Strategy for the Prevention and Control of Obesity in South Africa 2015-2020

Objectives

The strategy’s vision is a long and healthy life for all South Africans, and its mission is to enable healthy choices by creating environments that support healthy eating and physically active lifestyles to prevent and control overweight and obesity.[1]It adopts a population-based, life-course and multi-sectoral framework that addresses environmental, social and behavioural drivers rather than relying solely on individual action.[2][3][1]

• Prevent increases in obesity prevalence by 2016, achieve a 3% reduction across all age groups by 2017, and achieve a 10% reduction across all age groups by 2020.[1]
• Establish an institutional framework for inter-sectoral engagement, clarify stakeholder roles and incorporate obesity actions into participating departments’ plans.[1][4]
• Improve the availability, affordability and accessibility of healthy food through fiscal policies, nutrition standards for ultra-processed foods, food reformulation, responsible marketing, clearer labelling, healthier retail and restaurant practices, and increased access to fruit and vegetables.[1][4][5]
• Increase population physical activity through safe recreational facilities, active transport, walkable and bicycle-friendly urban planning, school and workplace activity, community participation and physical-activity guidance.[6][7]
• Protect health from pregnancy to age 12 by strengthening maternal nutrition, breastfeeding, complementary feeding, growth monitoring, early childhood development, and healthy eating and activity in childhood.[3][7][8]
• Communicate with, educate and mobilise communities to increase knowledge, demand and uptake of healthier diets, healthy food environments and opportunities for physical activity.[3][9]
• Establish surveillance and strengthen monitoring, evaluation and research, including access to screening, evidence synthesis and a research agenda.[1][10]

Implementation

Implementation is designed as a systems-based, multidisciplinary and multi-sectoral response involving government, communities, civil society, academia, international organisations and the private sector.[11][3][1]A coordinating structure is intended to provide leadership and ownership, set research priorities, oversee intervention implementation and evaluation, and monitor outcome objectives.[3]

• Coordinate action across national, provincial and local government, including health, education, transport, sports, social development, public service and local-government institutions, alongside schools, workplaces, healthcare facilities and communities.[11][4][7]
• Develop phased sectoral micro-plans with specific targets, advocate for resources across participating sectors and allocate departmental resources for agreed activities.[1][4]
• Implement healthy-food measures through legislation and fiscal policy, standards for sugar and fat, retailer and manufacturer engagement, school nutrition initiatives, employee wellness programmes, dietary guidance, front-of-pack and menu-labelling education, and advertising controls.[4][5]
• Deliver physical-activity measures by maintaining safe footpaths, enabling access to school grounds and community facilities, supporting physical education and school sport, embedding activity in employee wellness programmes, and integrating active transport into planning.[6][7]
• Integrate obesity prevention into maternal, newborn and child-health services through provider guidance, counselling and educational materials, updated Road-to-Health Booklet content, breastfeeding and complementary-feeding support, and early childhood development policies.[7][8]
• Expand access to health screening and counselling through private-sector campaigns, body mass index assessment, workplace wellness assessments, nutritional referral systems and strengthened primary-care counselling capacity.[12][10]
• Engage communication experts, media platforms, community leaders, consumer groups, civil-society organisations and conflict-free private-sector partners to develop healthy-lifestyle messages, campaigns, dialogues and public information on weight-status services.[9]
• Build an evidence and accountability system using agreed indicators, monitoring tools, a national repository of interventions, cross-sector activity tracking and frequent reporting through an inter-sectoral forum.[10][13]Existing data sources include the District Health Information System, Statistics South Africa, the South African Demographic and Health Survey, the South African National Health and Nutrition Examination Survey, and other surveys and research.[13]
• Establish government, academic and research partnerships to identify priority research areas, investigate social determinants and implementation barriers, evaluate programme impact and support effective scale-up.[13][14]

Monitoring & Evaluation

Monitoring, evaluation, surveillance and research form a core strategic goal for obesity prevention and management. The framework aims to establish a surveillance system, strengthen monitoring and evaluation, improve access to screening, communicate evidence, and implement a prioritised research agenda.[10][13]

• Track progress against population obesity-prevalence targets: no increase by 2016, a 3% decrease across all age groups by 2017, and a 10% decrease by 2020.[1]
• Monitor implementation indicators covering inter-sectoral structures, departmental resource allocation, legislation on sugar-sweetened beverages, nutritional standards, food and menu labelling, healthy food provision, advertising codes and reduced exposure to unhealthy products at points of sale.[4][5]
• Measure outcomes including fruit and vegetable consumption, adherence to school nutrition guidance, healthy-food initiatives in government departments, physical-activity participation, access to facilities, active transport, learner activity and public knowledge of nutrition and physical activity.[5][6][7][9]
• Track maternal and child-health measures, including exclusive breastfeeding at 14 weeks and six months, optimal complementary feeding, updated Road-to-Health Booklet content, childcare facilities in government departments, and obesity-prevention messages in early childhood development policies.[7][8]
• Use body mass index and waist circumference to assess weight-related risk, while recognising limitations of body mass index and the need for age- and sex-specific reference standards for children.[15]

Existing surveillance and evidence sources include the District Health Information System, Statistics South Africa, the South African Demographic and Health Survey, the South African National Health and Nutrition Examination Survey, specific surveys and research, the National Income Dynamics Study, and the Youth Risk Behaviour Survey.[16][13]A comprehensive tracking system is nevertheless required to monitor unhealthy lifestyles and exposures, obesity and related outcomes, cause-specific mortality, and the health-system response, including service capacity, access and intervention quality.[13]

The proposed coordinating structure is intended to coordinate research priorities, intervention implementation and evaluation, and monitoring of outcome objectives.[3]Monitoring arrangements include agreed indicators, reporting tools, cross-sector activity tracking, frequent reporting through an inter-sectoral forum, and a national repository of obesity interventions.[10][13]Implementation tables assign targets over 2015/16 to 2019/20, although the supplied extracts do not define a separate reporting timetable, formal evaluation design or named accountability process.[4][6]

Research should examine macro-economic, social and context-specific determinants of obesity, implementation barriers, intervention effectiveness and opportunities for scale-up, particularly in resource-constrained settings.[17][13][14]Government, academic and research institutions are expected to partner on priority-setting, implementation research and assessment of intervention impact.[10][14]The World Health Organization monitoring and evaluation framework is identified as guidance for assessing key actions, and disability-adjusted life-years averted are proposed as a measure of intervention effectiveness over differing time horizons.[12][1]

Costing & Financing

The strategy recognises obesity as an economic and social-development challenge, generating healthcare costs, productivity losses, disability and wider economic disenfranchisement.[18][19]It promotes affordable and accessible healthy food, fiscal measures, healthier workplace practices and employee wellness, but does not provide an overall programme budget, financing plan, funding-gap assessment or resource-mobilisation target.[18][12]

• Estimate the global economic impact of obesity at approximately US$2.0 trillion, or 2.8% of global gross domestic product.[19]
• Identify high body mass index as driving an estimated 2% to 7% of global healthcare expenditure, with obesity-related diseases potentially accounting for up to 20% of healthcare spending.[19]
• Classify implementation costs below L$1 per capita as low and costs above L$2 per capita as high; the meaning of the currency label “L$” is not clarified in the supplied extract.[12]
• Identify fiscal measures as consistently cost-saving in low- and middle-income settings and among the interventions expected to generate the largest health gains over 20-year and 50-year periods.[12]
• Recognise a modelled 20% tax on sugar-sweetened beverages as a potential obesity-reduction measure in South Africa, particularly for adults, without specifying implementation costs, expected revenue or an earmarked use of proceeds.[20]

In 2010 South African rand, estimated costs per head were R0.20 for fiscal measures, R0.90 for food-advertising regulation, R2.50 for food labelling, R4.50 for worksite interventions, R7.50 for mass-media campaigns, R11.10 for school-based interventions and R11.80 for physician counselling.[12]These figures are intervention-specific estimates rather than a stated national allocation or total programme cost.[12]

Participating departments are expected to allocate resources and the coordinating structure is expected to advocate for resources across sectors.[4]However, the supplied material does not specify departmental allocations, donor or domestic funding sources, private-sector financial commitments, resource requirements, funding gaps, budget years beyond the cited 2010 estimates, or economic assumptions for implementation.[4][10][13]