An obesity epidemic is not the first thing that comes to mind when thinking about health problems in Africa. You're far more likely to associate the region with infectious diseases like HIV/AIDS and malaria, or starvation and malnutrition. In fact, though, the past two decades have seen a dramatic increase in obesity in sub-Saharan Africa. In South Africa alone, 64 percent of the black population and 50 percent of the white population are overweight or obese, according to a study by the International Association for the Study of Obesity (IASO). The Ugandan Heart Institute predicts that obesity-related heart disease will be the leading cause of death in sub-Saharan Africa by 2020. Complicating the picture are social attitudes that make being overweight seem harmless, if not explicitly attractive.
This is not to say that no one is starving anymore in Africa. "This region may have started to experience what's called a 'double burden' … with malnutrition on the one hand and a growing prevalence of obesity on the other," explained Eduardo Villamor, assistant professor of international nutrition at Harvard. Malnourishment—in the form of both starvation and overconsumption of cheap and fried foods—is increasingly pandemic in Africa. This double whammy is largely due to increasing urbanization. As jobs have moved out of rural areas and into cities, the health of many Africans has suffered. Prof. Arne Astrup of the faculty of life sciences at the University of Copenhagen (and president of the IASO) explains that in rural communities, people were used to large amounts of physical labor and walking as well as an abundance of fruits and healthy grains to eat. In the cities, they encountered a new world of less energy-demanding jobs and a plentiful supply of fried, cheap meats laden with trans fats.
Despite the growing problem, many sub-Saharan Africans do not find the region's increasing waistline to be of concern. Instead, obesity and fatness in general are widely viewed as a positive. Prof. Philip James, chairman of the International Obesity Task Force, found that the "index of affluence and power is linked to one's size." In other words, bigger is better, even if its unhealthy. HIV/AIDS is another unlikely factor in the acceptance of obesity. The virus, known as "slim disease" throughout Africa, is strongly associated with weight loss. So being fat is viewed as a "great thing because it means you don't have HIV," says James. Some Africans, he adds, purposely gain large amounts of weight to prove that they don't have the disease.
Cultural attitudes about fatness take a special toll on women. Astrup says that women, especially in black populations, think being overweight is "something that is beautiful and attractive." As a result, 75 percent of black women in South Africa between the ages of 18 and 65 are overweight or obese, according to IASO. Among certain tribes in Nigeria, women are traditionally fattened up before marriage to make them seem more attractive and healthy to their future husbands. Also contributing to the weight problem among Nigerian women: younger women there are not allowed to play sports or walk outside without an escort.
Historically, black Africans have been less prone to heart disease, making some believe that obesity has no downside. However, the incidence of type 2 diabetes—which is known to increase the risk of developing heart disease—has increased among black Africans in recent years. According to the IASO, 8 to 12 percent of the black South African population has type 2 diabetes, compared with just 4 percent of the country's white population. And African doctors, Astrup has found, are making matters worse. Many patients, he says,"are being told by their doctor that they should relax and that [being overweight] is not too important to their health." Radio and television also dish out incorrect medical advice, he adds.
For Astrup, it all seems woefully familiar. "If you go back in time to about 1950 in the U.S. and Denmark," he says, "they had more or less the same picture … nobody cared, nobody recognized that it was an issue." That's not a good place to be, especially for a region with a patchwork, often overwhelmed, health-care system. Without effective government intervention and a change in cultural attitudes, sub-Saharan Africa's obesity epidemic is likely to worsen in the coming years, bringing yet more medical horror to its beleaguered population.