Turning the Tide on Lifestyle Diseases: The obesity epidemic – a symptom of a deeper problem

Dr David Glass - MBChB, FCOG(SA)

A couple of years ago my wife and I visited family working in Myanmar (formerly Burma).  One of the first things that struck me was the virtual absence of fat people.  In fact, the only overweight people I saw were the tourists, and a few of the local people patronising Western-style fast food restaurants.

Japan has seen a significant increase in obesity after the arrival of fast-food joints.  Research has shown a reduction in consumption of carbohydrate (rice) consumption and an increase in dairy and red meat in modern Asia.  Traditionally Japanese ate rice three times per day, with minimal animal proteins and very little dairy.

What is the extent of the problem in South Africa?  Seventy percent of women are overweight, and within that figure 40% are obese.  Thirty five percent of men are overweight.  But of great concern is that 25% of girls and 20% of boys between the ages of 2 and 14 years of age are overweight.  And this figure is climbing year by year.

South Africans are the largest people on the continent.

Why has this change taken place?  There are so many theories, and each proponent is so adamant that their theory is correct.  How can we know the truth?  More importantly what can we each do to arrest the inexorable decline to obesity and all its health-limiting complications.  We know that obesity is strongly associated with so many of the conditions that shorten life and reduce the joy of living – high blood pressure, diabetes, heart attacks, strokes, arthritis and many cancers.

If you look at nature, you will seldom see an obese mammal or bird in their natural environment.  When animals live as they are designed to live, and eat what they are designed to eat, there are complex control mechanisms to balance optimum mass and energy storage.

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It is only when we introduce unnatural circumstances that this fine balance is disturbed.  The only animals that are commonly obese are humans, dogs and cats and some domestic animals – all fed processed foods, altered from their original composition.  Foods as they come from the designer have nutrients finely balanced with fibre, water and all the right substances that keep the organism healthy.

The industrial revolution introduced factories, processing plants and the ability to manufacture foods into energy dense, altered “foods” that can be packaged, stored and distributed anywhere in the world.  Often in the process of production, extra energy in the form of sugars and fats are added for both flavouring as well as preservation.  Unfortunately for us humans, these additives also boost our dopamine response – making them addictive in many people.


Imagine if you were given 5 large apples to eat for a meal.  Most people would battle to eat that many large fruits at one meal – you would soon feel full.  However, if you were given a slice of apple pie with a scoop of ice-cream, you could probably have a variety of other foods to eat as well.  It so happens that that slice of apple pie/ice-cream has the same number of kilojoules as the five large apples.  Why does the one meal fill you up, and the other not?  It has to do with energy density.

Certain foods have very high energy density – the highest being oil.  Oil is the most refined product on earth, and has the highest number of kilojoules – 38 kj per gm.  Other high-density foods are things like cheese, eggs, and other animal products.  If your diet is high in these foods, you are likely to battle with your weight, unless you are very active.

Carbs have had a bad rap.  And yet carbohydrates and proteins both have only 17 kj per gm.  The problem is not with carbohydrates per se, it is with the refined carbs – carbs that have had their fibre, minerals, phytochemicals and vitamins stripped away, leaving only rapidly absorbed sugars.  Natural carbohydrates are packaged in fibre and other nutrients that gradually release the sugars into the body.  These provide natural energy and other health- stimulating effects on both the body as well as our microbiome, a vitally important part of our gut and body function.

The foods that have the lowest energy density are fruits and vegetables.  You can eat these with gay abandon – as much as you can, and you will not gain weight.  Although fruits are rich in fructose and other sugars, these sugars are packaged in a way that promote health.  However, if you were to consume the same amount of fructose in the form of sugary drinks, you would suffer harm.

What does this approach do to weight control?  The idea is to increase the consumption of low-density foods – a variety of fresh fruits, vegetables of all the shapes and colours, whole grains, fibre-rich legumes and limited seeds and nuts.  Animal products are best used as a side-dish, rather than the main focus of the meal.  Studies, conducted by Dr Neal Barnard, have shown that just going onto a low-fat intake diet, with limited animal products, weight just naturally falls off.

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You don’t have to count kilojoules; you don’t have to cut portion sizes; you don’t even have to go onto a strenuous exercise programme (although that will certainly improve your well-being).  Most participants in the study continued to follow the programme even after 2 years.  Most weight-loss programmes tend to be short-lived because they are not sustainable.  But people who go for a natural food programme mostly feel so full of energy and vitality that they are happy to continue.

In summary:  The biggest single factor to improve our health is to change our diet from processed foods to foods as found in their natural state.  These are the foods our bodies are designed to utilise.  There is such a variety of foods to try out and enjoy.

Begin this journey of discovery of life-giving foods.

Dave Glass

References are available if needed.

Dr David Glass graduated from UCT in 1975.  He spent the next 12 years working at a mission hospital in Lesotho, where much of his work involved health education and interventions to improve health, aside from the normal busy clinical work of an under-resourced mission hospital. 

He returned to UCT in 1990 to specialise in obstetrics/gynaecology and then moved to the South Coast where he had the privilege of, amongst other things, ushering 7000 babies into the world.  He no longer delivers babies but is still very clinically active in gynaecology.

An old passion, preventive health care, has now replaced the obstetrics side of his work.  He is eager to share insights he has gathered over the years on how to prevent and reverse so many of the modern scourges of lifestyle – obesity, diabetes, ischaemic heart disease, high blood pressure, arthritis, common cancers, etc.

He is a family man, with a supportive wife, and two grown children, and four beautiful grandchildren. His hobbies include walking, cycling, vegetable gardening, bird-watching, travelling and writing.  He is active in community health outreach and deeply involved in church activities.  He enjoys teaching and sharing information.


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Dr Dave Glass

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