Over the past two decades, South Africa has adopted a broad array of food and nutrition policies to improve children’s food and nutrition security. However, according to the 2020 Child Gauge, most indicators show disappointing results. While self-reported hunger of children has declined, stunting (an indicator of chronic undernutrition) remains exceptionally high for an upper-middle-income country. This has been accompanied by an increase in child and adolescent overweight and obesity, which is driving a growing burden of diet-related non-communicable diseases (NCDs).  

To better understand where the country stands on healthy eating for children, Maverick Life spoke to various nutrition experts in South Africa, including the National Department of Health. They discussed why this topic is essential and what should be done to ensure children are exposed to healthy foods.

Healthy eating for our children: A challenge

According to the Unicef 2021 Child Nutrition Report titled Fed to Fail?, nutritious diets build strong immune systems, fuel growing bodies and nourish developing brains. Enriched with the benefits of good nutrition, children are better able to enjoy healthy lives, learn, access opportunities and embark on a path to lifelong wellbeing and prosperity. Nutritious diets in early childhood, this research says, have the power to shape a healthier future – yet today millions of young children around the world are being fed to fail.  

“Healthy eating among children is extremely important. We are facing the double burden of both undernutrition and overweight/obesity among South African children. Obesity rates among South African children are increasing at an alarming rate, of 8.2% per annum,” explains Tamryn Frank, a researcher at the University of the Western Cape, adding that by 2030, South Africa is predicted to have an obesity prevalence of 27.14% among 10- to 19-year-olds. 

Angelika Grimbeek, the nutrition programme manager at the Healthy Living Alliance (Heala), a coalition of civil society organisations advocating equitable access to affordable, nutritious food in South Africa, says: “The scary and sad reality of South Africa is that there is a double burden of under- and overnutrition. One in four young children are stunted (which has remained unchanged for the past three decades, 27 years), and one in eight young children are overweight or obese (obesity has tripled in the past 17 years).” 

According to Grimbeek, it is incredibly concerning that this double burden of malnutrition can exist on a household level or in the same individual. She says it is often seen that a child that develops stunting in early childhood can grow up to become overweight and obese. “Furthermore, teenage girls are especially susceptible to obesity which can lead to non-communicable diseases such as diabetes, hypertension and some cancers in adulthood.”

While malnutrition might be associated with insufficient food or poverty, Nzama Mbalati of Heala tells Maverick Life: “South Africa as a country is self-sufficient in terms of the amount of food available, but distribution remains a problem. This is due to poverty and past inequalities that are major impediments to food security… The majority of people either do not have the means of production such as land, water and agricultural expertise needed for farming, or the financial means to purchase adequate food for children.”

Like the other researchers in this article, the Department of Health agrees that good nutrition is the foundation of child survival, health and development, and that well-nourished children are better able to grow and learn to participate in and contribute to their communities. “Poor nutrition, including overweight and obesity, poses a major concern and does not afford children a fighting chance against the risk of developing non-communicable diseases such as diabetes, hypertension, cardiovascular disorders, and some cancers in the future,” says department spokesperson Foster Mohale.

Other research by the Black Sash shows that many parents or caregivers rely on the Child Support Grant as a main source of income, which is not nearly enough to provide enough or the best-quality food needed for their growing children. This is coupled with the fact that many people do not understand what they should be feeding their children or what is in the food they give – often readily available and affordable ultraprocessed foods high in sugar, salt and fat. The industry that produces these foods often targets children in product marketing, manipulating them from a young age when healthy eating habits can be established. 

So, what are the recommendations for healthy eating?

In South Africa, most nutritional recommendations are based on international guidelines; specific recommendations differ based on the age of a child, since growing children have different nutritional needs at different times. 

A healthy eating plan contains a variety of safe foods consumed in sufficient quantities and quality to provide all the many different nutrients a child needs. “Different types of foods contain different types of nutrients. There is no single food that contains all the nutrients needed for the normal functioning of the body. It is for this reason that we have to eat a variety of foods to get all the nutrients needed,” Mohale says.  

According to the 2013 South African food-based dietary guidelines, a healthy eating plan comprises:

“Enjoy a variety of foods; make starchy foods part of most meals; eat dry beans, split peas, lentils and soya at least four times per week; eat plenty of vegetables and fruit every day; have milk, maas or yogurt every day; fish, chicken, lean meat, milk or eggs can be eaten daily; drink lots of clean, safe water; eat fats sparingly. Choose vegetable oils rather than hard fats; use sugar and food and drinks high in sugar sparingly; use salt and food high in salt sparingly.” 

Eating healthy? Often not a cheap option

Families can include nutritious foods in their diets only if they are affordable, according to Unicef’s report, published in September 2021. It notes that many nutritious foods – including vegetables, fruit, dairy, eggs, fish and meat – are far more expensive than starchy staples because they cost more to produce, transport and store, especially in low-income countries. 

In fact, nutritious diets are five times more expensive than those that meet only energy needs, putting them beyond the financial reach of more than three billion people worldwide. Unicef collaborated with the Global Alliance for Improved Nutrition to assess the affordability of nutritious foods for young children in nine countries in eastern and southern Africa and south Asia. The study identified locally available nutritious foods in each country and assessed how affordable they were in the quantities needed to meet 50% of a young child’s nutrient needs; it found several affordable food sources of vitamin A in all countries, but few affordable food sources of iron and calcium and no affordable food sources of zinc in any country. For poorer households, there were very limited options for meeting any micronutrient needs other than vitamin A.

Equitable access to nutritious food 

Researchers say that for all South Africans, especially women and children, to receive equitable access to nutritious food, the food system needs to be fixed. This includes regulating the unhealthy food environment through food regulation measures (the Health Promotion Levy on sugar-sweetened beverages) and introducing front-of-package warning labels that will help consumers make more informed decisions and can help guide what foods are provided in the National School Nutrition Programme meals. 

“We also need to stop the food industry from having the power to manipulate mothers and children into buying their unhealthy products. Everyone, including (and especially caregivers and children) deserves the right to make informed decisions about the food they eat,” says Grimbeek.

According to Heala, given the high levels of poverty and unemployment, as well as rising food prices, it is the responsibility of the government to satisfy our children’s right to basic nutrition; it is the role of civil society to speak out against the high levels of poverty and hunger, and it is the role of parents to ensure they provide good food to children if they have the means. DM/ML/MC

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