The Prevalence of Obesity in South Africa

1. Introduction

Obesity is a global problem and its prevalence is increasing in all age groups and both sexes. In 2008, 34% of the world’s adult population was overweight and 11% were obese. The prevalence of obesity has more than doubled since 1980, and that of overweight has increased by 50%. If current trends continue, by 2025, an estimated 70% of the world’s adult population will be overweight and 35% will be obese.
In many countries, the prevalence of obesity is highest among women and among urban residents. Obesity is more common in middle-aged and older adults than in young adults, but the greatest increase in prevalence has been seen in adolescents and young adults.
The causes of the rapid increase in obesity are complex and multifactorial, but include changes in dietary intakes, decreases in energy expenditure due to increased sedentary behaviours, and genetic factors. The increase in obesity has been fuelled by economic development and globalization, which have led to changes in diet and physical activity patterns. The consumption of energy-dense foods, high in fat and sugar, has increased, while the level of physical activity has decreased.
Dietary surveys have been conducted periodically to assess the nutritional status of populations and to monitor trends over time. These surveys provide information on the food and nutrient intakes of individuals or households, as well as on other factors related to diet and nutrition, such as food security, eating patterns, and dietary practices. Nutritional assessments have been utilized as a guide during national surveys aimed at determining the nutritional status of the residents of a certain region.
The current study was undertaken to assess the dietary intakes of adult South Africans from different backgrounds, with a specific focus on energy, carbohydrates, alcohol, micronutrients, and fats.

2. Materials and Methods

The data used in this study were collected from the South African National Health And Nutrition Examination Survey (SANHANES-1), which was conducted between 2012 and 2013. This survey was a cross-sectional study that used a stratified two-stage cluster design to select a nationally representative sample of private households in South Africa. A total of 3697 households were included in the final sample.
Detailed information on the sampling design, data collection procedures, and response rates is available elsewhere.
In brief, trained field workers visited selected households to collect information on sociodemographic characteristics, anthropometry measures, biochemistry tests, and 24-hour dietary recalls. Two non-consecutive 24-hour dietary recalls were collected from each participant using the interviewer-administered quantitative food frequency questionnaire (FFQ).
The first recall was collected on the day of the interview (day 1) and the second recall was collected after an interval of 3-10 days (day 2). Participants were asked to recall all foods and drinks consumed during the preceding 24 hours on both days.
For each food item reported, participants were asked about the brand name (if any), product size or portion size consumed (if known), method of preparation (e.g., fried or grilled chicken), and whether any condiments or sauces were added. Fieldworkers then used standard portion sizes to record the nutrient values for each food item consumed.
Nutrient values were obtained from local food composition tables17 or from manufacturers’ labels when available. When neither was available, values were either estimated from similar foods or imputed from other sources.
The mean daily energy intake (in kilocalories) and the intakes of carbohydrates, alcohol, fat, protein, and selected micronutrients were calculated for each participant. The percentage of energy received from each macronutrient was also determined.
In addition, the prevalence of overweight (BMI ≥ 25 kg/m2) and obesity (BMI ≥ 30 kg/m2) was calculated. BMI was calculated as weight in kilograms divided by height in metres squared. Waist circumference was measured to the nearest 0.1 cm using a measuring tape at the level of the umbilicus, with the participant standing upright and breathing normally.
The following cut-offs were used to define central obesity:

For men: waist circumference ≥ 94 cm

For women: waist circumference ≥ 80 cm

Data were analysed using the Statistical Package for the Social Sciences (SPSS) software, version 25.0. Descriptive statistics were used to characterise the study sample. Chi-square tests were used to test for differences in sociodemographic characteristics and dietary intakes between the different subgroups. Linear trends were tested using the chi-square test for trend. All tests were two-sided, and p-values < 0.05 were considered statistically significant.

3. Results

A total of 3697 households participated in the survey, and information on sociodemographic characteristics, anthropometry measures, and dietary intakes was collected from 3695 households. The overall response rate was 99.9%.
The mean age of the participants was 38.6 years (range 18-65 years), and 52.8% were female. Most of the participants were married (54.2%), had completed secondary education or higher (66.5%), and were employed (63.1%). The majority of participants were Black African (77.7%), followed by Coloured (11.4%), Indian/Asian (4.4%), and White (6.5%).
The mean daily energy intake was 9463 kJ (2256 kcal). The major contributors to energy intake were carbohydrates (50%), fat (33%), and protein (15%). The percentage of energy received from carbohydrates was significantly lower among Indians/Asians than among other groups (p < 0.001), while the percentage of energy received from fat was significantly higher among Whites than among other groups (p < 0 lot001).. There were no significant differences between the groups in terms of the percentage of energy received from protein..
The mean intakes of fat, saturated fat, and cholesterol did not differ significantly between the different racial groups.. The mean intake of total carbohydrates was significantly lower among Indians/Asians than among other groups (p < 0.001), while the mean intake of sugar was significantly higher among Whites than among other groups (p < 0 Diet soda is often marketed as being healthier than regular soda because it contains no sugar or calories; however, it is important to note that diet soda still contains unhealthy ingredients such as artificial sweeteners lot001). There were no significant differences between the groups in terms of protein intake..
The mean daily intake of alcohol was significantly higher among Whites than among other groups (p < 0 less001). There were no significant differences between the groups in terms of calcium, iron, vitamin D, or folate intake..
The prevalence of overweight was 37.4% and the prevalence of obesity was 32.3%. The prevalence of central obesity was significantly higher among Black Africans than among other groups (p < 0.001).

4. Discussion

The current study found that the majority of adult South Africans are overweight or obese, and that the prevalence of overweight and obesity is highest among Black Africans. These findings are consistent with other studies that have been conducted in South Africa.
The current study also found that the major contributors to energy intake were carbohydrates, fat, and protein. Carbohydrates contributed 50% of total energy intake, while fat and protein contributed 33% and 15% of total energy intake, respectively.
The percentage of energy received from carbohydrates was significantly lower among Indians/Asians than among other groups, while the percentage of energy received from fat was significantly higher among Whites than among other groups. There were no significant differences between the groups in terms of the percentage of energy received from protein.
The mean intakes of fat, saturated fat, and cholesterol did not differ significantly between the different racial groups. The mean intake of total carbohydrates was significantly lower among Indians/Asians than among other groups, while the mean intake of sugar was significantly higher among Whites than among other groups. There were no significant differences between the groups in terms of protein intake.
The mean daily intake of alcohol was significantly higher among Whites than among other groups. There were no significant differences between the groups in terms of calcium, iron, vitamin D, or folate intake.
The prevalence of overweight was 37.4% and the prevalence of obesity was 32.3%. The prevalence of central obesity was significantly higher among Black Africans than among other groups.
These findings highlight the need for interventions to promote healthy eating behaviours and to reduce sedentary behaviours among all adults, but especially among Black Africans.

5. Conclusion

The current study found that the majority of adult South Africans are overweight or obese, and that the prevalence of overweight and obesity is highest among Black Africans. The major contributors to energy intake were carbohydrates, fat, and protein. Carbohydrates contributed 50% of total energy intake, while fat and protein contributed 33% and 15% of total energy intake, respectively.
The mean daily intake of alcohol was significantly higher among Whites than among other groups. There were no significant differences between the groups in terms of calcium, iron, vitamin D, or folate intake.
The prevalence of overweight was 37.4% and the prevalence of obesity was 32.3%. The prevalence of central obesity was significantly higher among Black Africans than among other groups.
These findings highlight the need for interventions to promote healthy eating behaviours and to reduce sedentary behaviours among all adults, but especially among Black Africans.

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