While public health experts in South Africa spent much of the last decade focusing on controlling infectious diseases such as HIV/AIDS and eradicating malnutrition, the growth of another public health crisis has gone almost unnoticed.
High obesity levels, which have given rise to a virtual epidemic of non-communicable diseases like diabetes and hypertension, are finally grabbing attention.
Being overweight brings with it serious health risks: obesity usually comes first, followed by hypertension as the heart has to work much harder to pump blood to all parts of the body. Health officials have warned that when accompanied by an unhealthy diet, lack of exercise and smoking, it can also result in heart disease and diabetes.
Women are more at risk, with 56 percent falling into the overweight category, and black, urban women the most likely to be overweight, according to a 1998 Demographic and Health Survey.
Researcher and dietician Tandi Matoti-Mvalo believes diet is not the only factor behind South Africa's growing weight problem. "In South Africa, women are not keen to lose weight because of associations of thinness with HIV," she told delegates at the 4th Public Health Association of South Africa conference in Cape Town this week.
In the results of a study among women living in Khayelitsha, a black township outside Cape Town, Matoti-Mvalo found that although most participants were overweight, they did not consider this unhealthy; in fact, a third preferred it.
When they were shown pictures of eight women ranging from thin to obese, most participants selected the overweight or obese women as representing their body image ideal; the thin women were strongly linked with HIV and AIDS.
"Much effort has gone into teaching people about HIV and AIDS, but most women in this study still believe you could tell if someone had HIV just by looking at them," Matoti-Mvalo commented. Rather than risk the stigma associated with HIV, the women in the study preferred to be overweight.
She said health professionals working in such communities needed to be aware that not only were an unbalanced diet and lack of exercise major risk factors for obesity, but also cultural beliefs and attitudes. She recommended more education to counteract misconceptions about what constitutes a healthy body weight.
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