Obesity problem grows with HIV crisis
Being heavy seen as sign of health in hard-hit country
Quentin Casey
National Post
Saturday, August 19, 2006
South Africa's AIDS crisis is fueling a second epidemic as obesity steadily rises, particularly among women who gain pounds to prove they don't have the disease.
Many in South Africa associate thinness with AIDS and value plumpness as a sign of wealth and good health.
"[Patients] will say to you, 'But I don't want to lose this weight because [they] will think that I'm dying of AIDS,' " said Tessa van der Merwe of the International Association for the Study of Obesity, who heads the country's first obesity clinic. "They say, 'Doctor, I am scared. I don't want to do anything.' "
Such resistance to lifestyle change and treatment has caused obesity rates to skyrocket.
Roughly half of South African women are overweight, Ms. van der Merwe said. But that number is more pronounced within the black community, where up to 64% of the population is overweight. As many as 30% of women there are considered obese.
"That's quite catastrophic," she said in an interview. "It's a crisis."
Ms. van der Merwe, who last week addressed a major gastroenterology congress in South Africa, said that among many groups extra fat has historically been an indication of health and prosperity.
"It was a sign that your husband had enough food in his little empire," she said. Those perceptions have persisted among middle-aged and older women.
Yet ironically, many young black women, captivated by Western ideals of beauty, have developed eating disorders in their attempts to be wafer-thin.
Ms. van der Merwe attributes much of the obesity problem to a lack of education surrounding AIDS.
"You can actually be very well for a long time without dropping weight. It is only in the terminal stages that you will start losing weight," Ms. van der Merwe said. "[AIDS] is a very misunderstood disease in South Africa, as is obesity for that matter."
Roughly five million of South Africa's 45 million people are infected with HIV/AIDS, one of the highest rates in world.
The obesity epidemic is likely to spawn yet another problem: wide-spread diabetes. The International Diabetes Federation has estimated that cases of diabetes will increase as much as 98% in Africa by 2030.
The situation is not helped by a spike in childhood obesity. At least 22% of children in South Africa are either overweight or obese, thanks in part to the introduction of Western perils: high-calorie foods, vending machines and fast food.
Ms. van der Merwe said the increase in diabetes will overburden the country's health system with heart attacks, strokes and hypertension. She is calling for more obesity clinics to help fight the trend.
"This is a developing country. We have limited resources.... We are facing a health economic situation that will be unaffordable," she said. "The economic implication is astronomical. There is no way we can afford to treat a 98% increase in diabetes in this country. We just haven't got the financial resources to do it.
"We are definitely facing a catastrophe."
Obesity in South Africa