101
Obesity in Black Women in Soweto, South Africa: Minimal Effects on Hypertension, Hyperlipidaemia and Hyperglycaemia A. R. P. WALKER, B. F. WALKER, B. MANETSI, N. G. TSOTETSI and *A. J. WALKER Human Biochemistry Research Unit, Department of Tropical Pathology, School of Pathology of the University of the Witwatersrand, and the South African Institute for Medical Research, Johannesburg. *Computer Engineering, Department of Electrical Engineering, University of the Witwatersrand,
Johannesburg ABSTRACT were made on 50 South African urban STUDIES obese women aged 25-40 years, with Body Index (BMI) ) 2 of 29.5 or more, and (Kg/m on 50 non-obese women with BMI of 25 or less. In the two groups, mean triceps skinfolds were 25.5mm and
black Mass
17.8mm, respectively. Hypertension (≥160/95mm present in 6 and 4 women (12% and
Hg) 8%),
was
hypercholesterolaemia (≥5.2mmol/l) in 5 and 3 women (10% and 6%), hypertriglyceridaemia (≥1.8mmol/l) in 5 and 3 (10% and 6%), and hyperglycaemia One or (≥7.8mmol/l) in 2 and 1 women (4% and more adverse sequelae were present in 11 (22%) obese and in 9 (18%) of non-obese women, proportions not significantly different. Dietarily, mean daily intakes were Kcals 2273 and 2240, protein 73g and 70g (12.9% and 12.5% energy), fat 65g and 67g (25.7% and 26.9% energy), carbohydrate 349g and 330g (61.4% and 60.5% energy), and dietary fibre, 12g and 13g. In this low socioeconomic and low fat dietary context, obesity in the black women studied was not specifically evocative of deleterious sequelae of obesity.
2%).
—
INTRODUCTION
populations, obesity (BMI of 29.5 or although variable in frequency. reported for adult males and females in the UK 8% and 9%2, in the USA 12% and 15%3, and in the South African white population 14% and 18%4, The obese, compared with the non-obese, respectively. are significantly more prone to hypertension, hyperlipidaemia and hyperglycaemia. In such people, 25-35% may be affected by one or more of these sequelae, and they are at increased risk to hypertension-related IN DEVELOPED
~ver)B
proportions are is
common
diseases, diabetes, coronary heart disease, and dietrelated cancers’ 6. Obese people who are not characterized by the adverse sequelae enumerated, nor by excessive fat cell size, are regarded by some as evincing
’healthy’
tor~7,8’
obesity,
for whom
weight
loss is not manda-
In South Africa, among the black population, obesity is very common among young and middle-aged women, especially those living in urban areas9,10. In rural areas, series of 95 Zulu women in Natal, 30 in a were obese, having BMI of 30 or more&dquo;. A (31.6%) similar proportion was found in a study made in a near-by region 12 . As to sequelae, in an investigation made on obese women aged 25-40 years in a rural area in Central Transvaal, only 3 out of 40 (12.5%) were
representative
adversely affected; i.e. 87.5% could be regarded as exhibiting ’healthy’ obesity 13 . Among rural blacks, despite obesity being common, coronary heart disease, gallstones, and breast and colorectal cancers are rare 14 In urban areas, obesity in black women is very common. In Johannesburg, in a large-scale study made in 1979, the proportion of women aged 20 to 60 years having a BMI of 29 or more was 50% 10. Yet in several studies made on obese women at that time, hyperlipidaemia and hyperglycaemia were uncommon, or were less common, compared with the situation among white
obese women15-18. Furthermore, coronary heart disease and diet-related cancers were rare or uncom-
mon19,2o. In the last decade, among urban black populations there has been progressively increasing westernization of diet, and changes in physical activity and in other aspects of life-style. Dietarily, the energy contributed by fat has risen from 20-25% to 25-30%; moreover, dietary fibre intake has fallen from 20g or more to 10-15g daily2l. These and other changes could well augment frequencies of the adverse sequelae of obesity. To learn whether deterioration has taken place, we have investigated a series of obese black women in Soweto, also a control group, in relation to their diet, anthropometry, and prevalences of hypertension, hyperlipidaemia and hyperglycaemia.
SUBJECTS AND METHODS
Subjects drawn from non-working mothers in Soweto. They lived in the neighbourhoods of the residences of the Nursing Sisters (B M and N G T). All subjects were in everyday good health, and none were being treated for any disease. Socioeconomically, all were poor. They were brought, in sequences of usually 15 subjects, by taxies, to the laboratory for the various
THESE WERE
investigations. Anthropometry: Subjects wore everyday clothing. They were bare-foot for examination. Height was
measured in
cm to the nearest mm. Considerable care taken to encourage subjects to stand as upright as possible. Weight was measured to the nearest whole or kg using a Wedderburn Scale. Triceps skinfold was measured by Harpenden callipers. Blood pressure: Measurements were made with subjects sitting using a mercury sphygmomanometer, and performed according to recommendations made by World Health Organization22. In the measurement of was
half
Downloaded from rsh.sagepub.com at SETON HALL UNIV on March 28, 2015
102 diastolic pressure, the end-point taken was the final disappearance of sound, i.e. Korotoff phase 5. Determinations were made twice, often three times. Laboratory studies: Subjects had had their usual traditionally limited breakfast, which was eaten at least 3 hours before collections began. Blood was collected from the antecubital vein. For serum, the samples, after clotting, were spun at 3000rpm for 10 minutes. Serum and preserved whole blood samples were stored at -20°C. Serum cholesterol and triglycerides, also blood glucose, were determined using respective kits from Boehringer-Mannheim (Mannheim, West
Table 2. Characteristics of obese and non-obese black women in Soweto (Means, standard deviations, odds ratios and confidence intervals)
Germany).
Dietary intakes: These were obtained using a 24 hour diet-frequency-recall questionnaire. The general diet consisted mainly of maize products and bread (usually brown bread), vegetables and fruit in season, various beans, and rice. Dairy produce was eaten occasionally, and meat two or three times a week, mostly chicken, and polony. Questionnaires were administered by teachers, with the assistance of models. had had Helpers previous experience, after appropriate instruction. Data were coded and processed through a specially prepared computer programme with facilities for direct entry of food types and quantities. South African Food Composition Tables were used22. Criteria of adverse sequelae: The cut-off points used blood pressure 160/95mm Hg (WHO criterwere ia)23, serum cholesterol level 5.2mmol/l; triglycerides, l.8mmo1/1, and blood glucose 7.8mmol/I (WHO criteria)24. The criteria employed are those used in a recent study on obese women in Italy25. Statistical treatment: For dietary intake data, the significance between group differences was analysed using Students unpaired ’t’ test. For comparisons between the laboratory data on the groups of obese and non-obese women, odds ratios and 95% confidence intervals were calculated using methods given by black
nurses or
-
Schesselman26.
RESULTS RESULTS ARE summarised
in Tables I and II. respective means of the dietary data in two differed significantly In the the series of 50 obese and 50 non-obese black women, one or more adverse were present in 11 (22%) sequelae obese and in 9 non-obese women. The proportions which were obtained in the two groups are not significantly different. This prevailed despite the large contast in BMI, namely, 36.8 versus 20.2.
None of the
(P>0.05).
groups
(18%
Table 1. Characteristics of obese and non-obese black women in Soweto. (Means and standard deviations) Obese women
Non-Whcce women
DISCUSSION obtained indicate that (i) the black obese women had a low frequency of adverse sequelae; and (ii) the frequency did not differ meaningfully from that in the non-obese group. The sequelae in both groups were less frequent than is the case with white women 5, The observations made concerned poor urban black women, habituated to a diet relatively low in fat content. The results obtained and conclusions reached show no change compared with the observations made in Johannesburg a decade agoI5-18. The previous studies, carried out on obese adolescents and older women, revealed that frequencies of hypertriglyceridaemia, hypercholesterolaemia, and hyperglycaemia were very low; moreover, levels did not differ significantly from those of non-obese black women. It is noteworthy too that in one of the investigations, in which studies were undertaken on adipocytes in a number of sites in very obese black women, cell size was found to correlate with percentage of ideal body weight. But cell size did not correlate with any of the other parameters measured, including blood glucose, serum cholesterol and triglycerides, as well as basal or stimulated plasma insulin concentrations. Similar situations have been reported from elsewhere. In Barbados, obesity is very common; 19% men and 60% women attending a medical outpatient department were reported to be 20% or more ideal weight2~. In a random series of 122 blacks age 50-59 years, 20% of men and 43% of women were obese (BMI * 29.5%). Mean triceps skinfolds of the total groups of men and women were 16.4mm and 22.0mm, respectively. The authors reported there to be a very low correlation between BMI and the use of hospital or outpatients’ facilities. In explanation, it was noted that local attitudes did not view obesity as a health problem; the condition was actually perceived as a normal and attractive state. Closely similar sociocultural attitudes exist in African and other developing THE RESULTS
socioeconomicall
abov
populations2g.
Attention is drawn to
an
Santiago, Chile29. There,
a
illuminating report from group of severely obese
women, of average 40 years, of low socio-economic
class, sedentary, and consuming only 22% of energy as fat, had low mean lipid values triglycerides 1.18 ± -
0.57 mmol/1 and cholesterol 4.63± 0.97 mmol/1. However, also in Santiago, in an equally obese group in a high socio-economic state, and who consumed 31 % of energy from fat, mean lipid values were much higher triglycerides 1.68 ± 0.92mmol/l and cholesterol 5.93± 1.94mmol/l. Thus, in the poor obese group of women, a
Downloaded from rsh.sagepub.com at SETON HALL UNIV on March 28, 2015
103 low fat diet, associated with a low intake of animal products and with other features, was consistent with a low frequency of hyperlipidaemia. The South African obese women studied were aged 25-40 years. At older ages, frequency of obesity increases 10. Hypertension too becomes more common 10. In the urban black population, diabetes and cerebral vascular disease are important causes of morbidity and mortality 14 . However, the incidence of coronary heart disease continues to be very IOW14,19. The incidences of breast and colorectal cancers, in which obesity is a risk facto.-3°,32, remain only a quarter of the incidences found in the white population2o. The specific role of obesity in promoting hypertension appears to be of lesser moment in blacks, as prevails in the case of blacks versus whites in the USA5. noxiousness of in of lower the However, obesity regard this variable, and of the others studied, can only be satisfactorily validated from prospective studies undertaken in contrasting socioeconomic and dietary
11
contexts.
20
12
13
14
15
16
17
18
in part by grants from the STUDY was Association and the National South African Cancer Association of South Africa.
22
23
REFERENCES 1 BRAY G. A., How is 8-14.
24
obesity
measured? Disease-a-Month, 1979; 26:
2 ROSENBAUM. S., SKINNER, S. K. KNIGHT, J. B. and GARROW, J. S. A survey of weights and heights of adults in Great Britain, 1980. Ann. Hum. Biol. , 1985; 12: 115. 3 ABRAHAM, S. and JOHNSON, C. L. Prevalence of severe obesity in
adults in the United States. Am. J. Clin. Nutr., 1980; 33: 364-365 BENADÉ, A. J. S., and ROSSOUW, J. obesity and its relation to coronary heart disease in the CORIS study. S. Afr. Med. J., 1988; 74: 101-104. 5 VAN ITALLIE, T. B. Health implications of overweight and obesity in the United States. Ann. Int. Med., 1985; 103; 983-988. 6 BORRELLI, R., ISERNIA, C., DI BIASE, G., and CONTALDO, F. Mortality rate causes and predictive factors of death in severely obese 58: 343-350. patients. Internat. J. Vit. Nutr. Res., 1988; 7 KNAAP, T. R., A methodological critique of the ’Ideal Weight’ concept J. Am. Med. Ass., 1983, 250; 506-510. 8 JARRETT, R. J. Is there an ideal body weight? Br. Med. J., 1986; 293: 493-495. 9 WALKER, A. R. P. Overweight and hypertension in emerging populations. Am. HeartJ., 1964; 68: 581-585. SEFTEL, H. C., JOHNSON, S., and MULLER, E. A. Distribution and correlations of blood pressure levels in Johannesburg blacks. : 313-320. Afr. Med. J., 1980; 57
4
JOOSTE, P. L., STEENKAMP, H. J., E. Prevalence of overweight and
10 S.
biosocial
A., ALBERTSE, E. C. and McLACHAN, M. H. The
WALKER, A. R. P., WALKER. B. F., WALKER, A. J. and VORSTER, H. H. Low frequency of adverse sequelae of obesity in South African rural black women. Internat. J. Vit. Nutr. Res., 1989; 59: 224-228. WALKER, A. R. P. Nutrition and public health. S. Afr. J. Continuing Med. Educ., 1987; 5: 15-20. JOFFE, B. I., GOLDBERG, R. B. and SEFTEL, H. C. Insulin, glucose and triglyceride relationships in obese African subjects. Am. J. Clin. Nutr., 1975; 28: 616-620. SHIRES, R. JOFFE, B. I. and SEFTEL, H. C. Intravenous fat tolerance in obese Africans with varying grades of carbohydrate tolerance. Atherosclerosis, 1978; 31: 59-64. JOFFE, B. I. GOLDBERG, R. B. FEINSTEIN, J. KARK, A. and SEFTEL, H. C. Adipose cell size in obese Africans: Evidence against the existence of insulin resistance in some patients. J. Clin. Path., 1979; 32: 471-474. WALKER, A. R. P., BHAMJEE, D. WALKER, B. F. and MARTIN, A. P. Serum high-density lipoprotein cholesterol, glucose tolerance and other adolescent girls. variables in obese Afr Med. J., 1979; 56: . S 221-224. of H. C. The SEFTEL, rarity coronary heart disease in South African blacks. S. Afri. Med. J., 1978; 54: 99-105. South African Cancer Registry, 1986, Johannesburg: South African Institute for Medical Research, 1988. SEGAL, I. and WALKER, A. R. P. Low-fat intake with falling fibre intake commensurate with rarity of non-infective bowel diseases in blacks in Soweto, Johannesburg, South Africa. Nutr. Cancer, 1986; 8: 185-191. Report of an Expert Committee. Arterial hypertension and ischaemic heart disease: preventive aspects. Wld. Hlth. Org. Tech. Rep. Ser. No., 231, Geneva: 1962; pp. 3. GOUWS, E. and LANGENHOVEN, M. L. NRIND Food Composition Tables, 1981. Parrow: South African Medical Research Council, 1981. World Health Organization Expert Committee on Diabetes Mellitus. Wld. Hlth. Org. Tech. Rep. Ser. No., 646, Geneva: 1980; pp. 4. BORRELLI, R., CANTALDO, F., REED, L. A. ISERNIA, C., DI BIASE, G. and MANCINI, M. Cardiovascular risk factors and age of onset of obesity in severely obese patients. Internat. J. Vit. Nutr. Res., 1988 58: 236-240. SCHLESSELMAN, J. J. Case-control studies design, conduct, analysis. New York; Oxford University Press, 1982; p. 174. HOYOS, M. D. and FRASER, H. S. Obesity and the use of health services in a Barbadian community. Hum. Nutr. Clin. Nutr., 1984; 38C: 77-78. ADEDEVOH, B. K. Obesity. London; Churchill Livingstone, 1974; p. 60. ALBALA, C., OLIVARES, S., ANDRADE, M. VIO, F., TRUFELLO, I., BILLARROEL, P. and SAITUA, M. T. 5th International Congress on Obesity. Jerusalem: 1986; p. 65. HERBERT, J. R., AUGUSTINE, A., BARONE, J. KABAT, G. C., KINNE, D. W., and WYNDER, E. L. Weight, height and body mass index in the prognosis of breast cancer; Early results of a prospective study., Int. J. Cancer, 1988; 42: 315-318. DALES, L. G., FRIEDMAN, G. D., WAY, H. K., GROSSMAN, S. and WILLIAMS, S. A. A case-control study of the relationships of diet and other traits to colorectal cancer in American blacks. Cancer Res., 1984; 44: 4633-4637. WILLETT, W. C. Implications of total energy intake for epidemiologic studies of breast and large-bowel cancer. Am. J. Clin. Nutr., 1987; 45 354-360.
black
19
21
supported ACKNOWLEDGMENT is Sugar
DE VILLIERS, M.
prevalence of obesity and hypertension among Zulu women in a remote rural area. S. Afr. J. Sci., 1988; 84: 601-602. O’KEEFE, S. J. D. Energy balance in rural Africans: Comparisons between men and women amongst the Zulus, Hereros, Kavangos and Bushmen. S. Afr. J. Sci., 1988, 84: 602.
25
26
27
28
29
30
31
32
Downloaded from rsh.sagepub.com at SETON HALL UNIV on March 28, 2015
Obesity in Black Women in Soweto, South Africa: Minimal Effects on Hypertension, Hyperlipidaemia and Hyperglycaemia A. R. P. WALKER, B. F. WALKER, B. MANETSI, N. G. TSOTETSI and *A. J. WALKER Human Biochemistry Research Unit, Department of Tropical Pathology, School of Pathology of the University of the Witwatersrand, and the South African Institute for Medical Research, Johannesburg. *Computer Engineering, Department of Electrical Engineering, University of the Witwatersrand,
Johannesburg ABSTRACT were made on 50 South African urban STUDIES obese women aged 25-40 years, with Body Index (BMI) ) 2 of 29.5 or more, and (Kg/m on 50 non-obese women with BMI of 25 or less. In the two groups, mean triceps skinfolds were 25.5mm and
black Mass
17.8mm, respectively. Hypertension (≥160/95mm present in 6 and 4 women (12% and
Hg) 8%),
was
hypercholesterolaemia (≥5.2mmol/l) in 5 and 3 women (10% and 6%), hypertriglyceridaemia (≥1.8mmol/l) in 5 and 3 (10% and 6%), and hyperglycaemia One or (≥7.8mmol/l) in 2 and 1 women (4% and more adverse sequelae were present in 11 (22%) obese and in 9 (18%) of non-obese women, proportions not significantly different. Dietarily, mean daily intakes were Kcals 2273 and 2240, protein 73g and 70g (12.9% and 12.5% energy), fat 65g and 67g (25.7% and 26.9% energy), carbohydrate 349g and 330g (61.4% and 60.5% energy), and dietary fibre, 12g and 13g. In this low socioeconomic and low fat dietary context, obesity in the black women studied was not specifically evocative of deleterious sequelae of obesity.
2%).
—
INTRODUCTION
populations, obesity (BMI of 29.5 or although variable in frequency. reported for adult males and females in the UK 8% and 9%2, in the USA 12% and 15%3, and in the South African white population 14% and 18%4, The obese, compared with the non-obese, respectively. are significantly more prone to hypertension, hyperlipidaemia and hyperglycaemia. In such people, 25-35% may be affected by one or more of these sequelae, and they are at increased risk to hypertension-related IN DEVELOPED
~ver)B
proportions are is
common
diseases, diabetes, coronary heart disease, and dietrelated cancers’ 6. Obese people who are not characterized by the adverse sequelae enumerated, nor by excessive fat cell size, are regarded by some as evincing
’healthy’
tor~7,8’
obesity,
for whom
weight
loss is not manda-
In South Africa, among the black population, obesity is very common among young and middle-aged women, especially those living in urban areas9,10. In rural areas, series of 95 Zulu women in Natal, 30 in a were obese, having BMI of 30 or more&dquo;. A (31.6%) similar proportion was found in a study made in a near-by region 12 . As to sequelae, in an investigation made on obese women aged 25-40 years in a rural area in Central Transvaal, only 3 out of 40 (12.5%) were
representative
adversely affected; i.e. 87.5% could be regarded as exhibiting ’healthy’ obesity 13 . Among rural blacks, despite obesity being common, coronary heart disease, gallstones, and breast and colorectal cancers are rare 14 In urban areas, obesity in black women is very common. In Johannesburg, in a large-scale study made in 1979, the proportion of women aged 20 to 60 years having a BMI of 29 or more was 50% 10. Yet in several studies made on obese women at that time, hyperlipidaemia and hyperglycaemia were uncommon, or were less common, compared with the situation among white
obese women15-18. Furthermore, coronary heart disease and diet-related cancers were rare or uncom-
mon19,2o. In the last decade, among urban black populations there has been progressively increasing westernization of diet, and changes in physical activity and in other aspects of life-style. Dietarily, the energy contributed by fat has risen from 20-25% to 25-30%; moreover, dietary fibre intake has fallen from 20g or more to 10-15g daily2l. These and other changes could well augment frequencies of the adverse sequelae of obesity. To learn whether deterioration has taken place, we have investigated a series of obese black women in Soweto, also a control group, in relation to their diet, anthropometry, and prevalences of hypertension, hyperlipidaemia and hyperglycaemia.
SUBJECTS AND METHODS
Subjects drawn from non-working mothers in Soweto. They lived in the neighbourhoods of the residences of the Nursing Sisters (B M and N G T). All subjects were in everyday good health, and none were being treated for any disease. Socioeconomically, all were poor. They were brought, in sequences of usually 15 subjects, by taxies, to the laboratory for the various
THESE WERE
investigations. Anthropometry: Subjects wore everyday clothing. They were bare-foot for examination. Height was
measured in
cm to the nearest mm. Considerable care taken to encourage subjects to stand as upright as possible. Weight was measured to the nearest whole or kg using a Wedderburn Scale. Triceps skinfold was measured by Harpenden callipers. Blood pressure: Measurements were made with subjects sitting using a mercury sphygmomanometer, and performed according to recommendations made by World Health Organization22. In the measurement of was
half
Downloaded from rsh.sagepub.com at SETON HALL UNIV on March 28, 2015
102 diastolic pressure, the end-point taken was the final disappearance of sound, i.e. Korotoff phase 5. Determinations were made twice, often three times. Laboratory studies: Subjects had had their usual traditionally limited breakfast, which was eaten at least 3 hours before collections began. Blood was collected from the antecubital vein. For serum, the samples, after clotting, were spun at 3000rpm for 10 minutes. Serum and preserved whole blood samples were stored at -20°C. Serum cholesterol and triglycerides, also blood glucose, were determined using respective kits from Boehringer-Mannheim (Mannheim, West
Table 2. Characteristics of obese and non-obese black women in Soweto (Means, standard deviations, odds ratios and confidence intervals)
Germany).
Dietary intakes: These were obtained using a 24 hour diet-frequency-recall questionnaire. The general diet consisted mainly of maize products and bread (usually brown bread), vegetables and fruit in season, various beans, and rice. Dairy produce was eaten occasionally, and meat two or three times a week, mostly chicken, and polony. Questionnaires were administered by teachers, with the assistance of models. had had Helpers previous experience, after appropriate instruction. Data were coded and processed through a specially prepared computer programme with facilities for direct entry of food types and quantities. South African Food Composition Tables were used22. Criteria of adverse sequelae: The cut-off points used blood pressure 160/95mm Hg (WHO criterwere ia)23, serum cholesterol level 5.2mmol/l; triglycerides, l.8mmo1/1, and blood glucose 7.8mmol/I (WHO criteria)24. The criteria employed are those used in a recent study on obese women in Italy25. Statistical treatment: For dietary intake data, the significance between group differences was analysed using Students unpaired ’t’ test. For comparisons between the laboratory data on the groups of obese and non-obese women, odds ratios and 95% confidence intervals were calculated using methods given by black
nurses or
-
Schesselman26.
RESULTS RESULTS ARE summarised
in Tables I and II. respective means of the dietary data in two differed significantly In the the series of 50 obese and 50 non-obese black women, one or more adverse were present in 11 (22%) sequelae obese and in 9 non-obese women. The proportions which were obtained in the two groups are not significantly different. This prevailed despite the large contast in BMI, namely, 36.8 versus 20.2.
None of the
(P>0.05).
groups
(18%
Table 1. Characteristics of obese and non-obese black women in Soweto. (Means and standard deviations) Obese women
Non-Whcce women
DISCUSSION obtained indicate that (i) the black obese women had a low frequency of adverse sequelae; and (ii) the frequency did not differ meaningfully from that in the non-obese group. The sequelae in both groups were less frequent than is the case with white women 5, The observations made concerned poor urban black women, habituated to a diet relatively low in fat content. The results obtained and conclusions reached show no change compared with the observations made in Johannesburg a decade agoI5-18. The previous studies, carried out on obese adolescents and older women, revealed that frequencies of hypertriglyceridaemia, hypercholesterolaemia, and hyperglycaemia were very low; moreover, levels did not differ significantly from those of non-obese black women. It is noteworthy too that in one of the investigations, in which studies were undertaken on adipocytes in a number of sites in very obese black women, cell size was found to correlate with percentage of ideal body weight. But cell size did not correlate with any of the other parameters measured, including blood glucose, serum cholesterol and triglycerides, as well as basal or stimulated plasma insulin concentrations. Similar situations have been reported from elsewhere. In Barbados, obesity is very common; 19% men and 60% women attending a medical outpatient department were reported to be 20% or more ideal weight2~. In a random series of 122 blacks age 50-59 years, 20% of men and 43% of women were obese (BMI * 29.5%). Mean triceps skinfolds of the total groups of men and women were 16.4mm and 22.0mm, respectively. The authors reported there to be a very low correlation between BMI and the use of hospital or outpatients’ facilities. In explanation, it was noted that local attitudes did not view obesity as a health problem; the condition was actually perceived as a normal and attractive state. Closely similar sociocultural attitudes exist in African and other developing THE RESULTS
socioeconomicall
abov
populations2g.
Attention is drawn to
an
Santiago, Chile29. There,
a
illuminating report from group of severely obese
women, of average 40 years, of low socio-economic
class, sedentary, and consuming only 22% of energy as fat, had low mean lipid values triglycerides 1.18 ± -
0.57 mmol/1 and cholesterol 4.63± 0.97 mmol/1. However, also in Santiago, in an equally obese group in a high socio-economic state, and who consumed 31 % of energy from fat, mean lipid values were much higher triglycerides 1.68 ± 0.92mmol/l and cholesterol 5.93± 1.94mmol/l. Thus, in the poor obese group of women, a
Downloaded from rsh.sagepub.com at SETON HALL UNIV on March 28, 2015
103 low fat diet, associated with a low intake of animal products and with other features, was consistent with a low frequency of hyperlipidaemia. The South African obese women studied were aged 25-40 years. At older ages, frequency of obesity increases 10. Hypertension too becomes more common 10. In the urban black population, diabetes and cerebral vascular disease are important causes of morbidity and mortality 14 . However, the incidence of coronary heart disease continues to be very IOW14,19. The incidences of breast and colorectal cancers, in which obesity is a risk facto.-3°,32, remain only a quarter of the incidences found in the white population2o. The specific role of obesity in promoting hypertension appears to be of lesser moment in blacks, as prevails in the case of blacks versus whites in the USA5. noxiousness of in of lower the However, obesity regard this variable, and of the others studied, can only be satisfactorily validated from prospective studies undertaken in contrasting socioeconomic and dietary
11
contexts.
20
12
13
14
15
16
17
18
in part by grants from the STUDY was Association and the National South African Cancer Association of South Africa.
22
23
REFERENCES 1 BRAY G. A., How is 8-14.
24
obesity
measured? Disease-a-Month, 1979; 26:
2 ROSENBAUM. S., SKINNER, S. K. KNIGHT, J. B. and GARROW, J. S. A survey of weights and heights of adults in Great Britain, 1980. Ann. Hum. Biol. , 1985; 12: 115. 3 ABRAHAM, S. and JOHNSON, C. L. Prevalence of severe obesity in
adults in the United States. Am. J. Clin. Nutr., 1980; 33: 364-365 BENADÉ, A. J. S., and ROSSOUW, J. obesity and its relation to coronary heart disease in the CORIS study. S. Afr. Med. J., 1988; 74: 101-104. 5 VAN ITALLIE, T. B. Health implications of overweight and obesity in the United States. Ann. Int. Med., 1985; 103; 983-988. 6 BORRELLI, R., ISERNIA, C., DI BIASE, G., and CONTALDO, F. Mortality rate causes and predictive factors of death in severely obese 58: 343-350. patients. Internat. J. Vit. Nutr. Res., 1988; 7 KNAAP, T. R., A methodological critique of the ’Ideal Weight’ concept J. Am. Med. Ass., 1983, 250; 506-510. 8 JARRETT, R. J. Is there an ideal body weight? Br. Med. J., 1986; 293: 493-495. 9 WALKER, A. R. P. Overweight and hypertension in emerging populations. Am. HeartJ., 1964; 68: 581-585. SEFTEL, H. C., JOHNSON, S., and MULLER, E. A. Distribution and correlations of blood pressure levels in Johannesburg blacks. : 313-320. Afr. Med. J., 1980; 57
4
JOOSTE, P. L., STEENKAMP, H. J., E. Prevalence of overweight and
10 S.
biosocial
A., ALBERTSE, E. C. and McLACHAN, M. H. The
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