Cancer Association of South Africa (CANSA)

Transcription

1 Cancer Assciatin f Suth Africa (CANSA) Fact Sheet n Obesity and Cancer Intrductin Obesity can be described as an imbalance between energy intake and expenditure, such that excess energy is stred in fat cells, which enlarge r increase in number. Hwever, the cmplex medical cnditin f besity is affected by a hst f cntributing factrs. Obesity is defined as a bdy mass index (BMI) f mre than 30 accrding t Wrld Health Organizatin criteria. [Picture Credit: Obesity 1] Obesity has becme a glbal epidemic with an estimated 1,3 billin peple being verweight r bese. Its prevalence in develped cuntries, such as the United States, is as high as 26,6% in men and 32,2% in wmen abve the age f 20 years. Hwever, besity is nt nly a prblem f develped natins but is becming an increasing prblem in cuntries underging epidemilgical transitin, such as Suth Africa, Mexic and Suth American cuntries (Medical Research Cuncil, Suth Africa). Lyn, France, 26 Nvember A new study by the Internatinal Agency fr Research n Cancer (IARC), the specialised cancer agency f the Wrld Health Organizatin (WHO), shws that nearly half a millin new cancer cases per year can be attributed t high bdy mass index (BMI). The study, published in The Lancet Onclgy, highlights that verweight and besity have becme majr risk factrs, respnsible fr an estimated 3.6% ( ) f all new cancer cases in 2012 (IARC). Key Facts Abut Obesity The Wrld Health Organizatin (May 2014) prvided the fllwing key facts arund besity: Wrldwide besity has nearly dubled since In 2008, mre than 1.4 billin adults, 20 and lder, were verweight. Of these ver 200 millin men and nearly 300 millin wmen were bese. 35% f adults aged 20 and ver were verweight in 2008, and 11% were bese. 65% f the wrld's ppulatin live in cuntries where verweight and besity kills mre peple than underweight. Mre than 40 millin children under the age f 5 were verweight r bese in Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved by Ms Elize Jubert, Chief Executive Officer [BA Scial Wrk (cum laude); MA Scial Wrk] June 2017 Page 1

2 Obesity is preventable. Overweight and besity are leading risks fr glbal deaths. Arund 3.4 millin adults die each year as a result f being verweight r bese. In additin, 44% f the diabetes burden, 23% f the ischaemic heart disease burden and between 7% and 41% f certain cancer burdens are attributable t verweight and besity. Sme WHO glbal estimates frm 2008: Mre than 1.4 billin adults, 20 and lder, were verweight. Of these verweight adults, ver 200 millin men and nearly 300 millin wmen were bese. Overall, mre than 10% f the wrld s adult ppulatin was bese. In 2012, mre than 40 millin children under the age f 5 were verweight r bese. Once cnsidered a high-incme cuntry prblem, verweight and besity are nw n the rise in lw- and middle-incme cuntries, particularly in urban settings. In develping cuntries with emerging ecnmies (classified by the Wrld Bank as lwer- and middle-incme cuntries) the prevalence f childhd verweight and besity in preschl children is in excess f 30%. Mre than 30 millin verweight children are living in develping cuntries and 10 millin in develped cuntries. Overweight and besity are linked t mre deaths wrldwide than underweight. Fr example, 65% f the wrld's ppulatin live in cuntries where verweight and besity kill mre peple than underweight (this includes all high-incme and mst middle-incme cuntries). (Wrld Health Organizatin, 2014) Obesity is a Majr Preventable Cause f Cancer Majr studies cnfirm that being verweight r bese increases the risk f varius cancers (Bianchini, et al., 2002; Internatinal Agency fr Research n Cancer, 2002; Renehan, et al., 2008; Reeves, et al., 2007). The Wrld Health Organizatin (WHO) says that verweight and besity are the mst imprtant knwn avidable causes f cancer after tbacc (Wrld Health Organizatin, 2003). Obesity in Suth Africa In Suth Africa, where under-nutritin, pverty and infectius diseases (such as HIV/AIDS and tuberculsis), are realities, the prblem f besity culd be viewed as less pressing. Hwever, besity and its c-mrbidities negatively affect the lives f many Suth Africans and the cnsequent burden f disease cntributes t the increasing cst f health care, bth at a state level and in the private sectr (Medical Research Cuncil, Suth Africa). [Picture Credit: Obesity 2] Accrding t a study by the Natinal Department f Health, mre than half f Suth African wmen are verweight r bese, with the figure fr Black wmen nearly 60%. Fat intake amng Blacks has jumped Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved by Ms Elize Jubert, Chief Executive Officer [BA Scial Wrk (cum laude); MA Scial Wrk] June 2017 Page 2

3 almst 65% since 1940, when recrds first started being kept. Obesity-related diseases like hypertensin and diabetes are spiralling. Mre Suth African adults nw die frm besity than frm pverty (Health Systems Trust). In a recent survey cnducted by the SA Medical Research Cuncil, it was fund that 61% f the Suth African ppulatin is verweight, bese r mrbidly bese. In additin, 70% f all Suth African wmen ver the age f 35 were verweight r bese with 33% f Black wmen expsed t this risk and 25% f Clured, White and Asian wmen fllwing suit. In cntrast, 18% f White men ver the age f 35 are bese, fllwed by 9% percent f Asian, 8% percent f Clured, and 6% f Black men. With an estimated 2,8 millin peple annually dying as a result f being verweight r bese, it is time fr Suth Africans t take stck, says the Self-Medicatin Assciatin f Suth Africa (SMASA) (Self-Medicatin Assciatin f Suth Africa; IOL News). Accrding t the Wrld Health Organizatin (WHO), besity was previusly assciated with high-incme cuntries, but is nw gaining prevalence in lw- and middle-incme cuntries. In Octber 2011, Cmpass Grup Suthern Africa, a fd services cmpany, placed Suth Africa third in the wrld in terms f besity rankings after the United States f America and Great Britain. Obesity is linked t nn-cmmunicable diseases, such as diabetes mellitus, crnary heart disease and hypertensin, which are amng the tp 10 causes f death in Suth Africa (Gbyega A Ogunbanj). Accrding t Wrld Obesity, in 2012: 10,6% f Suth African men were bese 39,2% f wmen were bese. (Wrld Obesity). Defining Being Overweight and/r Obese Overweight and besity are bth labels fr ranges f weight that are greater than what is generally cnsidered healthy fr a given height. The terms als identify ranges f weight that have been shwn t increase the likelihd f varius diseases and ther health prblems. Fr adults, verweight and besity ranges are determined by using weight and height t calculate a number called the bdy mass index (BMI). BMI is used because, fr mst peple, it crrelates with the amunt f bdy fat. An adult wh has a BMI between 25 and 29.9 is cnsidered verweight An adult wh has a BMI f 30 r higher is cnsidered bese (Wrld Health Organizatin; Centers fr Disease Cntrl and Preventin). Devised between 1830 and 1850 by the Belgian Adlphe Quetelet during the curse f develping scial physics, BMI is defined as the individual's bdy mass divided by the square f their height with the value universally being given in units f kg/m 2. Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved by Ms Elize Jubert, Chief Executive Officer [BA Scial Wrk (cum laude); MA Scial Wrk] June 2017 Page 3

4 (Wikipedia). One imprtant categry f besity nt captured by BMI is s-called abdminal besity - the extra fat fund arund the middle that is an imprtant factr in health, even independent f BMI. The simplest and mst ften used measure f abdminal besity is waist size. Guidelines generally define abdminal besity in wmen as a waist size 89cm r higher, and in men as a waist size f 101cm r higher. (Harvard Schl f Public Health). Bdy Mass Index (BMI) and Bdy Mass Index Categries The chart belw can be used t determine the Bdy Mass Index (BMI) f an individual. Cmmn Health Cnsequences f Being Overweight and/r Obese Raised BMI is a majr risk factr fr nn-cmmunicable diseases such as: Cardivascular diseases (that includes mainly heart disease and strke), which were the leading wrldwide causes f death in 2008 diabetes Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved by Ms Elize Jubert, Chief Executive Officer [BA Scial Wrk (cum laude); MA Scial Wrk] June 2017 Page 4

5 musculskeletal disrders (especially stearthritis - a highly disabling degenerative disease f the jints) cancers The risk fr these nn-cmmunicable diseases increases with the increase in BMI. Childhd besity is assciated with a higher chance f besity, premature death and disability in adulthd. In additin t increased future risks, bese children experience breathing difficulties, increased risk f fractures, hypertensin, early markers f cardivascular disease, insulin resistance and psychlgical effects. (Natinal Cancer Institute; Stanfrd Hspital and Clinics; Harvard Schl f Public Health; NHS Chice UK). In a recent study by Slveig, et al. (2014) it was fund that: Overweight 5-year-lds were fur times as likely as nrmal-weight children t becme bese Amng children wh became bese between the ages f 5 and 14 years, nearly half had been verweight and 75% had been abve the 70 th percentile fr bdy-mass index when they were 5 years ld Incidence f besity between the ages f 5 and 14 years was mre likely t have ccurred at yunger ages, primarily amng children wh had entered kindergarten verweight [Picture Credit: Medical Cmplicatins f Obesity] Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved by Ms Elize Jubert, Chief Executive Officer [BA Scial Wrk (cum laude); MA Scial Wrk] June 2017 Page 5

6 Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved by Ms Elize Jubert, Chief Executive Officer [BA Scial Wrk (cum laude); MA Scial Wrk] June 2017 Page 6

7 (Wrld Ecnmic Frum) Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved by Ms Elize Jubert, Chief Executive Officer [BA Scial Wrk (cum laude); MA Scial Wrk] June 2017 Page 7

8 Obesity and Cancer Acute inflammatin, a physilgical prcess generated by the bdy in respnse t injury, infectin, r irritatin, is vital t healing. Hwever, when this prcess becmes chrnic it may cntribute t a variety f diseases, including cancer. Obesity is assciated with a lw-grade chrnic inflammatin, characterised by increased circulating fatty acids and chem-attractin f immune cells that cntribute t the inflammatry cnditin. Althugh the features f chrnic inflammatin in bese adipse tissue are clearly defined, the signals and mechanisms that trigger chrnic inflammatin are nt yet well understd. There is a strng relatinship between metablism and immunity, which can becme deleterius under cnditins f metablic stress. Obesity, cnsidered a chrnic inflammatry disease, is ne example f this link. Chrnic inflammatin is increasingly being recgnised as an aetilgy in several cancers, particularly thse f epithelial rigin and, therefre, the link between besity and cancer. (Rams-Nin, 2013). Cancers linked t besity include: Endmetrial cancer Breast cancer Cancer f the Cln Cancer f the Uterus Cervical cancer Oesphageal cancer Pancreatic cancer Kidney cancer Prstate cancer Thyrid cancer Gall bladder cancer Althugh mre evidence is needed, being verweight and/r bese has been assciated with ther cancers as well. These include: Liver cancer Nn-Hdgkin lymphma Multiple myelma (Cancer.Net; Cancer Research UK; Natinal Cancer Institute; Cancer.Net; Web MD). Causes f Being Overweight r Obese The fundamental cause f besity and verweight is an energy imbalance between calries cnsumed and calries expended. Glbally, there has been: an increased intake f energy-dense fds that are high in fat r added sugars; and an increase in physical inactivity due t the increasingly sedentary nature f many frms f wrk, changing mdes f transprtatin, and increasing urbanisatin. Changes in dietary and physical activity patterns are ften the result f envirnmental and scietal changes assciated with develpment and lack f supprtive plicies in sectrs such as health, agriculture, transprt, urban planning, envirnment, fd prcessing, distributin, marketing and educatin. (Wrld Health Organizatin). Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved by Ms Elize Jubert, Chief Executive Officer [BA Scial Wrk (cum laude); MA Scial Wrk] June 2017 Page 8

9 A lack f energy balance mst ften causes verweight and besity. Energy balance means that energy IN equals energy OUT. Energy IN is the amunt f energy r calries ne gets frm fd and drinks. Energy OUT is the amunt f energy ne s bdy uses fr things like breathing, digesting and being physically active. T maintain a healthy weight, energy IN and OUT d nt have t balance exactly every day. It is the balance ver time that helps ne maintain a healthy weight. The same amunt f energy IN and energy OUT ver time = weight stays the same Mre energy IN than energy OUT ver time = weight gain Mre energy OUT than energy IN ver time = weight lss Overweight and besity happen ver time when a persn takes in mre calries than what is used (Natinal Heart, Lung and Bld Institute). Causes include: An Inactive Lifestyle - Many Suth Africans are nt very physically active. One reasn fr this is that many peple spend hurs in frnt f TVs and cmputers ding wrk, schlwrk, and leisure activities. In fact, mre than 2 hurs a day f regular TV viewing time has been linked t verweight and besity. [Picture Credit: Viewing TV] Reasns fr nt being active include: relying n cars instead f walking, fewer physical demands at wrk r at hme because f mdern technlgy and cnveniences and lack f physical educatin classes in schls. Peple wh are inactive are mre likely t gain weight because they d nt burn the calries that they take in frm fd and drinks. An inactive lifestyle als raises the risk fr crnary heart disease, high bld pressure, diabetes, varius cancers and ther health prblems. Envirnment - Mst envirnments d nt supprt healthy lifestyle habits; in fact, it encurages besity. Sme examples include: Lack f neighburhd sidewalks and safe places fr recreatin - nt having area parks, trails, sidewalks, and affrdable gyms makes it hard fr peple t be physically active Wrk schedules - peple ften say that they d nt have time t be physically active because f lng wrk hurs and time spent cmmuting Oversized fd prtins - many individuals are expsed t huge fd prtins in restaurants, fast fd places, mvie theatres, supermarkets and even at hme. Sme f these meals and snacks can feed tw r mre peple. Eating large prtins means t much energy IN. Over time, this will cause weight gain if it is nt balanced with physical activity Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved by Ms Elize Jubert, Chief Executive Officer [BA Scial Wrk (cum laude); MA Scial Wrk] June 2017 Page 9

10 Lack f access t healthy fds - sme peple d nt live in neighburhds that have supermarkets that sell healthy fds, such as fresh fruits (in seasn) and vegetables. Or, fr sme peple, these healthy fds are t cstly [Picture Credit: Advertisement] Fd advertising - mst cmmunities are surrunded by advertisements frm fd cmpanies. Often children are the targets f advertising fr high-calrie, high-fat snacks and sugary drinks. The gal f these advertisements is t sway peple t buy these high-calrie fds Genes and Family Histry - Studies f identical twins wh have been raised apart shw that genes have a strng influence n a persn's weight. Overweight and besity tend t run in families. One s chances f being verweight is greater if ne r bth parents are verweight r bese. [Picture Credit: Obese child] One s genes als may affect the amunt f fat stred in the bdy and where n the bdy the extra fat is carried. Because families als share fd and physical activity habits, a link exists between genes and the envirnment. Children adpt the habits f their parents. A child wh has verweight parents wh eat high-calrie fds and are inactive will likely becme verweight t. Hwever, if the family adpts healthy fd and physical activity habits, the child's chance f being verweight r bese is reduced. Health Cnditins - Sme hrmne prblems may cause verweight and besity, such as underactive thyrid (hypthyridism), Cushing's syndrme, and plycystic varian syndrme (PCOS). Underactive thyrid is a cnditin in which the thyrid gland des nt make enugh thyrid hrmne. Lack f thyrid hrmne will slw dwn the metablism and cause weight gain. The persn als feels tired and weak. [Picture Credit: Cushing s Syndrme] Cushing's syndrme is a cnditin in which the bdy's adrenal glands make t much f the hrmne crtisl. Cushing's syndrme als can develp if a persn takes high dses f certain medicines, such as prednisne, fr lng perids. Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved by Ms Elize Jubert, Chief Executive Officer [BA Scial Wrk (cum laude); MA Scial Wrk] June 2017 Page 10

11 Peple wh have Cushing's syndrme gain weight, have upper-bdy besity, a runded face, fat arund the neck, and thin arms and legs. PCOS is a cnditin that affects abut 5 t 10% f wmen f childbearing age. Wmen wh have PCOS ften are bese, have excess hair grwth as well as have reprductive prblems and ther health issues. These prblems are caused by high levels f hrmnes called andrgens. Medicines - Certain medicines may als cause ne t gain weight. These medicines include sme crticsterids, antidepressants and seizure medicines. [Picture Credit: Crticsterids] These medicines can slw the rate at which the bdy burns calries, increase appetite, r causing the bdy t hld n t extra water. All f these factrs can lead t weight gain. Emtinal and Psychlgical Factrs - sme peple eat mre than usual when they are bred, angry, r stressed. Over time, vereating will lead t weight gain and may cause verweight r besity. [Picture Credit: Emtins] Psychlgical factrs als influence eating habits and besity. Many peple eat in respnse t negative emtins such as bredm, sadness, r anger. Peple wh have difficulty with weight management may be facing mre emtinal and psychlgical issues; abut 30% f peple wh seek treatment fr serius weight prblems have difficulties with binge eating. During a binge-eating episde, peple eat large amunts f fd while feeling they cannt cntrl hw much they are eating. Smking - Sme peple gain weight when they stp smking. One reasn is that fd ften tastes and smells better after quitting smking. [Picture Credit: Stp Smking] Anther reasn is that nictine raises the rate at which ne s bdy burns calries, s ne burns fewer calries when ne stps smking. Hwever, smking is a serius health risk and quitting is mre imprtant than pssible weight gain. Age - As ne gets lder, ne tends t lse muscle, especially if less active. Muscle lss can slw dwn the rate at which the bdy burns calries. If there is n reductin in calrie intake as ne gets lder, weight gain becmes a reality. Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved by Ms Elize Jubert, Chief Executive Officer [BA Scial Wrk (cum laude); MA Scial Wrk] June 2017 Page 11

12 Midlife weight gain in wmen is mainly due t aging and lifestyle, but menpause als plays a rle. Many wmen gain abut 2 t 3kg during menpause and have mre fat arund the waist than they did befre. [Picture Credit: Abdminal Obesity] Many middle-aged men als develp abdminal besity by nt balancing energy IN and energy OUT. Pregnancy - During pregnancy, wmen gain weight in the prcess f supprting their babies grwth and develpment. [Picture Credit: Pstnatal Weight Gain] After giving birth, sme wmen find it hard t lse weight. This may lead t verweight r besity, especially after a few pregnancies. Lack f Sleep - Research shws that lack f sleep increases the risk f besity. Fr example, ne study f teenagers shwed that with each hur f sleep lst, the dds f becming bese went up. Lack f sleep increases the risk f besity in ther age grups as well. Peple wh sleep fewer hurs als seem t prefer eating fds that are higher in calries and carbhydrates, which can lead t vereating, weight gain and besity. [Picture Credit: Sleep] Sleep helps maintain a healthy balance f the hrmnes that make ne feel hungry (ghrelin) r full (leptin). When nt getting enugh sleep, the level f ghrelin ges up and the level f leptin ges dwn. This makes the persn feel hungrier than when well-rested. Sleep als affects hw the bdy reacts t insulin, the hrmne that cntrls bld glucse (sugar) level. Lack f sleep results in a higher than nrmal bld sugar level, which may increase the risk fr diabetes. (Natinal Heart, Lung and Bld Institute; Web MD; Harvard Schl f Public Health; Stanfrd Hspital and Clinics; May Clinic; Life is Beautiful). Hw t Prevent Being Overweight r Obese The best way t prevent being verweight r becming bese is t eat a healthy diet f at least five prtins f vegetables r fresh fruit (in seasn) as well as t be physically active. Preventing Obesity in Infants The lnger babies are breastfed, the less likely they are t becme verweight and bese as they grw lder. Breastfed babies are 15 t 25% less likely t becme verweight. Fr thse wh are breastfed fr six mnths r lnger, the likelihd is 20 t 40% less. Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved by Ms Elize Jubert, Chief Executive Officer [BA Scial Wrk (cum laude); MA Scial Wrk] June 2017 Page 12

13 [Pht Credit: Himba Wman and Child] Many frmula-fed babies grw up t be adults f healthy weight. If a child was nt breastfed, it des nt mean that he r she cannt achieve a healthy weight. Preventing Overweight and Obesity in Children and Adlescents Yung peple generally becme verweight r bese because they d nt get enugh physical activity in cmbinatin with pr eating habits. Genetics and lifestyle als cntribute t a child s weight status. There are a number f steps ne can take t help prevent verweight and besity during childhd and adlescence. This includes: Gradually wrk t change family eating habits and activity levels rather than fcusing n weight. Change the habits and the weight will take care f itself. Be a rle mdel - parents wh eat healthy fds and are physically active set an example that increases the likelihd their children will d the same. Encurage physical activity fr the whle family - children shuld have an hur f mderate physical activity mst days f the week. Mre than an hur f activity may prmte weight lss and subsequent maintenance. [Pht Credit: Adlescents] Reduce screen time - this means reducing time spent in frnt f the TV, cmputer and vide games t less than tw hurs a day. Encurage children t nly eat when they are hungry. It is als imprtant t eat slwly. Avid using fd as a reward r withhlding fd as a punishment. Keep the refrigeratr well stcked with fat-free r lw-fat milk and vegetables and fresh fruit (in seasn) instead f sugary drinks and snacks high in sugar and fat Serve at least five servings f vegetables and fresh fruit (in seasn) daily Encurage children t drink water rather than beverages with added sugar, such as sft drinks, sprts drink and fruit juice drinks Preventing Overweight and Obesity in Adults Many f the strategies that prduce successful weight lss and maintenance will help prevent verweight and besity. Imprving eating habits and increasing physical activity play a vital rle in preventing verweight and besity. Things that can be dne include: Eat at least five prtins f fresh fruit (in seasn) and vegetables each day. A vegetable serving is ne cup f raw vegetables r ne-half cup f cked vegetables r vegetable juice. A fruit serving is ne piece f small t medium fresh fruit (in seasn) r fresh fruit juice, r a quarter cup f dried fruit. Select whle grain fds such as brwn rice and whle wheat bread. Avid prcessed fds especially thse made with refined sugar, flur and saturated fat. Start ff by weighing and measuring fd t gain an understanding f prtin sizes. Fr example, a adequate serving f meat is the size f the palm f ne s wn hand. Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved by Ms Elize Jubert, Chief Executive Officer [BA Scial Wrk (cum laude); MA Scial Wrk] June 2017 Page 13

14 Avid super-sized menu items particularly at fast-fd restaurants. One can achieve a lt just with smart chices in serving sizes. Balance the fd check bk. Eating mre calries than ne burns fr energy will lead t weight gain. Get n a scale regularly t check weight. Avid fds that are high in energy density r that have a lt f calries in a small amunt f fd. Fr example, a large cheeseburger and a large rder f ptat fries may have almst calries and 30g r mre f fat. By rdering a grilled chicken sandwich r a plain hamburger and a small salad with lw-fat dressing, ne can avid hundreds f calries and eliminate much f the fat intake. Fr desert, have a prtin f fruit. Avid r limit fizzy sugary drinks - ne tin f sugar sweetened beverage (350ml) cntains mre than 40g f sugar (equals 6-7% f ne day s energy intake). Ideal added sugar intake is between 5-6% energy intake per day. Be physically active up t cracking a sweat. Be invlved in at least 30 minutes f mderate t vigrus physical activity n mst, r preferably, all days f the week. An activity includes walking a 15-minute kilmetre r weeding and heing the garden. [Picture Credit: Obese Man] Rather climb the stairs than using the escalatr r lift. Make pprtunities during the day fr a 10 t 15 minute f sme calrie-burning activity, such as walking arund the blck r up and dwn a few flights f stairs at wrk. Every little bit helps. Preventing Overweight and Obesity fr the whle Family Be active - make persnal and family time active Find activities that the whle family can jin in - g fr a brisk family walk arund the blck r wrk in the garden Encurage children t g bike riding r rllerblading Children s prtin sizes shuld be smaller than thse fr adults Cut back n prtin size that will help balance energy IN and energy OUT (Stanfrd Hspital and Clinics; Natinal Heart, Lung and Bld Institute; St Jhn Prvidence Health System; Harvard Schl f Public Health; Web MD; NHS Chices; Life is Beautiful). Wrld Obesity Map One might think the U.S. is the mst bese natin in the wrld. Saring rates f besity in the Pacific Islands, natins in the Suth Pacific Ocean east f Australia and Fiji, have sht t the tp f the wrldwide besity scale. Previusly it has been therised that Pacific Islanders are genetically predispsed t besity, but experts nw say the intrductin f Western diets t the islands are t blame fr the prblem. Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved by Ms Elize Jubert, Chief Executive Officer [BA Scial Wrk (cum laude); MA Scial Wrk] June 2017 Page 14

15 American Sama, fund suth f Sama, tps the chart, with 75 per cent f the ppulatin reprted as bese. The psitin in Suth Africa is nt gd at all. [Picture Credit: Wrld Obesity Map] An Example f a Healthy Eating Pyramid The Harvard Schl f Public Health created the Healthy Eating Pyramid, and updated it in The Healthy Eating Pyramid is based n the best available scientific evidence abut the links between diet and health. The Healthy Eating Pyramid sits n a fundatin f daily exercise and weight cntrl. Why? These tw related elements strngly influence ne s chances f staying healthy. They als affect what ne eats and hw fd affects ne. [Picture Credit: Harvard Schl f Public Health] Exercise and weight cntrl are linked thrugh the simple rule f energy balance: Weight change = calries in calries ut. If ne burns as many calries as ne takes in each day, there is nthing left ver fr Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved by Ms Elize Jubert, Chief Executive Officer [BA Scial Wrk (cum laude); MA Scial Wrk] June 2017 Page 15

16 strage in fat cells, and weight remains the same. Eating mre than ne burns, ends up adding fat and kil s. Regular exercise can help cntrl ne s weight, and it is a key part f any weight-lss effrt. (Harvard Schl f Public Health). Medical Disclaimer This Fact Sheet is intended t prvide general infrmatin nly and, as such, shuld nt be cnsidered as a substitute fr advice, medically r therwise, cvering any specific situatin. Users shuld seek apprpriate advice befre taking r refraining frm taking any actin in reliance n any infrmatin cntained in this Fact Sheet. S far as permissible by law, the Cancer Assciatin f Suth Africa (CANSA) des nt accept any liability t any persn (r his/her dependants/estate/heirs) relating t the use f any infrmatin cntained in this Fact Sheet. Whilst CANSA has taken every precautin in cmpiling this Fact Sheet, neither it, nr any cntributr(s) t this Fact Sheet can be held respnsible fr any actin (r the lack theref) taken by any persn r rganisatin wherever they shall be based, as a result, direct r therwise, f infrmatin cntained in, r accessed thrugh, this Fact Sheet. Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved by Ms Elize Jubert, Chief Executive Officer [BA Scial Wrk (cum laude); MA Scial Wrk] June 2017 Page 16

17 Surces and References Abdminal Obesity Adlescents Advertisement e=univ&sa=x&ei=gsdlupxqh4ys7qbgjihadq&ved=0cdmqsaq&biw=1517&bih=714&dpr =0.9#facrc=_&imgdii=_&imgrc=3GgBQBr0rGFqvM%253A%3BFDujDwE3KwGcAM%3Bhttp %253A%252F%252Fcdn.visualnews.cm%252Fwp- cntent%252fuplads%252f2012%252f01%252falphaila-fast-fd-false-advertising-vs- Reality- 5.jpg%3Bhttp%253A%252F%252Fwww.visualnews.cm%252F2012%252F01%252F13%25 2Ffast-fd-advertisements-vs-reality%252F%3B600%3B433 Bianchini, F., Kaaks, R. & Vaini, H Overweight, besity, and cancer risk. The Lancet Onclgy 3, (2002). PubMed Cancer.Net Cancer Research UK Centers fr Disease Cntrl and Preventin Crticsterids =isch&sa=x&ei=3s3kuhrbmrxhqerxh4bg&ved=0cacq_auaq#facrc=_&imgdii=_&img rc=1scmhvlp5snlbm%253a%3bm4ubfn8sbedyym%3bhttp%253a%252f%252fwww.he nryschein.cm%252fus-en%252fimages%252fmedical%252fse-crticsteridsinjectins.jpg%3bhttp%253a%252f%252fwww.henryschein.cm%252fcrticsteridsinjectins.aspx%3b550%3b300 Cushing s Syndrme sch&sa=x&ei=gszkutr3icsbhafnuicdg&ved=0cacq_auaq&biw=1517&bih=714&dpr=0. 9#facrc=_&imgdii=_&imgrc=G_FUhMCywTpP_M%253A%3BJbsvnIUFPCayBM%3Bhttp%2 53A%252F%252Fwww.hrmne.rg%252F~%252Fmedia%252FHrmne%252FImages% 252FQuestins%252520and%252520Answers%252FPituitary%252FCushings.jpg%3Bhttp %253A%252F%252Fwww.hrmne.rg%252Fquestins-andanswers%252F2012%252Fcushing-syndrme%3B500%3B487 Emtins &ei=y87kuqkhnjsvhqf94hwdw&ved=0cacq_auaq&biw=1517&bih=666&dpr=0.9#fac rc=_&imgdii=_&imgrc=7mwkkgta4nlj5m%253a%3bjc2vywxvlylrym%3bhttp%253a%2 52F%252F1.bp.blgspt.cm%252F- Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved by Ms Elize Jubert, Chief Executive Officer [BA Scial Wrk (cum laude); MA Scial Wrk] June 2017 Page 17

18 IfQE1P4Q6OQ%252FUQe8enAiBQI%252FAAAAAAAAAB8%252Fedbj1IWcwi0%252Fs160 0%252F _f260.jpg%3Bhttp%253A%252F%252Fklinikalpsychlgy.blgspt.cm%2 52F%3B260%3B245 Gbyega A Ogunbanj Harvard Schl f Public Health Health Systems Trust IARC Internatinal Agency fr Research n Cancer (IARC) Weight Cntrl and Physical Activity.IARC Handbks f Cancer Preventin/ Wrld Health Organizatin, Internatinal Agency fr Research n Cancer 6, (2002). IOL News #.UuPBExD8LIU Life is Beautiful A Balanced Lifestyle bklet f the Cancer Assciatin f Suth Africa (CANSA). Bedfrdview. May Clinic Medical Cmplicatins f Obesity nh=194&tbnw=259&zm=1&dcid=vqpoe_py4ksjkm&ei=br7jutblepgz0qxtkg4bw&v ed=0ca4qscuba Medical Research Cuncil, Suth Africa Natinal Cancer Institute Natinal Health, Lung and Bld Institute NHS Chices Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved by Ms Elize Jubert, Chief Executive Officer [BA Scial Wrk (cum laude); MA Scial Wrk] June 2017 Page 18

19 Obese Child X&ei=1MnkUvkBcWphAe104DYDw&ved=0CAcQ_AUAQ&biw=1517&bih=714&dpr=0.9#facrc=_&imgdii= _&imgrc=np41cgzfl_ulym%253a%3bavwzem78yogxm%3bhttp%253a%252f%252f Fds.jpg%3Bhttp%253A%252F%252Fwww.tpnews.in%252Fkids-watch-mre-tv-ads-fastfds %3B320%3B213 Obese Man Ur7WFsHKhAemlGQBA&ved=0CAcQ_AUAQ&biw=1517&bih=714&dpr=0.9#facrc=_&img dii=_&imgrc=x_act-4uafksom%253a%3brc- 6ehcRAEYB4M%3Bhttp%253A%252F%252Fs1.ibtimes.cm%252Fsites%252Fwww.ibtimes.cm%252Ffiles%252Fstyles%252Fv2_article_large%252Fpublic%252F2011%252F06%25 2F12%252F weight-lss-surgery-desnt-lead-t-lnger-life-fr-besemen.jpg%3Bhttp%253A%252F%252Fwww.ibtimes.cm%252Fmind-trick-bese-may-lackmental-cntrl-high-calrie-fd-impulses %3B770%3B514 Obesity 1 &sa=x&ei=v7zjuv2ym5gthqfg0hqaw&ved=0cfuqsaq&biw=1517&bih=714&dpr=0.9#fa crc=_&imgdii=_&imgrc=0wee0buh3- ykfm%253a%3bd9c1a2ow47ndtm%3bhttp%253a%252f%252fcdn.24.c.za%252ffiles% 252FCms%252FGeneral%252Fd%252F1903%252F8c aeb b.jpg%3bhttp%253a%252f%252fwww.parent24.cm%252fteen_13-18%252fhealth_safety%252fobesity-is-a-huge-challenge-fr-sas-big-kids %3B600%3B400 Obesity 2 &sa=x&ei=v7zjuv2ym5gthqfg0hqaw&ved=0cfuqsaq&biw=1517&bih=714&dpr=0.9#fa crc=_&imgdii=_&imgrc=1wst0sgcrvemm%253a%3bnzhj1zwls7mgxm%3bhttp%253a%252f%252fwmannline.c.za%252 Fwp-cntent%252Fuplads%252F2012%252F10%252Fbesity-in- SA1.jpg%3Bhttp%253A%252F%252Fwmannline.c.za%252FHealth-detail%252Fbesitygaining-weight-in-s-a%3B556%3B429 Pstnatal Weight Gain i=undkut- ABYishQeawD4Dw&ved=0CAcQ_AUAQ&biw=1517&bih=666&dpr=0.9#facrc=_&imgdii=_ &imgrc=zq-zib_fnid1zm%253a%3bmfqcxcp1jyq- WM%3Bhttp%253A%252F%252Fwww.weightlsssurgerychannel.cm%252Fwpcntent%252Fuplads%252F2009%252F12%252Fbelly-fat-linked-tdementia.gif%3Bhttp%253A%252F%252Fwww.weightlsssurgerychannel.cm%252Fbreaki ng-wls-news%252fmidsectin-fat-may-lead-t-dementia-inwmen.html%252f%3b400%3b314 Rams-Nin, M.E The Rle f Chrnic Inflammatin in Obesity Assciated Cancers. ISRN Onclgy. Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved by Ms Elize Jubert, Chief Executive Officer [BA Scial Wrk (cum laude); MA Scial Wrk] June 2017 Page 19

20 Reeves, G. K. et al Cancer incidence and mrtality in relatin t bdy mass index in the Millin Wmen Study: chrt study. BMJ 335, 1134 (2007). PubMed Renehan, A. G., Tysn, M., Egger, M., Heller, R. F. & Zwahlen, M Bdy-mass index and incidence f cancer: a systematic review and meta-analysis f prspective bservatinal studies. The Lancet 371, (2008). PubMed Self-Medicatin Assciatin f Suth Africa Slveig, A., KIramer, M.R. & Narayan, K.M Incidence f Childhd Obesity in the United States. N Engl J Med, 2014; 370: Sleep KXhQe7kCCg&ved=0CAcQ_AUAQ&biw=1517&bih=666&dpr=0.9#facrc=_&imgdii=_&im grc=jkodi6lnyi1zsm%253a%3bfap2b1tcuxuc5m%3bhttp%253a%252f%252fvlpesline n.files.wrdpress.cm%252f2013%252f03%252fsleepinglady.jpg%3bhttp%253a%252f%252fblg.vlpes.c.za%252f2013%252f03%252f06%25 2Fneed-mre-sleep%252F%3B899%3B508 Stanfrd Hspital and Clinics surgery/besity/causes.html surgery/besity/preventing.html Stp Smking E6qO7Qbp0IGQAQ&ved=0CAcQ_AUAQ&biw=1517&bih=666&dpr=0.9#facrc=_&imgdii=_ &imgrc=h3wgkyuyzqvfum%253a%3bbwk6zd0h8cbzim%3bhttp%253a%252f%252ft hepubscut.cm%252fthepubscut%252fwpcntent%252fuplads%252f2013%252f06%252fstpsmking11.jpg%3bhttp%253a%252f%252fthepubscut.cm%252fwacky-tbacky-the-liesf-anti-smking%252f%3b1782%3b769 St Jhn Prvidence Health System Viewing TV h&sa=x&ei=z8jkuscmtsihgfyi4cdg&ved=0cacq_auaq#facrc=_&imgdii=_&imgrc=1ul GITXzUnx2TM%253A%3BeVYG0nx3YSFj0M%3Bhttp%253A%252F%252Fwww.ericssn.c m%252fres%252fimages%252f2011%252fnews%252f111014_family_500x281.jpg%3b http%253a%252f%252fwww.ericssn.cm%252fnews%252f111014_cnsumerlab_ _c%3B500%3B281 Web MD Wikipedia Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved by Ms Elize Jubert, Chief Executive Officer [BA Scial Wrk (cum laude); MA Scial Wrk] June 2017 Page 20

21 Wrld Ecnmic Frum Wrld Obesity Wrld Health Organizatin Obesity and verweight. Fact Sheet N 311, Reviewed May Wrld Health Organizatin Reprt f a Jint WHO / FAO Expert Cnsultatin n Diet, Nutritin and the Preventin f Chrnic Diseases. 160 (2003). Wrld Obesity Map Researched and Authred by Prf Michael C Herbst [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupatinal Health] Apprved by Ms Elize Jubert, Chief Executive Officer [BA Scial Wrk (cum laude); MA Scial Wrk] June 2017 Page 21