For years, obesity was often seen as a simple matter of overeating and a lack of self-control. But our understanding has evolved dramatically in the past decade. Now, experts widely recognise obesity as a chronic disease, much like diabetes or high blood pressure. The very term ‘obesity’ is under scrutiny by experts due to the significant misunderstandings, misconceptions, and stigmatisation it carries.

This shift in perspective acknowledges the complex, long-term health issue it truly is, moving beyond blame to a need for understanding and support.

What is obesity?

Medically speaking, it is when someone has an excessive amount of body fat that can harm their health. Doctors often use something called Body Mass Index (BMI) – that’s your weight in kilograms divided by your height in meters squared. A BMI of 25 to 29.9 is usually considered overweight, while a BMI of 30 or higher falls into the obesity category. For example, the ideal weight for a woman who is between 162 and 165 cm tall is between 50 and 65 kg. A weight between 66 and 79 kg could fall into the overweight category, while a weight exceeding 79 kg might be classified as obese.

Why is it considered a chronic disease?

Like other long-term illnesses, obesity has complicated roots and needs ongoing attention. It’s not as simple as just eating too much for a day or two.

Often, it’s a mix of things happening over time. Your genes can make you more likely to gain weight.  In our modern environment, unhealthy, processed foods are readily available and sometimes cheaper than healthy options. Even things like stress and not getting enough sleep can throw our bodies’ natural hunger and fullness signals off balance. It’s not just about someone “choosing” to overeat. Sometimes, even malnutrition early in life can play a role in how our bodies regulate weight later on.

A global health concern

In 2022, about one in eight people worldwide were living with obesity, with rates having more than doubled in adults and quadrupled in adolescents since 1990.  The World Health Organization estimates that in 2022, around 2.5 billion adults were overweight, and a staggering 890 million of them had obesity. It’s also affecting kids, with 37 million children under five being overweight and over 390 million children and teens (aged 5-19) being overweight, including 160 million with obesity.

Here in South Africa, the latest statistics show that half of all adults are either overweight (23%) or obese (27%). Experts predict this will keep rising, with an estimated 37% of adults in South Africa being obese by 2030. This is a major contributor to other serious health issues in the country, like the high rate of diabetes, which affects more than 11% of adults in the country. It’s estimated that around 12 million people in South Africa are dealing with weight-related diseases like diabetes, high blood pressure, heart problems, arthritis, and some cancers, putting a huge strain on the healthcare system.

Risks to mental and physical health

The risks of living with obesity are significant, both for our physical and mental health. Physically, it increases the chances of developing type 2 diabetes, heart disease, high blood pressure, certain cancers, and problems with bones and joints.

Mentally, it can lead to lower self-esteem, body image issues, depression, and anxiety. Sadly, the stigma surrounding obesity often makes these mental health challenges even worse. People facing obesity can experience judgement and discrimination, which can lead to feelings of isolation and make it harder to seek help.

There is no quick fix

Obesity is a chronic condition that takes time and consistent effort to manage, so beware of misleading advertising that promises quick and easy cures like teas, supplements, or devices that claim you can lose a significant amount of weight in a short period with little effort. The truth is there is no magic bullet. These advertisements of so-called ‘magic’ weight-loss products often play on people’s desperation and can not only be ineffective but even harmful to their health and their wallets. Sustainable weight management is usually a gradual process.

Managing obesity healthily

So, how do we healthily manage obesity? It starts with making sustainable lifestyle changes. This includes being more mindful about eating and tuning into your body’s hunger and fullness cues.

Participating in regular physical activity that you enjoy is key – it doesn’t have to be intense! Learning healthy ways to manage stress and making sure you’re getting enough sleep are also important pieces of the puzzle. Focusing on a balanced diet rich in whole foods like fruits, vegetables, whole grains, and lean protein, and being mindful of portion sizes are crucial.

It is about making changes you can stick with long-term, not restrictive fad diets. Talking to a registered dietitian can provide personalised guidance on healthy eating. For the mental and emotional side, connecting with a therapist or a coach who specialises in weight management can offer invaluable support and coping strategies. In some cases, doctors might also suggest medications or even bariatric surgery (for more severe cases) as part of a comprehensive treatment plan.

It’s crucial to remember that this is a journey, not a quick fix. Small, consistent steps towards healthier habits can make a big difference over time. Let’s stop the judgement and the trap of unrealistic promises. Instead, let’s focus on understanding, support, and providing people with the evidence-based tools and genuine hope they need to manage their health and weight in a sustainable and positive way. Every positive change, no matter how small, is a step in the right direction.

Understanding obesity: Key messages

  • Obesity is a chronic disease, not just a willpower issue, with complex causes like genetics, environment, and stress.
  • It’s defined by excessive body fat (BMI ≥ 30), with overweight (BMI 25-29.9) being a precursor.
  • Globally and in South Africa, obesity rates are high and rising, increasing the risk of physical (e.g., diabetes, heart disease) and mental health problems.
  • Be wary of misleading advertisements. Sustainable management involves gradual lifestyle changes (diet, exercise, stress management, sleep), therapy, and sometimes medication.
  • Focus on whole foods, mindful eating, and long-term healthy habits.
  • Combating stigma and offering support are crucial for individuals managing obesity.

References:

https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight

Psychological Issues Associated with Obesity.  https://www.ncbi.nlm.nih.gov/books/NBK603747/

World Health Organization. Obesity: Health consequences of being overweight. Published 1 March 2024.

Obesity costs South Africa billions. We did the sums. www.wits.ac.za Published September 2022.