The weighty issue of obesity among South African women

More than 50% of all adults in South Africa are overweight or obese, with these rates expected to increase a further 10% by 2030 (1).

According to The World Health Organisation, this statistic is even higher in South African women, with as many as 68% of those who are classified as overweight or obese being women (2). If these current trends continue, the percentage of overweight and obese females in the country could increase to as much as 90% by 2060 (3).

Some of the factors contributing to this concerning increase in obesity include the predominance of low-energy jobs and reliance on motorised transportation, which has led to less energy expenditure. Longer working hours and easy access to processed foods are also factors impeding healthy eating habits. Additionally, family history, multiple pregnancies and negative emotions were also identified as contributing factors (4).

Assessing a women’s weight status
Body mass index (BMI) is the most common measure to assess an individual’s weight status. This is calculated by dividing their weight (kg) by their height (m) squared. A BMI between 18.50 and 24.99 is considered “normal”. Above 25.00, the range is considered overweight, and above 30.00 is considered obese (5).

While BMI is a well-recognised measurement, calculating waist-to-height ratio has been shown to offer a more accurate picture of a person’s risk of obesity than BMI (6).

The waist-to-height measurement aligns broadly with current guidelines that adults and children should keep their waist circumference to less than half their height (6). Females with a waistline of 80cm or more are considered to have an increased risk of being classified as obese (7).

Obesity is a major risk factor for serious disease
Far from only being about your appearance, obesity is a major risk factor for the development of many medical conditions. Research has shown that women with a BMI of 30 have a 28 times greater risk of developing diabetes than women of normal weight (2), and the risk of diabetes is 93 times greater if the BMI is 35. Obesity is responsible for 4.7 million premature deaths each year globally (4).

Obesity has also been found to increase women’s risk of certain cancers, including colorectal, post-menopausal breast, uterine, oesophagal, kidney and pancreatic cancers (8).

This also increases the risk of cardiovascular disease, which can lead to heart disease due to high cholesterol and strokes due to high blood pressure. Furthermore, when obesity is present, it can increase the stress placed on weight-bearing joints and increase inflammation within the body. These factors may lead to complications such as osteoarthritis.

Women with obesity are more likely to have sleep apnoea, a potentially serious disorder where breathing repeatedly stops and starts during sleep. The association between obesity and depression has also long been recognised (9).

BMI loading and implications on insurance
So evident are the health risks associated with obesity that it can also affect an individual’s health and insurance policies where the applicant’s BMI is taken into consideration for all products.

Insurers ask that applicants provide their weight and height information because many products in the industry include a loading for abnormal BMIs. This means policyholders with such BMIs will pay higher premiums for their insurance. The loading varies depending on the age group and type of product being applied for. A consideration includes individuals who may be underweight, which also poses a risk factor for adverse health and may be requested to provide more information to assess the applicant’s health.

Products also have a minimum and maximum BMI beyond which cover cannot be offered. Suppose individuals have additional co-morbidity conditions such as diabetes or cardiac disease. In that case, these policies may also attract loadings or exclusions due to the increased risk associated with the combination of high BMI and co-morbidities. Sometimes, even if the BMI is below the maximum limit, the risk may be too high when combined with other illnesses or factors, resulting in cover being declined.

Health risks in conjunction with the PPS underwriting method reflect that the 1.8% of high-risk female members are between 23 and 68 years old.

Females with a BMI score of higher than 30 should consult their health practitioner for advice on how to reduce it, which will greatly benefit not only their health but also their finances. An insurer such as PPS will require proof of reduced weight maintained for at least 12 months before considering reviewing the loading. As policies vary across the industry, it is important to understand the specific requirements to be met.

Even a modest weight loss of 5% to 10% of total body weight is likely to produce health benefits, such as improved blood pressure, blood cholesterol and blood sugars. For some, this will be enough to improve their risk profile, while for others, it will be the start they need on the journey to beat obesity (10).

References:
1. Obesity costs South Africa billions (2022) at https://www.wits.ac.za/news/latest-news/opinion/2022/2022-09/obesity-costs-south-africa-billions-we-did-the-sums.html
2. Obesity Index: Capetonians Carry Least Weight (2023) at https://health-e.org.za/2023/03/02/obecity-index-capetonians-carry-least-weight/
3. Projected % of individuals (aged >20 years) living with overweight or obesity (BMI>25kg/m²), 2020-2060 (2023) at https://data.worldobesity.org/downloader/1b3a5c01aef6c1678c533f9c840813e8.pdf
4. BMC Public Health. High prevalence of obesity among women who enrolled in HIV prevention trials in KwaZulu-Natal, South Africa: healthy diet and lifestyle messages should be integrated into HIV prevention programs (2013) at https://bmcpublichealth.biomedcentral.com/articles?query=south+africa%2C+obesity&volume=&searchType=&tab=keyword
5. Obesity – Our World in Data (2017) at https://ourworldindata.org/obesity#
6. AJMC – Waist-To-Height Ratio Beats BMI For Finding Obesity, Study Says (2017) at https://www.ajmc.com/view/waist-to-height-ratio-beats-bmi-for-finding-obesity-study-says
7. Heart Foundation. What is a Healthy Body Weight (2021) at https://www.heartfoundation.org.au/your-heart/know-your-risks/healthy-weight/waist-measurement
8. MD Anderson Cancer Center. How Does Obesity Cause Cancer (2017) at https://www.mdanderson.org/publications/focused-on-health/how-does-obesity-cause-cancer.h27Z1591413.html#
9. Post Grad Med. The Medical Risks of Obesity (2009) at (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2879283/
10. CDC. Losing Weight (2022) at https://www.cdc.gov/healthyweight/losing_weight/index.html#