Why South Africa must urgently tackle childhood obesity and its health risks

Young children in South Africa are developing serious health conditions such as high blood pressure, high glucose and abnormal cholesterol levels usually only seen in adults, due to obesity.

This was revealed in a study conducted by the South African Medical Research Council (SAMRC) and Inkosi Albert Luthuli Central Hospital in Durban, which assessed obesity-related comorbidities in children under the age of 12.

The study analysed health records of 430 children treated for obesity between 2012 and 2022. More than a quarter 27.9% of the children were under the age of five, the average age was just over seven years. Nearly half of the children had hypertension 46.1%, while another 12.8% were found to be pre-hypertensive.

In addition, 30.2% had dyslipidaemia, abnormal cholesterol or fat levels in the blood, and about 5% had either prediabetes or type 2 diabetes. 

According to researchers these conditions significantly increase the risk of cardiovascular diseases such as heart attacks and strokes, and kidney problems later in life.

The role of unhealthy lifestyle habits was also flagged, as many of the children reported behaviours known to contribute to weight gain and cardiometabolic issues. 

Almost half (47.9%) consumed sugary soft drinks daily, 43.5% spent more than two hours a day on screens, and 42.3% engaged in less than 30 minutes of physical activity per day.

A strong family history of obesity, diabetes and hypertension among participants, and researchers said this, may point to both genetic predispositions and unhealthy family environments where poor diet and inactivity are common.

Professor Nasheeta Peer, one of the study’s authors and a researcher at the SAMRC’s Non-Communicable Diseases Research Unit, stated that the high burden of chronic diseases in children, some as young as five, is a red flag.

“These are conditions we typically expect in middle-aged adults, yet they’re already taking root in childhood due to obesity. The data show a clear link between lifestyle and these health conditions. We must intervene early if we want to reverse the trend,” Peer said.

Researchers recommended urgent implementation of interventions that focus on prevention, including encouraging healthy diets, increasing physical activity, and reducing screen time in children. 

They also encouraged routine screening of children for obesity and its associated conditions so that early treatment can be provided.

“The earlier we act, the better the outcomes. Children with high glucose or high blood pressure levels still have a chance to reverse these conditions. But without action, we are looking at a generation facing high rates of heart disease and diabetes by the time they reach adulthood,” said Peer.

The researchers also emphasised the need for broader, multi-sectoral action, including tackling the political, socioeconomic and environmental drivers of obesity; such as the easy availability of unhealthy foods, inadequate recreational spaces, and limited access to health services.

Dr Laurencia Govender, a senior lecturer for dietetics and human nutrition at the University of KwaZulu-Natal, said dietary changes that can directly target obesity-related comorbidities in children include eating a well-balanced diet in the correct portions, and reducing added sugars, salt, saturated and trans fats, and fried and processed foods.

“It is important that children do not skip meals, especially breakfast. More fibre-rich foods like vegetables and fruit must be included, increasing water intake and having less refined foods (whole or minimally processed foods) is necessary,” Govender said.

She highlighted the need to avoid sugary drinks such as carbonated beverages, sweets, chocolates and sugar cereals.

“Avoid or limit processed foods such as fried snacks such as slap-chips; processed meats (e.g. polony, viennas, sausages, deli meats); frozen meals, fast food/takeout; pastries and salted snacks as these are high in fats and salt. Instead try including lean meat such as chicken. To reduce the salt intake, you can cook with herbs and spices instead of adding salt.

“Increase the fibre by adding beans and legumes to the diet, and more vegetables and fruits with skin. Fruits in season are generally cheaper, however, they should be consumed in moderation, especially if you have high glucose levels,” she said.

Govender added that eating healthy is not a diet but a lifestyle that can be adopted by the whole family, and that it is important to empower children by involving them and educating them to ensure that changes made will last.

“Families must foster supportive environments where children never feel singled out. Eating should remain a joyful, shared experience that strengthens family bonds. Families should prioritise activities together and minimise screen time to nurture these connections,” she said.

There has been a shift from traditional diets to more westernised practices. In South Africa, eating patterns are deeply rooted in community and cultural traditions. These traditional diets should not be abandoned but instead adapted using healthier cooking methods, adjusted portions and a focus on balanced meals, Govender said.

She advised any parent whose child is obese or has high blood pressure, high glucose or abnormal cholesterol, to see their local dietitian for individualised treatment that would be tailored specifically for their child.

Nzama Mbalati, chief executive of the Healthy Living Alliance (HEALA) said the findings of this study paint a deeply troubling picture of the health crisis facing “our” children, who are exposed to aggressive marketing tactics by the food and beverage industry, pushing ultra-processed and unhealthy products that are cheap, accessible, and often sold right in or near their schools.

“This is not just a health issue, it’s a policy failure. The government must urgently act to protect children from an environment that promotes obesity and chronic disease. South Africa cannot afford to wait while another generation of children is exposed to preventable health risks. The government must prioritise policies that create healthier food environments for all children, starting now.

“The regular or over consumption of sugary drinks is known to be a risk factor for the development of obesity. However, even with an overwhelming amount of evidence of health risks associated with consuming sugary drinks, we have seen that children’s health is not prioritised enough by our government,” Mbalati said.

He added HEALA advocates for a comprehensive set of policy interventions such as; transforming school environments to be healthy and safe, among others. 

He said if little effort is made to combat the overconsumption of sugary drinks “we” cannot be surprised that so many children are consuming a soft drink daily as the study found.

Living with obesity and other health conditions can be very difficult. Being diagnosed with diabetes or cardiovascular conditions is often a life changing moment. All of a sudden one needs to understand complex health, nutrition and medication information. They have to go for regular check-ups to manage the condition and  start making lifestyle changes that may be quite costly and stressful for the individual and their family, he said. 

“HEALA is deeply concerned that without urgent, preventive action, we are heading toward a future defined by rising healthcare costs, lost productivity, and worsening inequality. This is not just a health issue; it is a national development issue. Preventing disease before it starts is the smartest and most cost-effective investment we can make; for individuals, families, and the country as a whole,” Mbalati said.

gcwalisile.khanyile@inl.co.za