There’s an insidious condition affecting South African youth, slowly killing people. The prevalence of overweight and obesity in South Africans aged 15 and above is 68% in women and 31% in men. Policy needs a redirect with the youth at the forefront.

It’s International Youth Day – a resolution endorsed by the United Nations General Assembly two decades ago. In South Africa (SA) the government encourages the youth to organise events that’ll help raise awareness about the issues that affect them. One such problem is the increasing rate of overweight youth and the subsequent impact of this trend.

“If the current rate of increase continues, by 2025, there will be approximately 3.91 million overweight (BMI 25-29.9) and obese (BMI > 30) school children. This would result in 120 000 children with impaired glucose tolerance (pre diabetes) and 68 000 with overt diabetes,” read alarming statistics from Diabetes South Africa.

Doctor Janetta Harbron operates from the Faculty of Health Sciences at the University of Cape Town (UCT) and is working with a Sharmilah Booley, Olufunke Alaba, Marieke Theron, Megan Blacker, and Sonia Malczyk on the project. The team is housed in the Department of Human Biology’s Division of Human Nutrition and is part of a project looking to. “Work with adolescents to co-create new policy ideas with various stakeholders, to tackle adolescent obesity,” says Harbron. According to StatsSA 69.6% of elderly people in the country are overweight as measured by body mass index (BMI). Recognising that the youth are the next generation of adults, urgent intervention is needed to shift their trajectory.

The project’s website defines CO-CREATE as aiming to: Reduce childhood obesity and its co-morbidities by working with adolescents, to create, inform and disseminate obesity-preventive evidence-based policies. The project applies a systems approach to provide a better understanding of how factors associated with obesity interact at various levels. The underlying context of the project is how healthy lifestyles can be supported by broader policies, shifting the focus from individual responsibility to a model emphasizing how healthy lifestyles are affected by structural factors. UCT is part of a project consortium of 14 international research and advocacy organisations within nine countries. CO-CREATE is executed in five European countries with a section of the work kickstarting in SA this month. Funding was received from the European Commission’s Horizon 2020 research budget. The initiative involves young people as a key component throughout the project, designing policies and advocating practices they believe will help improve adolescent health.

“The causes of obesity are multiple, complex, and unique to various settings,” says Harbron. “Although an unhealthy diet high in energy and physical inactivity are responsible for the energy imbalance and consequent excess weight gain, the social, cultural, physical, political and economic environments we live in influence these lifestyle behaviours. For instance, factors such as urbanisation, globalisation, nutrition transition, food prices and the over-abundance of cheaper and palatable convenient or fast foods play a major role in food choices and dietary intake. These convenient foods are often high in fat, sugar, refined carbohydrates and energy. Sedentary work, unsafe environments and lack of opportunities for daily physical activities contribute further. These factors have fuelled the obesity epidemic in South Africa,” says Harbron.

It’s a tricky situation. Unhealthy choices are often the easiest – making them default for most people. What this means is that it is no longer enough to educate society about healthy lifestyles: “If they cannot be fully responsible for their own lifestyle and health-related behaviours. This, within an environment where healthy options or behaviours are unavailable, unaffordable or impractical to execute,” she says.

The country also faces a “double-burden of disease”, partly because of the co-existence of both over and under-nutrition. Inequities in nutritional status mean that the majority of households live under the poverty line so children remain at risk of malnutrition.

Harbron explains: “Effective policies and guidelines are needed to reshape the food and physical activity systems and environment surrounding adolescents, to support an active lifestyle and healthy dietary intake. The overall CO-CREATE project will contribute to the evidence for policy changes to make healthy choices the easiest, preferred, and most affordable choices for adolescents.”

Higher risk of non-communicable diseases (NCDs) like heart disease, high blood pressure, asthma, diabetes, hypertension, cardiovascular and kidney disease are just some of the risks of obesity. Once obesity is established it becomes difficult to treat and often extends into adulthood. “The psychological impact of adolescent obesity is critical to consider… Health education is of paramount importance in communicating the risk factors of NCDs, as well as implementing preventative strategies and interventions. Most children/adolescents can be reached as a captive audience in schools, ideally with health-promotion content built into various curricula. These messages must be supported by conducive environments: reduced access to unhealthy food and beverages, safe spaces for activity and exercise, as well as decreased social pressures, and decreased marketing of unhealthy products/lifestyles,” says Harbron.

CO-CREATE encourages youth agency. This population group is well-positioned as important change agents with their increasing autonomy. Harbron says, “Youth involvement is an essential component to the development of policies that are aimed at them. The project aims to involve and empower adolescents and youth organisations throughout the project by identifying unique drivers of unhealthy diet and physical activity behaviours in co-creating new policy ideas. Through our research we would like to empower youth and increase their readiness to take action.”

“Transforming Education” is this year’s theme for International Youth Day. The improvement of health education in the county is necessary and should be part of the overall multipronged strategy. Harbron adds: “Tackling the societal challenge of adolescent obesity is a notable task requiring input from various sectors and several stakeholders… Co-creating new policy ideas may also contribute to strengthening adolescents’ belief in the democratic process and their role in society.”