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The problem

South Africans are getting heavier and sicker. Obesity has become a modern day global pandemic that is contributing to deaths from non-communicable diseases (NCDs) –  such as high blood pressure, diabetes, heart disease, cancer, non-alcoholic fatty liver disease and dementia – at a faster rate than ever before. It is predicted that by 2030 deaths from NCDs will be five times greater than deaths from communicable diseases and this includes HIV/Aids and Tuberculosis.

If we’re going to slow down this modern plague, we need to stop blaming and shaming. It’s time to remove the stigma attached to obesity. Research is increasingly indicating that people with weight issues, particularly central obesity, are overweight not because of laziness, lack of discipline or greed but rather because the majority of them have a metabolic dysfunction called insulin resistance. This means that they have sustained high levels of insulin preventing the efficient burning of fat.

Approximately 80% of obese adults have  metabolic syndrome- a cluster of chronic diseases that includes high blood pressure, Type 2 diabetes, blood fat problems, heart disease, some cancers and dementia.  The syndrome is so important that the United Nations (UN) held a summit in 2011 with the specific purpose of formulating a worldwide strategy to address the growing pandemic. The UN issued the following statement: “Non-communicable diseases – or NCDs – like heart attacks and strokes, cancers, diabetes and chronic respiratory disease account for over 63% of deaths in the world today. Every year, NCDs kill nine million people under 60. The socioeconomic impact is staggering.”

There is no doubt that the metabolic syndrome has assumed pandemic status. We can’t afford to ignore this reality. We are fatter and sicker than ever. And our children are also not immune from this modern plague.  

So what is the solution?

When it comes to losing weight, insulin resistance is often a major invisible hurdle for many obese and overweight people. Obesity and insulin resistance go hand in hand. Insulin resistance means that cells have lost some of their sensitivity to the hormone insulin. Insulin is secreted by the pancreas in response to blood sugar (glucose) which is mainly derived from carbohydrates.

Starch and sugar are refined carbohydrates and because they are easily converted into blood glucose they drive insulin levels upwards. Bread, pasta, biscuits, cakes, breakfast cereals, sweets and chocolate, sugar sweetened beverages, fruit juice as well as some fruits and vegetables are just some of products that drive our insulin levels.

Sustained high levels of insulin make the body really good at storing fat and not very good at burning it. When fat production and storage exceeds the breakdown and burning of fat as fuel for energy, weight gain and retention are inevitable. Persistently high levels of insulin also often results in constant hunger and a lack of energy, which are all physiological responses to insulin resistance and not a matter of willpower.  Being overweight or obese is thus NOT simply a psychological problem as we have been led to believe, i.e. we eat too much and don’t exercise because of a lack of willpower. While psychological influences do play a role, the major factor appears to be physiological: It’s the insulin!  

As insulin is the primary regulator of fat storage and utilisation, it follows that re-establishing an insulin balance is key in terms of both obesity prevention and treatment. Bringing insulin levels back to normal can be achieved by cutting out sugar and other refined carbs because insulin secretion is mostly controlled by blood glucose levels, which is largely affected by carbohydrates and, to a lesser extent, protein in the diet. Other factors that exacerbate metabolic syndrome are sedentary lifestyle, advancing age, endocrine dysfunction and genetic predisposition.

How do we overcome this vicious cycle?

High levels of  blood glucose and  thus insulin mean three important things: Increased fat storage, hunger and inflammation – a deadly disease-risk troika.

Addressing obesity requires focused self-care in the form of whole-body lifestyle modification: thinking of food as medicine, understanding the importance of exercise, garnering psychosocial and spiritual support and, lastly, by using medicines and supplements appropriately.

To put it simply, improved self-care is essential. While medical care remains important, people need to be educated and empowered to be able to take charge of their own health. With an empowering self-care programme, people will be in a position to identify disease-related needs, set health-related goals, discuss and agree on a treatment strategy, implement the interventions and monitor the outcome.

It’s time to look at obesity and its associated conditions for what they are and stop blaming the victims. Obesity is a chronic condition just like high blood pressure and heart disease, yet society still attaches a stigma to it. We can no longer ignore the evidence that obesity is largely about physiology (insulin dysfunction) and not psychology (lack of will power).

Getting Healthy Together

Getting Healthy Together  is our motto and what we are about at UpForIt.  If you are interested in being supported on your journey to better health, then I’m happy to put you in touch with a trained coach. Or, if you are interested in becoming an UpForIt trained health coach we offer online training and support. Just  drop me an email  at and we will get back to you.


I’m Dr Peter Hill from UpForIt.