The page number in the footer is not for bibliographic referencingwww.tandfonline.com/ojfp 41 RESEARCH ARTICLE ABSTRACTS South African Family Practice is co-published by Medpharm Publications, NISC (Pty) Ltd and Taylor & Francis, and Informa business S Afr Fam Pract ISSN 2078-6190 EISSN 2078-6204 © 2016 The Author(s) RESEARCH South African Family Practice 2016; 58(4):148–152 http://dx.doi.org/10.1080/20786190.2016.1151643 Open Access article distributed under the terms of the Creative Commons License [CC BY-NC 3.0] http://creativecommons.org/licenses/by-nc/3.0 More than scales and tape measures needed to address obesity in South Africa R Ramlala and RD Govendera* a Department of Family Medicine, University of KwaZulu-Natal, Durban, South Africa *Corresponding author, email: Govenderr1@ukzn.ac.za Obesity is an emerging public health problem worldwide increasing from 857 million in 1980 to 2.1 billion by 2013. A study was done on a sample of 100 obese and overweight patients with a body mass index (BMI) above 25 kg/m2. The patients were asked to complete a questionnaire, which included socio-demographic data and perceptions regarding their weight. The patients were between the ages of 18 and 76 years old with 82% being female patients. The mean BMI for males was 41.7 kg/m2 (SD = 7.38112) and females 39.9 kg/m2 (SD = 7.90504). The results of this study confirm that 17% of overweight and obese patients saw themselves as having a normal weight and 97% felt that they were not unattractive. Of the sample, 96% affirmed that being obese was a health risk. The commonest reason cited for their obesity is by choice (70%). Although obese patients knew that obesity is a health risk, they have a positive image of obesity. The dramatic trend towards increasing obesity suggest that healthcare providers need to understand how people from different cultures view obesity. This will help them to promote key messages about the health risks associated with excess weight in a culturally sensitive way. Keywords: obesity, overweight, perceptions, South Africa Introduction Worldwide obesity has more than doubled since 1980.1 By 2014, more than 1.9 billion adults, aged 18 years and older, were overweight and of these over 600 million were obese.1 Overweight and obesity are defined as abnormal or excessive fat accumulation in adipose tissue. The body mass index (BMI) is a simple index of weight-to-height that is commonly used to classify overweight and obesity in adults. It is defined as a person’s weight in kg divided by the square of their height in meters (kg/m2). The WHO defines a BMI of > 25 kg/m2 as overweight and a BMI > 30 kg/m2 as obese. Globally the proportion of adults with a BMI > 25 kg/m2 increased between the years 1980 and 2013 from 28.8% to 36.9% in men and from 29.8% to 38% in women.2 In South Africa 7 in 10 women (69.3%) and 4 in 10 men (38.8%) are overweight or obese. South African children are showing a similar pattern with 7% of boys and 9.6% of girls classified as obese.2 Almost half the population in developed countries is obese.3 This is particularly prevalent in countries where a sedentary lifestyle together with an increased consumption of energy-rich, high-fat and high carbohydrate foods has resulted in obesity.3 However, the rates vary widely throughout the world with more than half of the world’s 671 million obese individuals living in just 10 countries: the USA, China, India, Russia, Brazil, Mexico, Egypt, Germany, Pakistan, and Indonesia.2 Developing countries, particularly those undergoing an epidemiological transition similar to South Africa, also show an increase in the prevalence of obesity4–6 with the overall prevalence in South Africa being higher than in most other African countries.7 The prevalence in South Africa is 29% of men and 56% of women are classified as overweight or obese. Of these obese women, 30% are aged between 30 and 59 years.2 Recent South African studies show a change in prevalence associated with ethnicity and age.8 Central obesity was found in 42.2% of women and was most prevalent in urban Black African and women of mixed ancestry whereas only 9.2% of the men had central obesity with older and white males having the highest prevalence.8 Overweight and obesity is a major contributor to the global burden of non-communicable diseases (NCDs) and the associated morbidity and mortality.9 In common with other African countries, South Africa (SA) is currently encountering an increasing burden of NCDs associated with overweight and obesity.10 In SA the burden of disease attributed to obesity is 87% for type 2 diabetes, 68% for hypertensive disease, 61% for endometrial cancer and 24% for osteoarthritis.11 Determinants of the obesity epidemic are complex and therefore patients’ perceptions regarding a preferred body image are important to help educate the patient regarding the association of obesity with the morbidity or mortality related to NCDs.12,13 In SA, in addition to the usual contributory factors for obesity in women, the perceptions of black women preferring a larger body size constitute an important additional factor.14 Being overweight is culturally acceptable and is seen as a sign of economic prosperity and a happy marriage.11 Perceptions not only reflect people’s views and thoughts but are ideas that exist in the minds of people about how they are viewed by others.15 This influences their actions, behaviour and lifestyles and has been documented as a barrier to weight loss.15 In a recent study, participants associated thinness with being afflicted by HIV.8 In an exploratory study conducted on black women attending the NCD outpatient clinic at a hospital in Durban, South Africa, it was shown that the women underestimated their actual weight and perceived themselves to be thinner.16 This is one of the barriers to patients losing weight.13,16 Thus this study aimed to describe perceptions of weight in overweight and obese patients in order to assess whether a weight loss programme was implementable in these two groups of people. Methodology Design This was a descriptive, observational study conducted in a sample of 100 overweight or obese patients, i.e. with a BMI > 25 kg/m2 in a private general practice situated in a peri- urban area north of Durban. The demographic profile of the South African Family Practice is co-published by Medpharm Publications, NISC (Pty) Ltd and Taylor & Francis, and Informa business S Afr Fam Pract ISSN 2078-6190 EISSN 2078-6204 © 2016 The Author(s) RESEARCH South African Family Practice 2016; 58(4):142–147 http://dx.doi.org/10.1080/20786190.2016.1148337 Open Access article distributed under the terms of the Creative Commons License [CC BY-NC 3.0] http://creativecommons.org/licenses/by-nc/3.0 Anti-epileptic prescribing patterns in the South African private health sector (2008–2013) Karen Jacobsa, Marlene Julyana , Martie S Lubbea, Johanita R Burgera* and Marike Cockerana a Medicine Usage in South Africa, Faculty of Health Sciences, North-West University, Potchefstroom Campus, Potchefstroom, South Africa *Corresponding author, Email: Johanita.Burger@nwu.ac.za Background: Little is known about longitudinal prescribing practices for anti-epileptic drugs (AEDs) in South Africa. The prescribing patterns and associated direct medicine costs of AEDs in the private health sector were investigated, using claims data from January 1, 2008 to December 31, 2013. Methods: The annual prevalence of prescriptions, AEDs and AED generics per patient with epilepsy (ICD-10 code G40) was determined. Cost analyses conducted included the calculation of the total direct cost of AEDs (medical scheme contribution, patient co-payment, and single exit price (SEP)), and the average cost per AED per year. Results: Prevalence of patients claiming anti-epileptics ranged between 0.87% and 0.91% from 2008 to 2013. AED prescriptions/ patient ranged from 11.76 (95% CI, 11.56–11.95)] in 2008 to 11.90 (95% CI, 11.71–12.09) in 2013. Patients aged 40–65 years had the highest number of AED prescriptions/year. Valproate was most prescribed, followed by lamotrigine and carbamazepine. Average cost per AED increased from R237.12 (95% CI, 233.58–240.65) in 2008 to R522.32 (95% CI, 515.24–529.41) in 2013, while the average patient co-payments increased from R27.76 (95% CI, 26.63–28.89) to R264.32 (95% CI, 260.61–268.03). Prescribing of generics increased by 12.84%. Conclusions: Generic prescribing increased over time; however, patient co-payments increased dramatically. Keywords: anti-epileptic, direct medicine costs, longitudinal, medicine claims database, prescribing patterns, South Africa Introduction Approximately 50 million people worldwide suffer from epilepsy.1 Based on a meta-analysis by Ngugi and colleagues,2 the median prevalence of lifetime epilepsy is 5.8 per 1 000 in developed countries, 10.3 per 1 000 in lower-income or developing countries and 15.4 per 1000 in rural areas of developing countries. Prevalence studies conducted in South Africa have reported a lifetime prevalence of 7.3 per 1 000 in children of a rural district and an estimated prevalence of 7.0 per 1 000 in a rural north-east district, respectively.3,4 Anti-epileptic drugs (AEDs) are increasingly being prescribed to patients of all ages in populations worldwide,5,6 either as monotherapy or polytherapy.7 Although AEDs are primarily prescribed for epileptic seizures, they are also used for other co- morbidities, such as neuropathic pain, particularly diabetic neuropathy and postherpetic neuralgia, migraine prophylaxis and bipolar disorder.8,9 The prescribing of first-choice AEDs in particular has changed over the last decade,10 with prescribers tending to prescribe newer AEDs (e.g. gabapentin, lamotrigine, levetiracetam and pregabalin) to patients due to their improved tolerability.11 Anti-epileptic drugs, in particular those that are still under patent such as some of the newer AEDs, are relatively expensive.12–14 Generic substitution of many drug classes is a common health care cost-saving practice;15 however, use of generic antiepileptic drugs in patients with epilepsy is controversial.16 Little is known about the longitudinal prescribing practices for anti-epileptic drugs (AEDs) in South Africa. The aim of this study was therefore firstly to investigate the prescribing patterns of AEDs in the private health sector of South Africa and secondly to determine the total direct cost of anti-epileptic treatment during the study period. Methods Study design A quantitative, retrospective drug utilisation review was conducted using nationally representative medicine claims data for a six-year period (January 1, 2008 to December 31, 2013). Data were obtained from a privately owned South African Pharmaceutical Benefit Management (PBM) company. The PBM currently manages the medicine benefits of 1.7 million beneficiaries on behalf of 40 medical schemes. All of South Africa’s pharmacies and 98% of all dispensing doctors are on this service provider database. Data for 758 505 patients from 2008 were obtained, compared with 1 033 057 from 2009, 968 158 from 2010, 864 977 from 2011, 815 810 from 2012, and 809 857 from 2013. In 2008 these patients represented 9.6% of all beneficiaries covered by medical aid schemes registered in terms of the Medical Schemes Act (Act 131/1998) in South Africa, compared with 13% in 2009, 11.7% in 2010, 10.3% in 2011, 9.5% in 2012, and 9.3% in 2013.17 Data fields used in this study included the following: patients’ member number, patients’ date of birth, treatment date, ICD-10 codes, active ingredients, the quantity of medicine items prescribed and the number of days for which the medicine items were supplied. Study population The study population consisted of all patients with an ICD-10 code for epilepsy (G40) as recorded on the database, in S Afr Fam Pract 2016; DOI:10.1080/20786190.2016.1148337 S Afr Fam Pract 2016; DOI:10.1080/20786190.2016.1151643 Abstract (Full text available online at www.tandfonline.com/ojfp) Abstract (Full text available online at www.tandfonline.com/ojfp)