify as a toxin.
On top of this chemical body burden, research shows women to be more prone to endocrine disrupting chemicals than men. These chemicals include the breakdown products of agricultural chemicals and pesticides, as well as storing water in plastic bottles and buckets. Local studies have found elevated levels of endocrine disrupting chemicals in rural water supplies through contamination by sewage, landfills and agricultural runoff.
So, besides being prone to inter-generational metabolic disruption because of poor nutrition, this legacy is further disrupted by other endocrine disruptors. These too have been shown to impact children and subsequent generations. For example, if a mother was exposed to high levels of DDT or PCBs, her daughter may be doubly prone to obesity caused by endocrine disruption without ever being exposed to these endocrine disrupting chemicals or their breakdown products. This gives us some clues as to why obesity is far higher in women than men in South Africa.
Another interesting trigger for obesity is stress. Stress is closely related to poverty in that high stress levels are caused directly through overcrowding, noise, crime and of course financial stress. These are exacerbated by the increased risks of infection by TB, not to mention the impacts of HIV and AIDS, child headed households and other social disruption endemic to poor communities.
Here we have an endless chain reaction – malnutrition, obesity, endocrine disruption, stress, abysmal living circumstances, with insult compounding insult.
The most obvious nutritional deficiency in the survival diet is the access to reasonably priced, fresh food - mainly fruit and vegetables but also dairy and eggs. The tragedy is that it is completely within our means to address this shortcoming.
Every single expert agency working on food security and nutrition has emphasised, with increasing urgency, the need to decentralise our global – and national - food supply. That such large proportions of our population are so prone to the twin curses of malnutrition and obesity indicates how badly we are losing the plot, literally.
By decentralising our food supply and encouraging the growth of market gardens, of communal food gardens, of vegetable plots on schools, in backyards, along the verges of our suburbs, in every available space in our cities, we can easily break this cycle. Why on earth do we plant decorative plants in the midst of such need when we can plant food? Why plant decorative trees when we can plant fruit trees? What is to stop our huge numbers of unemployed, malnourished citizens from being assisted to grow their own food? Huge opportunities exist to break this self-perpetuating scourge which is ruining the life of our people.
Our government – national, provincial and local – have all failed abysmally to meet their obligations in this regard. The Department of Agriculture pays lip service to smallholder farmers but in fifteen years it has delivered nothing meaningful. Instead it has promoted the industrial, genetically modified food industry which has prospered, along with its endocrine disrupting chemicals. Instead of fixing the problem it has perpetuated a failed model.
If South Africa is serious about the health and welfare of its people the fundamental issue of providing good food and therefore good nutrition must be prioritised. There are numerous examples around the country and around the world which work and which can be repeated. Every day that is lost costs us precious lives – obesity alone, let alone its fellow killers diabetes and hypertension - kills three South Africans, every hour.
This is a multifactoral crisis – it is not something that can be fixed by the any one department. Yet this crisis will continue if we do not shift away from a system of handouts, of poverty alleviation, where cash simply buys more rubbish cheap empty calories disguised as food.
Perhaps part of our problem is that when we see those trapped in the cycle of poverty, we look and say “Oh, she’s fat, she must have enough to eat.” This is not just a huge misunderstanding of the reality which faces the majority of our people every day, it is a malicious misrepresentation. It is time for the government, in every province, in every city and dorp, to stop talking and start doing something for the people they so passionately claim to represent.
Poverty, Malnutrition and Poor Health
Glenn, absolute excellent article.
Here are a few suggestions for how we can perhaps address all of the above problems and restore our peoples dignity, health , unemployment etc all in one go:
1) Stop welfare hand outs, let the people work for it on Govt farms and small holdings, kibutz style entities managed well
2) Teach working people on these kibutzes a useful skill, whilst cultivating the land, providing both employment, food and shelter for themselves, paid with the same welfare handout, but allowing people now to be constructive.- giving something and getting something.Sell surplus produce.
3) Do this organically, (no GMO's pesticides and herbecides) and our people will become healthier, fitter, self reliant with their dignity and self reliance and self worth raised.
4) Make people aware of alternatives, and the dangers of GMO's and have Companies like Monsanto, Bayer etc studied, scrutinised very carefully so informed decisions can be made.
5) It must not be forced on anyone, but promises/incentives to provide work, food, shelter and a marketable skill in the long run. This in turn will help with the scourge of unemployment, idleness, health vs obesity, restoring peoples dignity, giving back their aspirations of hope, self reliance and a brighter future.
6) If this is done correctly, it will stabilize the political arena, provided no corruption is TOLERATED