Abstract
Rapid changes in food environments, where less nutritious foods have become cheaper and more accessible, have led to the double burden of malnutrition (DBM). The role food environments have played in shaping the DBM has attained global interest. There is a paucity of food environment research in low-to-middle-income countries. We conducted a case study of the food environments of school aged learners. A primary school in Cape Town was recruited. A multi-method design was used: a home food and eating behaviours questionnaire completed by 102 household respondents and four questions completed by 152 learners; learner participatory photography; a semi-structured school principal interview; a tuckshop inventory; observation of three-day tuckshop purchases. Foods that were commonly present in households: refined carbohydrates, fats/oils, chicken, processed meats, vegetables, fruit, legumes, snacks/drinks. Two thirds of households had rules about unhealthy drinks/snacks, ate supper together and in front of the TV, ate a home cooked meal five–seven times/week and ate breakfast together under two times/week. Vegetables were eaten under two times/week in 45% of households. A majority of learners (84%) took a lunchbox to school. Twenty-five learners photographed their food environment and 15 participated in semi-structured interviews. Six themes emerged: where to buy; what is available in the home; meal composition; family dynamics; peer engagement; food preparation. Items bought at informal food outlets included snacks, drinks and grocery staples. The principal interview revealed the establishment of a healthy school food environment, including a vegetable garden, although unhealthy snacks were sold at the tuckshop. Key dimensions of the food environment that require further investigation in disadvantaged urban and informal settlement areas include the home availability of unhealthy foods, eating behaviours in households and healthfulness of foods sold by informal food outlets.
Highlights
The United Nations (UN) declared 2016–2025 the Decade of Action on Nutrition and aims to increase government policies and action to end all forms of malnutrition, which includes undernutrition, micronutrient deficiencies and overweightness and obesity [1].Unhealthy diets are an increasingly important risk factor for obesity and diet-related noncommunicable diseases (NCDs) globally [2].In South Africa, adolescents, especially urban females, were burdened by overweightness and obesity with prevalence increases of 6% in boys and 7% in girls between 2002–2008 [3].A key factor contributing to unhealthy diets is the food environment [4]
The three environmental settings, namely school, community and home environmental settings that emerged as themes, and subtheme results, are presented
Six themes were identified, presented across the interviews and food environment related photographs: All learner-contributed photos were considered in the data analysis, the number of photos taken by each learner varied
Summary
The United Nations (UN) declared 2016–2025 the Decade of Action on Nutrition and aims to increase government policies and action to end all forms of malnutrition, which includes undernutrition, micronutrient deficiencies and overweightness and obesity [1].Unhealthy diets are an increasingly important risk factor for obesity and diet-related noncommunicable diseases (NCDs) globally [2].In South Africa, adolescents, especially urban females, were burdened by overweightness and obesity with prevalence increases of 6% in boys and 7% in girls between 2002–2008 [3].A key factor contributing to unhealthy diets is the food environment [4]. Global actions to improve population nutrition and reduce the risk of diet-related NCDs, to achieve the SDG, involve increasing comprehensive monitoring efforts and indicators related to nutrition polices and food environments [12]. An example is the nine-module framework developed by the International Network for Food and Obesity non-communicable diseases Research, Monitoring and Action Support (INFORMAS) [5]. Thirty countries have implemented this framework to monitor, benchmark and support actions to create healthy food environments and reduce obesity risk and non-communicable diseases (NCDs) [5,13]. The Photovoice methodology [35] was used to elicit an understanding of the varied food environments of grade seven learners. Learners received a short information session from fieldworkers and received parent/primary caregiver consent forms to take home
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