Meanwhile, half of us have access to so little food that we are at risk of hunger. Doing the maths, this means that many South Africans then are both fat and hungry. About 40 percent of South Africans eat the amount of calories recommended daily but eat food with so little nutrition that they are actually malnourished, according to the South African National Health and Nutrition Examination Survey (SANHANES 1).

“People think of food insecurity as only having insufficient amounts of food, but it can also includes not having enough food of sufficient quality,” says Prof David Sanders from the University of the Western Cape’s School of Public Health. 

A typical “low quality” meal consists of mostly mealie meal, bread or rice, with very little animal protein or vegetables. The meal is also usually prepared with cheap oil and lots of salt.

This means that South Africans, even those who are overweight, experience high levels of nutrient deficiencies, including those relating to vitamin A, iron and other minerals and vitamins.

Raising a stunted generation?

Although all commercially-produced maize meal in South Africa must be fortified with micronutrients, three 850g-servings supply less than half of the Recommended Dietary Allowances (RDA) of protein and iron, and only about a third of the RDA of vitamin A.[quote float= right]On average, the IQs are being lowered because of this chronic under-nutrition, especially in early childhood”

Close to half of all children (43.6%) have vitamin A deficiency, while one in 10 are anaemic, a condition linked to iron deficiencies and can leave children feeling tired and weak. Both conditions result in stunting, or a failure to grow, in children, according to the SANHANES 1 report.

“They are not thin and wasted like children you see in pictures of places where there is famine,” Sanders tells Health-e News. “This is a much more chronic form of under-nutrition where they may not go to bed hungry, but they don’t get enough nutrition from their low-quality diet.”

Stunting may put children at risk of infections, particularly diarrhoea and pneumonia, and also may result in “sub-optimal intellectual development.”

“They’re not unintelligent, but if you take the population as a whole, on average the IQs are being lowered because of this chronic under-nutrition, especially in early childhood,” Sanders explains.

Adults on this diet are also predisposed to illness, and are likely to become overweight or obese, which puts them at high risk for diabetes, heart disease and certain cancers.

The economy of hunger

Poverty is at the heart of South Africa’s food problems. While the country produces more than enough food to feed all its citizens, many do not have access to the right amount and types of food, according to a 2014 report by the Southern Africa Food Lab, an organisation working towards food security in the region.

With a national unemployment level at 25 percent and 15 million people receiving social grants, many people do not have enough money to buy food, while others cannot afford to eat healthily, according to Oxfam’s Hidden Hunger in South Africa report. Oxfam is an international non-profit organisation working towards eradicating poverty.

The price of white maize increased by 90 percent between 2011 and 2012, according to the SANHANES 1 report.

“Poor South Africans are not able to spend money on a diverse diet, instead the only option to facilitate satiety and alleviate hunger is to feed family members large portions of maize meal porridge that do not address nutritional needs,” according to Laura Pereira, author of the Food Lab report.

Sanders adds that “energy dense” foods such as white bread, biscuits and processed meats that are high in calories but low in nutritional value, are cheaper than healthy food.

A 2012 study by Sanders and colleagues, published in PLOS Medicine, found that healthier foods typically cost South Africans between 10 and 60 percent more than less healthy foods when compared by weight. This discrepancy only grew when the cost of food was analysed by nutritious calories with consumers paying up to 110 percent more for healthy food.[quote float= right]Healthier foods typically cost South Africans between 10 and 60 percent more than less healthy foods

Many South Africans do not have refrigeration or readily available cooking facilities, which makes the storage and preparation of fresh food more difficult.

“These factors, combined with the fact that highly processed food are generally very tasty, makes an unhealthy diet quite attractive to people,” Sanders tells Health-e News.

According to Sanders, tackling poverty as well as unemployment and income inequality are among the most important solutions to South Africa’s hidden hunger. However he adds there are steps government can take now including taxing unhealthy food and using revenues to subsidise healthy foods.

Various countries have attempted to implement a so-called “sugar tax”, but food industry opposition has overthrown efforts in most cases. Last year a law implemented by New York City’s former Mayor Michael Bloomberg regulating the cup size of sugary drinks was withdrawn after lobbying by soft drink manufacturers.

In 2011, Denmark implemented a tax on all foods with high levels of saturated fat, or so-called “bad fat.”  The tax was repealed a year later after the food industry mobilised against it.

Mexico implemented a tax on sugary drinks last year and became the only country to have successfully implemented a “sin tax” on a foodstuff. Early reports indicate a positive impact on the country’s obesity rate.

Sanders also suggests other interventions could be successful including ensuring that fast food outlets are a certain distance away from schools and banning fast food advertising during children’s TV viewing times. – Health-e News.

• Read more: Poor left out of new plan to end hunger – activists
• Opinion: New policy lacks meat without public consultation 

Edited versions of this story were first published in the The Saturday Star, Independent on Saturday, Pretoria News and The Mercury newspapers. This story was also republished in the Herald newspaper.