A Research Report Submitted to the Faculty of Commerce, Law and Management in Partial Fulfilment of the Requirements for the Degree of Master of Commerce (Specialising in Taxation) / In the 2016 Budget Speech, the then Minister of Finance, Pravin Gordhan, announced a decision to introduce a Health Promotion Levy (‘sugar tax’) on sugar-sweetened beverages (‘SSBs’). Sugar tax came into effect on 1 April 2018 in South Africa. In its Policy Paper released by the National Treasury in July 2016, titled “Taxation of Sugar Sweetened Beverages” (‘Policy Paper’), the National Treasury outlined the proposed sugar tax. It argued that the primary objective of the introduction of sugar tax was to reduce excessive sugar intake and curb the growing problem of obesity. Obesity and other non-communicable diseases (‘NCDs’) have significantly escalated over the past 30 years and has become a growing concern in South Africa. This has resulted in South Africa being ranked the most obese country in sub-Saharan Africa. The impact of SSBs on obesity and other NCDs has received widespread attention on the international stage and by the World Health Organisation (‘WHO’). This is evident from the fact that South Africa is not the first country in recent years to introduce a form of sugar tax which has been gaining traction as popular intervention to combat the growing concern of NCDs. The argument arises as to whether the tax is actually intended to meet its desired health benefits or simply increase revenue for the fiscus. This research will examine whether the implementation of sugar tax will contribute to its intended health objectives envisaged. In order to achieve this, a study will need to be undertaken with countries which have successfully introduced sugar tax including, Mexico, Norway, Denmark, the United Arab Emirates, Chile and United Kingdom. Lastly, this study will also explore the success of the implementation of sugar tax and the impact it has had on the fiscus of these countries. / NG (2020)

Thesis (MPH.) -- University of Limpopo, 2019 / Background: Worldwide, childhood obesity has increased over the past few decades. It has become a public health concern in South Africa and in many developing countries. The aim of the study was to determine the knowledge and perceptions of grade 10 and 11 learners towards obesity within Seshego Circuit of Capricorn District in Limpopo Province. Methods: A quantitative descriptive cross-sectional study design and stratified random sampling method was used in the selection of 194 learners from three (3) high schools. Data were analysed using SPSS v24.0 and both frequencies and inferential statistics were analysed. Results: Results from the study showed that 53% of learners were females and 47% were males. The mean score for knowledge was 4.2 ± 1.08 ranges from 1 to 6 and 92% (179/194) of learners were considered to be knowledgeable. There was no statistical significant association between knowledge and socio- demographic profiles of learners (p>0.05). Shared perception of obesity among learners include lack of self-control (90%); losing weight naturally (40%); being less attractive than other children (74%). Conclusion: The findings from the study revealed varied perceptions on obesity with most learners significantly knowledgeable. Programmes focusing on prevention of obesity among learners should be strengthened.

MPH / Department of Public Health / See the attached abstract below

MPH / Department of Public Health / Obesity has been viewed as a serious problem that affects people of all ages, races, ethnicity, and political, religious, social and economic status. It presents a major health challenge worldwide, with an estimated 2 to 3 billion of overweight adults and 700 million of obese individuals. A cross- sectional descriptive research survey using quantitative approach was used to collect data from 318 adults aged 18-45 at Tshikota Location.. Data will be analysed using the Statistical Package for Social Sciences (SPSS) version 22.0. Cross tabulations and the Pearson’s Chi-square test will be used to obtain the associations and strength of relationship between independent and dependent variables. Results: Higher prevalence of obesity (35.5%) and overweight (28.6%) was found among the sampled population. The prevalence of obesity was found to be higher in males (51.3%) than females (46.7%), males also showed high prevalence in overweight (57.1%) than females (42.9%). There was significant different between socioeconomic status, family history and BMI. 75.2% of the participants who are obese was of those participants who do not engage in physical activity. Majority of the participants (63.5%) take meals 3 times a day and they are more likely to be obese, 19.2% of the participants do not skip breakfast. Mode of transport was positive significant to BMI as a sedentary behaviour. Neighbourhoods environment and psychological factors showed negative significant to BMI. Conclusion: The findings of this study found the prevalence of obesity and overweight to be high among residents of Tshikota Location. Males showed higher prevalence of obesity than females, they also showed high prevalence in overweight compared to that of females. Factors contributing to obesity were found to be diverse, they include socio- demographic, lifestyle, behavioral, environment, psychological and family history. / NRF

MPH / Department of Public Health / Sedentary lifestyle may contribute to obesity and non-communicable diseases, which are the major public health problem in South Africa. This study investigated the relationship between sedentary lifestyle and obesity among adults in Ha-Tshikundamalema area. A quantitative descriptive cross-sectional study among 298 participants (116 males and 182 females) aged 20-60 years, sampled systematically was conducted. Socio-demographic and, sedentary lifestyle and physical activity information was collected using a questionnaire, while anthropometric indices were measured according to ISAK protocol. Data were analysed using SPSS, version 24.0; where Pearson correlation and linear regression analyses to determine significant predictors of obesity were performed. The prevalence of TV viewing and low participation in moderate-vigorous activity were 75.8%, 69.1% and 82.6%, respectively. Twenty-nine point nine percent and 27.2% were overweight and obese, while 26.8% had very high WC (central obesity). According to Pearson correlation, TV viewing time, food, household activity, walking days and time, vigorous activity work vigorous activity, female gender, age (30-39), being married, unemployment, smoking and alcohol consumption were significantly related to BMI and WC. No significant association was found between most of the sedentary behaviours, level of education and socio-economic status. However, obesity was more prevalent among those with less education and low socio-economic status. In regression analyses, only TV viewing time, work vigorous activity, gender, being married and smoking were the independent and significant predictors of high BMI and WC (obesity) (P< 0.05). There was an association of sedentary lifestyle and socio-demographic characteristics, and obesity. Intervention to prevent sedentary lifestyle and obesity should target females, particularly married, unemployed and those with less level of education. / NRF

This study of 449 newspaper articles from South Africa from 1997 provides an analysis of the representations of obesity evinced in the corpus. The research argues that obesity is overwhelmingly framed as being diseased and that there are four main refrains within this frame, namely, statistics on obesity, the naturalisation of negative assumptions about fat, the social dysfunction of fat and the use of crisis metaphors to describe fatness. This framing lends itself to representations of obesity which are raced, gendered and classed. Fat bodies are portrayed as being in deficit and fat people as lacking agency. The disproportional focus on black bodies in the corpus can be attributed to assumptions of ‘incivility’ which are premised on racial stereotypes which construct black people as being unintelligent, irrational, lacking agency and being largely dependent on others to survive. This disproportional focus on black bodies can also be understood in the context of emerging markets. This study argues that the medicalisation of obesity has contributed to many oversimplifications and contradictions in the representation of obesity in the corpus, which seem to go unquestioned, such as the conflation of weight and health, something I argue is one of the main contributors to the negative consequences of the dominant framing of obesity. Framing obesity as medicalised also promotes fat shaming and acts as a form of social control which maintains existing power relations through the use of discursive practices for the identification and control of deviants. These representations are problematic chiefly because they promote the dehumanisation of fat people, but also because that they do not promote good health as they claim to do.

The aim of this research project was to assess and compare cardiovascular disease (CVD) risk in black males and females from an urban, working population in the Makana (Grahamstown) region of the Eastern Cape, South Africa. Two-hundred and ninety one individuals (males: n = 143, females: n = 148) with a mean age of 42.6 (±8.1) years were voluntarily recruited from the greater urban Makana (Grahamstown) area. Eight Cardiovascular disease (CVD) risks were assessed: stature and mass were obtained in order to calculate body mass index (BMI) (mass/stature2). Obesity, defined as a morphological risk, was classified according to the World Health Organisation (WHO) BMI criteria (BMI>30kg.m-2), as well as according to measures of waist circumference (WC) and body composition. Hypertension, hypercholesterolemia and type II diabetes, were grouped as cardiovascular (CV) risks. Hypertension was defined as a blood pressure greater than 140/90mmHg (JNC-7); hypercholesterolemia, as total cholesterol greater than 6.2mmol.L-1 (NCEP); and type II diabetes, as total glucose greater than 12mmol.L-1 (WHO). Physical activity, diet, tobacco use, and alcohol consumption and dependence were grouped as lifestyle-related risks. These were assessed by means of self-reporting through the use of various validated questionnaires. Finally, self-reporting of obesity, hypertension, hypercholesterolemia and type II diabetes was assessed, in addition to perception questions on individuals’ perceived body shape and size (Ziebland figures). Self-reported and perceived responses were then compared to actual measures. Females were significantly (p<0.001) heavier than the males (92.7kg compared to 72.1kg) and had significantly (p<0.001) higher BMIs than their male counterparts (37.6kg.m-2 compared to 25.7 kg.-2). They also recorded significantly (p<0.001) higher waist circumference (WC) values and had significantly (p<0.001) higher percentage and total body fat. Significantly (p<0.001) more females were obese (81%) compared to males (17%). While a higher percentage of males (25 % compared to 22%) presented with stage I hypertension (≥140/90mmHg, <160/95mmHg), significantly (p<0.05) more females (14% compared to 8%) presented with stage II hypertension (>160/95mmHg). The prevalence of hypercholesterolemia at a high level of risk (>6.2mmol.L-1) was relatively low (2.1 % of males, 3.4% of females), but notably more participants (22% of males and 26% of females) presented with the condition at a moderate level of risk (>5mmol.L-1). Type II diabetes was the least prevalent CV risk factor, with no males and only 3% of females presenting with the condition. Males consumed significantly (p<0.05) more in terms of total energy intake (9024 vs. 7234 kJ) and were significantly (p<0.05) more active (3315 compared to 2660 MET-mins.week). A significantly (p<0.05) higher percentage of males smoked (51.1% compared to 3.4%), consumed alcohol (73.4% compared to 46.6%) and were alcohol dependent (40% compared to 33.5%). Both males and females tended to be ignorant of their health status, with both samples under-reporting obesity, hypertension and hypercholesterolemia, while over-reporting type II diabetes. Furthermore, obesity was significantly (p<0.05) underestimated, with both male and female individuals perceiving themselves to be notably smaller than they actually were. Physical activity and diet were important determinants of CVD risk in this black urban sample of individuals. Obesity, in particular central adiposity, was the most notable risk (particularly in females), followed by hypertension (particularly in males). Although some risks presented at a moderate level of risk, a clustering of risk factors was evident in both samples, with 12.6% and 41.2% of males and females presenting with two risk factors, and 2.8% and 8.1% of males and females respectively presenting with three risks.

The purpose of the study was to investigate the cardiovascular disease (CVD) risk profile of black African females in the Makana region, Eastern Cape, South Africa. Baseline measures from 40 participants, who met the criteria, were compared against the 2003 South African Demographic and Health Survey (SADHS) and the 2013 South African National Health and Nutritional Examination Survey (SANHANES-1). The risk factors measured were anthropometric (stature, body mass and body mass index (BMI)), morphological (waist circumference (WC), fat mass and lean mass), cardiovascular (heart rate and blood pressure (BP)), physical activity (step count and energy expenditure), biochemical (glycated haemoglobin and full blood lipid profile) and behavioural (alcohol and tobacco use). Results showed significantly higher (p≤0.05) values for overweight/obesity (BMI 37.60 kg.m⁻²; WC 1130.58 mm; fat mass 45.23%) and high BP (130/88 mmHg) compared to the previous national surveys, highlighting these CVD risk factors as problematic. The subsequent sub-study aimed to assess the efficacy of a pedometer-based walking intervention on high BP. The walking programme (n=25) was based on individual step goals to be completed at a moderate-intensity on five days.week⁻¹ for 12 weeks. The same measurements were taken at monthly intervals, Week 0, Week 4, Week 8 and Week 12, with the addition of dietary intake and fitness level, and the exclusion of the behavioural variables. There were no significant differences (p≤0.05) in systolic and diastolic BP with the exercise intervention, although there was a strong, negative relationship with time for diastolic BP (r²=0.9857). This trend suggests that the lack of significance may be a result of poor compliance and/or the small sample size. Individual results, however, showed no compliance-result relationship for the two risk factors of interest: overweight/obesity and high BP. Future recommendations include supervised or group-based exercise interventions to improve compliance, and the addition of resistance training to the aerobic programme.

MPH / Department of Public Health

This study explores the possible efficacy of a low carbohydrate and high fat nutritional intervention (LCHF) as a treatment possibility aiming to improve the ability of self-control and regulation in the context of carbohydrate-addiction. The study first outlines why increased simple carbohydrate consumption has been implicated as a risk-factor in numerous chronic conditions, and then explores the possibility that a reduction of such consumption could lower general medical expenditure in the healthcare sector of already overburdened institutions, especially in developing countries like South Africa. Since the neurobiological evidence for food addiction is compelling, this study investigates the impact of a low carbohydrate and high fat eating (LCHF) regimen by measuring the change in the severity of addictive behaviour in relation to a reduced carbohydrate consumption. Results indicate that a LCHF nutritional intervention lessened addictive behaviour after just 30 days, resulting in a statistically significant decrease in addiction symptoms from day 1 to day 30. The weight and BMI values of the participants recorded at the end of the study showed a reduction from those obtained during the pre- treatment stage, and the self-perceived ‘feeling in control’ also improved in all participants after the intervention. The introduction of a LCHF nutritional intervention presents a relatively cost-effective treatment and preventative measure to combat carbohydrate over-consumption and its numerous health complications, and it is therefore hoped that the positive findings of this study will foster further research, using larger samples, into this type of nutritional intervention against addictive eating behaviour. / Psychology / M.A. (Psychology)