‘Delay, dilute, delegitimise’: How the food industry shapes what you eat — and what you weigh
For decades, the public has been told that what it eats — and weighs — is a matter of choice. In South Africa, ‘choosing’ to eat healthily is more complicated than it seems — and regulations aimed at changing that face steep and often hidden industry opposition.
It’s just after 7am and Queens Street on the outskirts of Hillbrow in Johannesburg has become a river of white minibus taxis ferrying commuters to work. The street forms the eastern boundary of the city’s Pieter Roos Park, which is hemmed in by Empire Road in the south.
In the morning sun, a man appears running east on Empire Road. He passes several primary schools and a McDonald’s restaurant before meeting Queens Street and turning left to sprint up the hill as the taxis rush by.
A pair of women in pink and grey gym clothes follow, jogging at a slow pace, chatting and laughing.
Named for a 1960s Johannesburg City Council official with a flair for drama and a love of white flowers, Pieter Roos Park doesn’t appear on city maps until some time after 1929. Before that, the parcel of land that would become the greenspace was crisscrossed by roads that, now, stop just short of its borders, shows one map from the era.
Today, the space is a favourite place for Sunday church gatherings, daily soccer games and the occasional protest. For decades, it has also been one of the few public places in this part of the city where every morning and afternoon, people — including women alone — run.
Some in the park are looking to get fit, but others are just looking to get by. Just metres away from joggers, the park’s homeless community lives along the banks of a stormwater drain, hidden from sight except for their freshly washed clothes spread out to dry on the grass or among the trees.
The park is, in many ways, a microcosm of the politics of food in South Africa.
According to Statistics South Africa, before Covid-19, about one in five households in South Africa reported not having enough to eat. In the immediate wake of the country’s Covid-19 lockdown, almost half of homes ran short of money for food, found the National Income Dynamics Study — Coronavirus Rapid Mobile Survey (Nids-cram).
And while hunger stalks some in South Africa, obesity haunts others, shows the first (and so far only) national nutrition survey, published in 2013: Four out of 10 women and almost 12% of men in South Africa are living with obesity.
People with obesity are at a higher risk of developing non-communicable diseases such as diabetes, heart disease and high blood pressure that can lead to strokes, the US health non-profit the Mayo Clinic explains. Conditions such as these are some of the leading causes of natural death in South Africa, according to the latest data from Statistics South Africa.
For decades, the messaging around weight loss and healthy eating has said that what we eat is a choice, but in the past two decades a growing body of research has revealed that what’s on our plate isn’t always just about what we elect to eat. Instead, it’s also about the policies that determine what kind of food we can access and from where. In South Africa, studies show that the food industry plays a more significant and often hidden role than we might think.
In 2012, more than 10% of South Africans had attempted to shed unwanted kilos, the 2013 national nutrition survey found. Women were almost twice as likely to report dieting or exercising to lose weight as men.
Around Pieter Roos Park, it’s easy to find adverts punting unproven diet aids.
“Mama’s flat stomach tea products,” boasts one. Another online seller of a similar beverage even has a Google Review: Professional and respectful.
More South Africans are turning to the web for information on slimming down than a decade ago. Google Trends data shows that searches for the term “lose weight” have soared in popularity since 2004.
People who typed the phrase into their search bar also often looked up “how to lose weight fast” or “what to eat to lose weight”.
But rarely anyone, if at all, googles: “Is my neighbourhood making me fat?”
In 2018, Health Systems Trust scientists set out to start to answer that question. Using 2016 data from Google Maps and websites, researcher Noluthando Ndlovu and colleagues mapped healthy food outlets in Gauteng — think supermarkets and smaller similar stores — as well as fast-food restaurants.
The study, published in the South African Health Review, found Gauteng was home to more than twice as many fast-food outlets as grocery stores in 2016. Black and low-income neighbourhoods were generally less likely to report having grocery stores.
In at least 10 wards, the majority of which were black, the only formal place to buy food was a fast-food outlet, the study revealed.
Johannesburg inner-city neighbourhoods, including some surrounding Pieter Roos Park, had exceptionally high concentrations of unhealthy food outlets.
Because the research used online data, it couldn’t account for the role of informal traders in Gauteng. Hawkers like these, past studies have shown, are often the go-to daily source for fresh food for low-income shoppers — particularly those without access to refrigerators.
Still — at least formally — many communities in Gauteng, Ndlovu discovered, are what the US Department of Agriculture calls food deserts: Low-income communities without easy access to a supermarket — or even the option of buying healthy food.
In the US city of Portland, high densities of fast-food restaurants were associated with an increased risk of obesity among adults aged 50 to 75. However, a subsequent national study failed to show a similar effect on teens and young adults.
Still, Ndlovu and colleagues found that Gauteng as a whole — particularly neighbourhoods like these — are what scientists began describing in the late 1990s as “obesogenic” or environments that promote weight gain.
And, Ndlovu says, inequality, poverty and crime — including gender-based violence — in South Africa also shape how obesogenic our neighbourhoods are.
“If you want to exercise or run — especially as a woman — your choices can be quite limited in terms of how you try to get out there and be active because you’re worried that [for instance] you’ll get raped.”
South Africa already regulates, in theory, the number of liquor stores in areas to curb problem drinking. It could do the same for fast-food outlets while also working to make healthy food more affordable, argue Ndlovu and her colleagues in the study.
“The thing with obesity is that currently the burden is placed very much on the individual,” she explains. “The message is that you are obese because you are making poor food choices, yet the environment you’re living in is literally promoting everything but [healthy] options.”
“Policies generally work when… you target the individual, but you also ensure the environment that they live in is conducive to them making those better choices,” she continues. “And I don’t think that we are looking at obesity and non-communicable diseases with that lens.”
“The emphasis on individual choice serves the interest of the food industry for one critical reason,” writes New York University nutrition professor Marion Nestle in the 10th edition of her book Food Politics, first published in 2002.
“If diet is a matter of individual free will, then the only appropriate remedy for poor diets is education, and nutritionists should be off teaching people to take personal responsibility for their own diet… not how to institute societal changes that make it easier for everyone to do so.”
She concludes: “We do not make food choices in a vacuum.”
But in South Africa, policies to curb the availability of unhealthy food still face stiff opposition.
In 2013, South Africa became one of the first countries globally to pass legislation regulating the salt content in certain foods, like bread, breakfast cereals and flavoured crisps. Bodies such as the World Health Organization and the United States Centers for Disease Control and Prevention agree that the move was in response to rising rates of high blood pressure and cardiovascular disease linked to sodium consumption.
Just three years later in 2016, South Africa became the first country on the continent to announce it would introduce a health promotion levy on sugary beverages. In doing so, South Africa followed in the footsteps of countries like Mexico, where a similar levy probably led to an almost 8% reduction in purchases of sugary drinks within its first two years, a 2017 study in the journal Health Affairs found. Scientists there found that the effect of the tax grew stronger the longer it was implemented and was most effective in reducing sugary drink consumption among the country’s poorest.
But in South Africa, industry pushback delayed the introduction of both salt and sugar regulations by about two years, says University of the Witwatersrand professor Karen Hofman, who is the founding director of the South African Medical Research Council and Wits Centre for Health Economics and Decision Science (Priceless SA).
It’s a page straight out of an industry playbook that fellow Priceless SA researcher Safura Abdool Karim says stretches far beyond food to include alcohol and tobacco industries: Delay. Dilute. Delegitimise.
Watch: How industry influences food policy in South Africa
In South Africa, food companies delayed food regulations by, for instance, arguing there wasn’t sufficient consultation or threatening litigation.
As late as 2018 — two years after the levy was first proposed — the Beverage Association of South Africa was still arguing that the health promotion levy should not be rolled out in its current form.
Instead, the association argued in a statement, “more time and investigation needs to be taken to allow for proper engagement and consultation among parties across the value chain”.
Second, Abdool Karim explains, the industry will try to dilute policy.
Treasury’s initial policy paper on the proposed levy, published in July 2016, recommended a tax of about two cents per gram of sugar on all sugary beverages — or about 20% on what was then a normal-sized Coca-Cola. This initial tax level was based on scientific evidence generated by Priceless SA, according to a 2020 report by the global public health organisation Vital Strategies.
Treasury then opened a call for public comments, which were only made public if their authors released them. However, by the time the policy was a bill, the levy was almost half the amount initially proposed and excluded 100% fruit juices — a particularly potent source of sugar.
“What we observed with both the sodium [regulations] and the Health Promotion Levy is that the biggest amount of influence happened before the formal policymaking process was open to the public,” Abdool Karim explains.
“In the instance of the sodium restrictions, what we observed is that a draft regulation was circulated to industry actors. They gave input on that, that ultimately diluted the policy… it allowed more sodium in products, it changed the way that some products were categorised and [delayed] implementation.”
She continues: “The reason why it’s so problematic is that they exert this influence prior to the public comment, through channels that only they have access to.”
In fora like these, she warns that there may not be dissenting voices to oppose pro-industry takes on health policies.
Abdool Karim analysed the position of civil society groups, academics and industry actors to both the salt and sugar regulations in a 2020 report. Companies overwhelmingly opposed both pieces of legislation.
Meanwhile, civil society groups representing patients and healthcare workers, such as Diabetes South Africa, the World Stroke Association and the South African Medical Association, overwhelmingly favoured the regulations.
Today, the national health department has a standing meeting with major food companies to talk about the enforcement of existing policies. Multiple researchers told Maverick Citizen that civil society and researchers are not allowed at this meeting. The health department did not return requests for comment.
Finally, Abdool Karim says that big food companies work to delegitimise policies to curb non-communicable diseases — even if they work.
In March, researchers presented preliminary findings that suggested that sodium regulations led to a substantial reduction in salt intake among young adults after it followed men and women for, on average, about five years after the legislation was introduced. A reduction of this size — if found nationally — could save 7,300 lives annually, researchers predicted in a 2012 article for the South African Medical Journal.
Meanwhile, a May 2021 review of research published in the journal Obesity Reviews found the health promotion levy led urban households to buy almost 30% less sugary beverages and cut the amount of sugar they consumed from these drinks by about half.
Changes like these were even more pronounced among poorer South Africans, who bear the brunt of the country’s non-communicable diseases epidemics and yet have poor access to healthcare.
The South African Cane Growers’ Association (SACGA) continues to maintain that in its first three years, there is no evidence that the health promotion levy has reduced obesity levels. The association claims that the levy has cost the sector about 16,600 jobs.
In May, the Department of Trade, Industry and Competition argued that annual sugar production in South Africa had declined by nearly a quarter in the past two decades while the number of sugar cane farmers had fallen by almost 60% in the same period. However, Thomas Funke, CEO of the SACGA, disputed these statistics, saying that there had been an upswing in the sugar industry just before the levy was introduced.
The Department of Trade, Industry and Competition has spent the last year consulting with the sugar industry, including cane growers, on a sugar master-plan to revive the industry. The department confirmed that no civil society organisations or independent academic researchers were involved in the drafting of the plan.
In response to questions from Maverick Citizen, Funke said “Placing a moratorium on the HPL for three years forms part of this stabilisation strategy”, although this is not spelt out in the document’s text. So far, the levy has not increased even to keep pace with inflation since it was introduced in 2018, weakening its effect.
Department of Trade, Industry and Competition spokesperson Bongani Lukhele says that the sugar master-plan aims to provide a long-term policy framework and tax approach to provide certainty to sugar investors and growers.
Any proposals emerging from the plan, Lukhele says, will undergo appropriate consultations.
Meanwhile, the food industry is already building opposition to South Africa’s latest policy to curb non-communicable diseases — better food labelling. It’s a high-stakes battle for both sides, Hofman says.
“The biggest issue for industry is if this happens in South Africa, they know it will go through the continent,” she says.
“For example, there’s now a sugary beverage tax in Botswana, which is the same as South Africa’s. Industry is absolutely horrified because their growth market is actually the poorest in Africa — they’ve said so openly.” DM/MC
Laura Lopez Gonzalez is a freelance health journalist and editor. Follow her on Twitter @LLopezGonzalez.
Full disclosure: Lopez Gonzalez completed a one-month editing consultancy for the Healthy Living Alliance in 2021. The Healthy Living Alliance advocates around the health promotion levy.