There is a bizarre paradox at work in South Africa: children are either going hungry or are eating too much of the wrong foods. This means that over and under nutrition co-exist. Both phenomena are extremely harmful for children’s physical and mental development and long term health.
The two “extremes” both lead to malnutrition. And while the impact is often not immediately apparent, over time it can have a major impact on whether or not they develop chronic diseases such as obesity, hypertension and high cholesterol, to name a few.
Malnutrition is a lack of proper nutrition. It is caused by either not having enough to eat or not eating enough of the right food, or being unable to use the food that you eat. The body battles to grow and resist disease.
For children growing up in the country’s informal rural areas, under nutrition is the ever present enemy. It suggests that every day children arrive at school with an empty stomach and go to bed hungry. This makes it easier to understand why some children are irritable and fall asleep in class or why others may even start avoiding school.
But the evidence also suggests that when these children do eat, they do not have enough fruit and vegetables. This is especially concerning among 15 to 24-year-olds. But it has been confirmed in other studies on younger learners.
A positive move is that many children are now receiving fruit and vegetables daily through the Department of Basic Education’s national schools nutrition programme. The implementation of this part of the programme has yet to be evaluated.
Research has found that as a result of under nutrition, up to 23% of boys from informal rural areas suffer from stunted growth. Their stunting is a direct consequence of under nutrition. Being under nourished, they develop recurring infections as a child or during foetal development because their mothers are malnourished.
The World Health Organisation has height standards for various age cohorts and defines stunting as a “height for age” value which is less than two notches below the norm.
The stunting may result in delayed mental development and therefore cognitive ability which has long term effects in terms of being able to get a job and productivity in the work place.
At the other end of the spectrum, there are many overweight and obese children and teenagers in South Africa, particularly from urban areas.
According to last year’s Healthy Active Kids report card for South Africa, which evaluates the health and well-being of the country’s children, in the last four years, the grade for obesity among children has dropped from a C rating to a D rating. This means that children are getting more obese.
There are numerous reasons for this. These include children being more inactive and lack of physical education in schools. In terms of nutrition, there are also many children living on convenience foods and fast foods.
Consumer research has found that the number of South Africans who purchased fast food in the four weeks before the survey increased from 57% in 2007 to 65% by 2011.
Many children also do not take lunch boxes to school and regularly buy sugary foods from the [tuckshops](http://www.hsrc.ac.za/uploads/pageNews/72/SANHANES-launch%20edition%20(online%20version.pdf). Children who are more likely to purchase from tuck shops have a higher body mass index. This means that they are more likely to be overweight and maybe even obese which increases their risk of developing chronic diseases over time - including diabetes and hypertension. It also impacts their self esteem.
The 2014 report card has also shown that South Africa has no regulation around food marketing to children.
Although there are certain provisions in draft legislation that specifically prohibit “advertising of foods not regarded as part of a healthy diet and healthy lifestyle to children under the age of 16”, these acts have not yet been promulgated.
A recent analysis of more than 1500 television advertisements found that 44% of tv adverts related to food. Half of the food advertising was aired during family viewing time slots. And the foods most commonly advertised were starchy foods, sugary drinks, desserts and sweets and fast foods.
The research has found strong associations between increases in the advertising of non-nutritious foods and rates of childhood obesity. Young children in particular cannot distinguish between programming and advertising. Children appear to remember advertisements particularly well which has been shown to result in product preference. This effects their purchase requests from their parents.
Dealing with the nutrition challenge
It is evident that the issues involving nutrition within the South African youth group is complex and multifactorial with no easy solution.
We need to ensure those children without food get fed and that those children who have too many options choose the right foods. Government action and policy change is essential and education is key. School nutrition programmes have been shown to work but need government support and funding.
Educating children about healthy food choices and the importance of leading a physically active lifestyle is also important. Further, educating teachers and parents would ensure that children only have healthy options to choose from at home and at school and that junk food is limited and that physical activity is encouraged and made fun. It does not have to be formal sport - play and fun are key.