At lunchtime outside South Africa’s biggest shopping mall, hungry workmen in hard hats pour out of a building site to buy cheap loaves of bread and jumbo bottles of fizzy drinks.

They are joined by middle-class office workers, forming long queues at fast-food restaurants to stack trays with fried chicken, pizza or local delicacies such as bunny chow — a hollowed out loaf of bread stuffed with steaming curry.

Nearly three quarters of South Africans are overweight and the country ranks third in a list of the world’s most obese nations behind the United States and Mexico, according to surveys by GlaxoSmithKline and medical journal The Lancet.

Africa has for decades been grappling with well publicized epidemics such as HIV/AIDS, malnutrition and malaria, but a wave of new health risks has gone relatively unnoticed.

An increase in disposable income among a rapidly growing middle class in developing nations such as South Africa is leading to unhealthy overeating, prompting a spike in diabetes, hypertension and strokes.

“We have an absolute epidemic of obesity in South Africa. It’s here and now and unless we do something dramatic it’s just going to become even worse,” said Dinky Levitt, head of the Chronic Diseases Initiative in Africa at the University of Cape Town.

South Africa is a striking example of a problem that is spreading in developing countries, where 60 percent of the world’s obese people live, a January study by the London-based Overseas Development Institute found.

The number of overweight people in developing countries has more than tripled in less than three decades, from 250 million, to nearly 1 billion in 2008, the study found.

Despite the heavy toll that obesity takes on their bodies and the country’s creaking hospitals, many South Africans share cultural values that glorify men with bulging bellies as successful and women with rounded hips as beautiful.

Nearly 90 percent of the 25,500 people interviewed in a 2013 study by the Human Sciences Research Council deemed fat as the preferable body type.

“I’d like to put on a bit more weight and I have asked my boyfriend to eat more because he’s too skinny. People are starting to think he’s sick,” said bank teller Dimakatso Masinga, 27, at a popular fast-food outlet.

Noncommunicable illnesses, such as strokes and heart attacks, account for more than 40 percent of all deaths in South Africa, and doctors say these health problems will soon overtake HIV and tuberculosis as the country’s biggest killers.

South African authorities are considering imposing tax on food and drinks high in fat and sugar and using the revenue to cut the price of foods they consider to be healthy.

“The thing that really disturbs me is how expensive a healthy basket of food is and how cheap junk foods are,” said Melvin Freeman, head of noncommunicable disease at the government health department.

Authorities are considering banning fast food advertising aimed at children, Freeman said, and meals sold in schools and work places may have to regulated.

“As a developing country, South Africa is least likely to respond to sick people. We have little option but to act on the prevention side,” Freeman said.

It costs up to 23 percent more to treat an overweight person in South Africa than someone of healthy weight, according to the South African Medical Journal, but much of the 146 billion rand ($13 billion) annual health budget is soaked up by building or revamping run-down hospitals.

Magic pill for obesity? Scientists working on drug to ‘replace treadmill’

Harvard University researchers say they’re one step closer to creating a pill that may someday replace the treadmill, thanks to a breakthrough that can change the way energy-storing white fat cells behave.

The laboratory work enables scientists to more easily manipulate white fat cells, the bad kind that stores energy for later use and contributes to obesity and diabetes, according to the report in Nature Cell Biology.

The scientists screened about 1,000 compounds and found two that make the white fat cells act more like their brown cousins, which burn excess energy rather than store it.

“What we wanted to do is take the white fat no one wants, especially post-holidays, and turn it into the fat everyone wants, the brown fat,” said senior author Chad Cowan, a faculty member at the Harvard Stem Cell Institute.

The results suggest “you could someday come up with a small molecule that might be a pill that would replace a treadmill in terms of its ability to burn fat or burn calories,” he said.

The researchers worked with stem cells that would normally turn into white fat cells.

Exposing the cells to drugs, including Pfizer Inc.’s rheumatoid arthritis medicine Xeljanz, made them behave more like brown cells that burn fat to regulate body temperature.

The researchers will next test the medicine in animals to see if it produces the same metabolic changes seen in the laboratory tests, Cowan said.

A cursory examination of Xeljanz research didn’t show if the drug had an effect on the metabolism or weight of rheumatoid arthritis patients, Cowan said.

The investigators are hoping to find a way to deliver the medicine directly to fat cells rather than infuse it widely in the body, where it depresses the immune system as a way to treat rheumatoid arthritis, Cowan said.

Patients taking the drug typically gained weight in carefully controlled clinical trials, said Steven Danehy, a Pfizer spokesman. After a year, patients on low and high doses of Xeljanz added about 2 kg, he said.

While the original investigation was conducted with the support of Roche Holding AG, the company has stopped working in the area, Cowan said.

He is talking with several pharmaceutical companies to interest them in the work.

Exercise has numerous benefits beyond burning fat and lowering weight, including controlling cholesterol and blood pressure, boosting mood and energy levels, and enhancing sleep and mental function.

A medicine “would never replace the other benefits of exercise, so in no way would I tell people to stop exercising,” Cowan said. “But this does give us great hope that with further research we could come to the realization that you could have a therapy for both obesity and diabetes.”

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