Lucky Nkosi, a young mother from Johannesburg in South Africa, is only 24 years old but already weighs 120kg (265lb). Although she has been trying desperately to lose weight since her doctor warned her that her life is in danger, it remains a challenge.
"I can’t leave junk food because it’s the cheapest," said Nkosi, who eats fried and processed food every day.
South Africans are sub-Saharan Africa’s most obese people, mainly due to the rising popularity of processed food. Heart attacks, strokes and type two diabetes now kill more people than infectious diseases.
But Nkosi’s health situation could have been worse had the South African government not acted to limit trans fats in processed foods back in 2011.
"Trans fats are of particular concern because high intake is correlated with increased risk of cardiovascular diseases," says Dr. Francesco Branca, Director of the WHO Department of Nutrition for Health and Development. "Trans fats are completely replaceable in foods, and mandatory national limits on industrially-produced trans fats are the most effective way to achieve elimination."
The trans fat content of any oils and fats cannot exceed two grams per 100 grams, according to South African legislation. Products with higher trans fats levels are prohibited from entering or being sold in the country.
Rebone Ntsie, Director of Nutrition at South Africa’s Department of Health (NDoH), says the legislation covers any oils and fats "either alone or as processed foods, which are intended for human consumption or assumed to be intended for human consumption, in the retail trade, catering businesses, restaurants, institutions, bakeries etcetera."
The regulations also require any product labelled as ‘trans fat-free’ to contain less than one gram of trans fats per 100 grams.
"We were not only the first African country, but also the first developing country worldwide to enact the trans fats legislation," said Ntsie.
South Africa’s trans fat control push started in 2008 when Dr. Ruth Rabinowitz, an opposition Member of Parliament, proposed that industrially produced trans fats in prepared foodstuffs be outlawed.
Initially, the NDoH considered including trans fat as part of regulations dealing also with food labelling and advertising. But, according to Ntsie, "due to the important role that reduced trans fats play in the prevention of non-communicable diseases (NCDs), NDoH decided that trans fats regulations should stand alone."
Daniel Matlala, Deputy Director for Food Control at NDoH, said that South Africa drew lessons from Denmark, which had enacted similar legislation.
In 2009, the NDoH held extensive consultations with industry, academia and civil society, as well as a stakeholder workshop to develop a working document. This led to draft regulations, which were published for public comment in March 2010.
"Support for the legislation was overwhelming," said Matlala.
The final Regulations Relating to Trans Fats in Foodstuffs – Regulation 249 – were signed into law in February 2011. Manufacturers and retailers were given six months to comply and reduce the trans fat content of their products to the required 2 grams per 100. The NDoH has been monitoring the labels of food products and it is satisfied that industry has complied.
"South Africa’s success with reducing trans fat is very important," said Dr. Branca of the WHO. "Restrictions on industrially-produced trans fat are often weaker in low- and middle-income countries. South Africa’s experience can help guide other countries to take action so the benefits are felt equally around the world."
Food science expert Nigel Sunley said that legislation was easy to introduce because the target was not big food companies but “the manufacturers of industrial fats, which is a consolidated industry with few players."
"There was a technological evolution in the food industry and the fat manufacturing companies managed to develop techniques of blending unsaturated and saturated fat to achieve the same functional properties previously generated [by trans fats]," he said. "The quantity of trans fats still being consumed in the country is likely very low, because next to nobody is manufacturing those fats any longer."