66-year-old Orah Bessit, foreground left, participates in a road race Sept. 16 in Johannesburg. Bessit, who grows her own vegetables, walks and runs, recognizes that staying healthy requires sacrifices, so she has given up hamburgers and switched from white bread to whole-grain. A growing urban middle class is defying the image of Africa as poor, underfed and under-medicated. And with the comforts of middle-class life, afflictions familiar in the West are making inroads here too: obesity, diabetes, lung cancer, strokes, heart disease.

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