Obesity, stunting on the rise among SA’s children

Obesity, stunting on the rise among SA's children
Children that experience stunted growth often grow up and become obese. A local researcher believes this is due to many households living with broken food systems. (Photo: Freepik)

Many South African households are unable to feed their children nutritious food which has seen a rise in the number of kids living with obesity or stunted growth.

Angelika Grimbeek, Nutrition Programme Manager at HEALA, said malnutrition and the availability of ultra-processed foods (UPFs) are behind the increasing rates. 

“There is inequality and poverty that do not allow children to access adequate amounts of nutritious food. Shockingly, 30% of South African children live in households living below the food poverty line,” said Grimbeek.

The root of the problem

She added: These households do not have the means to provide adequate nutrition to their children. Conversely, ultra-processed foods which are high in sugar, fat and salt, and sugary drinks are readily available and affordable. Unhealthy eating patterns, unfortunately, start from a very young age. Mothers’ rights to make informed decisions of infant feeding are manipulated by formula and other products which are made as substitutes for breastmilk . As the child grows up, they are further exposed to child-targeted marketing of  UPFs and sugary drinks which leads to higher rates of obesity,” she explained.

HEALA is a coalition of civil society organisations advocating for equitable access to affordable, nutritious food in South Africa by building a more just food system.

A research report, commissioned by Black Sash, which aimed to understand the relationship between social assistance and child food practices in SA, confirmed that child malnutrition in SA has increased. The report revealed that one in four children, under the age of one, are too short for their age, and one in eight, are overweight. 

Grimbeek said that if a child develops stunting early on, they can grow up to become overweight or obese. Furthermore, teenage girls are especially susceptible to obesity which can lead to diabetes, hypertension, and some cancers in their adulthood,” she said.

Nutritious food a luxury for most

According to the Consumer Price Index report, released in December 2021, over 12 million children under the age of 18 benefit from the Child Support Grant (CSG). The grant amounts to R460, which is R285 less than the current Food Poverty Line, sitting at R744,96 per person. This leaves a number of families unable to buy enough food for their families, let alone food with higher nutritional values.

Dr Portia Mutevedzi is a Senior Epidemiologist at the University of Witwatersrand (Wits). Her research includes working in the Child Health and Mortality Prevention Surveillance program, which is a long-term study that looks at all deaths of children under five. The cause of death is determined by doing a pseudo-autopsy from collected heart, lung, and brain tissue and background information using clinical records.

“We have a significant proportion of children that are undernourished and babies well under the required weight for their ages. This generally reflects poor growth. Another problem on the rise is obesity in children. Commonly, in our medium income bracket households, we see a lot of obese and overweight children. This affects children both in terms of their physical growth and mental development,” said Mutevedzi. 

Food and the brain 

Mutevedzi said that nutrition is important because it drives all aspects of a child’s growth. 

“There are a set of nutritional components that a child needs to get in certain portions. So, when a child’s diet doesn’t include these components, there is an impact. For example, if they don’t get enough proteins, then that means that the development is also going to be hindered. If they don’t have enough carbohydrates, it means that they won’t have enough of the energy that they need. Especially for their brain function to drive the energy production in their body throughout the day,” she explained. 

Mutevedzi highlighted that, similarly to the effect of a lack of nutrients, consuming a high volume of nutrients in food can also be harmful. 

She added: “If a child has too much carbohydrates, the body converts this into fat which end up being stored, and eventually the child can become obese.  The nutritional components in the food we eat is directly related to the growth in your muscles, the development of your immune system, and your brain. Different nutrients feed different spheres. We tend to give children sugary breakfast cereals like cornflakes and milk. This gives them a high energy and sugar spike, but no sustained energy for a child. So, they will be hyperactive but not attentive or have the ability to concentrate. When their sugar dips, then they won’t have sufficient energy for their brain to function for a long time throughout the day.”

Impact of COVID-19

“The coronavirus pandemic and lockdown had a huge impact in terms of a household’s ability to buy food and provide proper nutrition. On the other side, you also have households where they do not have enough income or any. Some are sort of in that transition of being between poor and rich. These people feel it’s okay not to cook and buy KFC, and for their children to spend time on their devices.  A lot of this is also driven by children’s lack of activity. So, children spend hours watching TV or playing on a tablet instead of going out and doing physical exercise,” said Mutevedzi.

 The examples above lead to undernutrition, while the other one leads to obesity. Both are equally dangerous when it comes disease and death.  Mutevedzi also noted that a lack of education about what good nutrition is, is seriously lacking. 

Mutevedzi shared research by Child Health and Mortality Prevention Surveillance (CHAMPS). It shows that 20% of households reported either having lost a job or some sort of income. Even if a job wasn’t lost, income was reduced or the death of a breadwinner was reported.

Obesity and lockdown

“COVID-19 had a huge impact on household income and the ability to feed children. What makes it even worse, is the fact that children couldn’t go to school to get nutritional supplements. Some of these children depend on these school meals in the absence of any breakfast,” she added.

Mutevedzi noted the impact that COVID-19 also had on the numbers of overweight and obese children. Due to lockdown restrictions, children were not participating in sports. They stayed inside which reduced the physical activity to help combat being obese or overweight. 

“Another issue was with the closure of the markets. All fruit and vegetables usually available through tuck shops, open markets or street vendors, weren’t since a lot of them were closed. The access was very limited, which again, impacted nutrition to many people living in townships,” she said. 

Younger children suffering 

Dr Roisin Drysdale, who has worked in public health with a special interest in child nutrition since 2014, explained why SA’s stunting rates haven’t improved.

“Over the last 20 to 30 years, our stunting rates have been between 20 and 30%. We have a lot of children who are experiencing chronic malnourishment. The school feeding programs only start when you are at school so, children under five years old, do not have access to that, said Drysdale.

Drysdale is currently a postdoctoral fellow hosted at the Center of Excellence in human development, which is a research entity based at Wits University. 

What is stunting?

Stunting is a condition of chronic malnutrition which affects physical growth. This means that you are shorter than what you should be, according to your age. So, if a child is not getting enough nutrients and enough food for a long time, it will affect them in the long term.

Drysdale said it’s especially problematic if a child is stunted in the first two years of life. She explained that the outcomes include poor educational progress, poor adult wages and even a loss of productivity.

Obesity, stunting on the rise among SA's children
Joint child malnutrition estimates as provided by Unicef, WHO and the World Bank. (Photo: Scaling Up Nutrition)

“Stunting comes down to a food security problem in a country. Although, we have enough food to feed the whole country and import our own, people can’t access it. It mainly comes down to money, living in poverty, and in an unequal country like SA,” Drysdale added. 

Stunting is a slow progression, so, it’s not something that happens immediately. Drysdale reckons that we are yet to see rise in the numbers.

Mutevedzi said that stunting is not only linked to malnutrition and food, but also to multiple infections.

“It is linked to a child who is repeatedly sick or not stimulated enough socially. So, children who are malnourished, are more likely to get infections and these children are more likely to be stunted,” she said. 

SA’s obesity problem

The South African National Health and Nutrition Examination Survey (NHANES-1) showed a combined overweight and obesity prevalence of 13.5% in children aged 6–14 years. This is higher than the 10% prevalence in schoolchildren globally.

Mutevedzi noted that the main reason behind SA’s huge proportion of obesity is due to lack of exercise and nutrition.

“If they are under five, there is more chance of rectifying their obesity compared to older children. Obese kids, at about nine or 10, are at a higher risk of other diseases linked to obesity. Unfortunately, we still see a significant chunk of our primary school kids that are obese and morbidly obese,” she added.

One of the concerns raised by Mutevedzi is the common misbelief that a chubby baby, is a healthy baby. She said society is generally drawn to overweight babies while normal weight babies are overlooked. 

“We tend to think that when a baby is battling to walk because they are fat, that they are very cute. Living with this mentality drives people to overfeed themselves, to overfeed their children, and normalise unhealthy eating habits,” said Mutevedzi.

Necessary intervention 

Mutevedzi said that if a child is suffering from malnutrition, school feeding schemes could come in very handy. Clinics and hospitals are also able to provide food supplements for children that are failing to thrive.

“Baragwanath Hospital in Soweto has launched a programme which assesses the nutritional status of each child during appointments. The team looks at several aspects including food supplements, daily food intakes and the caregiver’s level of knowledge about nutrition. The nutrition team said that educating parents and caregivers has made a huge impact,” she said.

She concluded that there is a lack of education about nutrition among parents.

Starting early

Drysdale noted that nutrition can already be addressed during pregnancy. 

“Early nutrition and the health of pregnant mothers ideally starts during the first 1,000 days. This is a unique window of opportunity for optimal human development.  Interventions during the adolescent phase may provide an opportunity for catch up in some cases,” she said. 

HEALA formed the food justice coalition in order to address SA’s broken food system. By fixing it, all South Africans, especially women and children, can receive equitable access to nutritious food. This includes regulating the unhealthy food environment through food regulation measures. They include the health promotion levy on sugar-sweetened beverages, introducing front of package warning labels that will help consumers make more informed decisions, and improving early child development and school nutrition programmes. – Health-e News 


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