tag:theconversation.com,2011:/us/topics/national-school-nutrition-programme-26572/articlesNational School Nutrition Programme – The Conversation2022-08-11T15:24:31Ztag:theconversation.com,2011:article/1877342022-08-11T15:24:31Z2022-08-11T15:24:31ZThe right to food: activism and litigation are shifting the dial in South Africa<figure><img src="https://images.theconversation.com/files/476665/original/file-20220729-19-k0tzk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A recent court case forced the Department of Basic Education to resume the National School Nutrition Programme for nine million learners around the country.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Even before the pandemic and the recent global rise in food prices, millions of South Africans were hungry. In 2019, nearly <a href="https://www.statssa.gov.za/publications/P0318/P03182019.pdf#page=68">18% of households</a> could not access enough nutritious food for a healthy and productive life. Child stunting remains stubbornly high, affecting <a href="https://dhsprogram.com/pubs/pdf/FR337/FR337.pdf#page=33">27% of children</a> under five (double the global average). And <a href="https://dhsprogram.com/pubs/pdf/FR337/FR337.pdf#page=211">10% of children</a> are either wasted (thin for their height) or underweight.</p>
<p>At the same time, overweight and obesity rates are increasing, affecting <a href="https://dhsprogram.com/pubs/pdf/FR337/FR337.pdf#page=331">68% of women</a> and 31% of men. They are behind a rise in health problems such as heart disease and <a href="https://diabetesatlas.org/en/">diabetes</a>. In South Africa, diabetes affects <a href="https://diabetesatlas.org/en/">approximately 4.5 million</a> people and is the leading <a href="https://www.statssa.gov.za/publications/P03093/P030932017.pdf#page=44">cause of death</a> among women. </p>
<p>Obesity and stunting are linked, and often found in the same households as both result from not being able to access the right kinds of (nutritious) food.</p>
<p>The protracted nature of the pandemic and its ongoing social and economic impact have <a href="https://www.tandfonline.com/doi/full/10.1080/0376835X.2022.2062299">increased</a> these persistently high levels of food insecurity. This has been driven by <a href="https://theconversation.com/rising-food-prices-hit-poor-people-the-hardest-a-close-look-at-inflation-in-south-africa-184465">rising food prices</a>.</p>
<p>Yet, in South Africa, everyone should be able to access their basic needs, like food, in a <a href="https://www.sahrc.org.za/home/21/files/brochure_A3_English.pdf">dignified manner</a> (without shame and unreasonable obstacles). The right to food is enshrined in South Africa’s constitution. Section 27(1)(b) states that “everyone has the right to have access to sufficient food and water”. Section 28 recognises the right to food for children. </p>
<p>South Africa has also ratified many international and regional human rights agreements on the right to food. The right to food is a <a href="https://www.gov.za/south-african-human-rights-commission-launch-right-food-campaign">human right</a> recognised under national and international law, which protects the right of people to access food and feed themselves, either by producing their food or by purchasing it.</p>
<p>This right has been successfully litigated in countries like India. Until recently no case directly related to the right had been brought to the Constitutional Court of South Africa.</p>
<p>This changed in mid-2020 when the NGO Equal Education and the public interest group Section27, together with two Limpopo school governing bodies, <a href="https://www.dailymaverick.co.za/article/2020-07-17-court-order-the-department-of-basic-education-to-urgently-feed-9-million-hungry-children/">won</a> their case, forcing the Department of Basic Education to resume the National School Nutrition Programme for nine million learners around the country.</p>
<p>The case is significant as it means that the <a href="https://theconversation.com/south-africa-still-has-a-long-way-to-go-on-the-right-to-food-125423">question of hunger</a> is now on the list of socioeconomic rights recognised under the law in South Africa. Other rights have been litigated, creating a body of jurisprudence for the court to act on. </p>
<h2>Important principles</h2>
<p>According to Baone Twala from Section27, speaking at an online <a href="http://foodimbizo.org/">Food Imbizo</a>, a number of principles were set out in the landmark court case, which helps flesh out what the constitutional right to food means in practice in South Africa.</p>
<p>First, the case confirms that the right to basic nutrition for children is unqualified. The progressive realisation of the right depending on the government’s available resources – which usually applies to other social economic rights in the constitution and the right to food for adults – does not apply here. The government has an obligation to ensure the immediate fulfilment of those rights, as opposed to housing, for example, where it depends on what government can do.</p>
<p>Second, the implication of this right is that the state must provide it in circumstances where parents and caregivers are unable to. An example would be when they can’t afford to.</p>
<p>Third, the National School Nutrition Programme is a component of the right to basic education in the sense that it enables the child to be able to fulfil their right to education; eating gives the child the mental ability to focus.</p>
<p>Fourth, the right to basic nutrition for children is self-standing and independent of the right to education. This means that the right to food exists whether or not a child is in school, and the state has a duty to fulfil that right, regardless of where the child is.</p>
<p>Finally, removing a pre-existing right (like cancelling the school nutrition programme) is a retrogressive measure, and can only be implemented under very specific circumstances. When it comes to children, this should be the very last measure that is taken.</p>
<h2>Moving forward</h2>
<p>The first direct Constitutional Court ruling on the right to food was used in 2020 to force the Department of Basic Education to restart the school nutrition programme. The challenge now is how to ensure these principles are reflected across a broader set of policies. </p>
<p>It might be tempting to immediately focus on finding other strategic litigation cases on the right to food to build up a body of jurisprudence. But court cases can be difficult and time-consuming to build. Sometimes the outcomes are very specific, and they can even go against the intended outcome.</p>
<p>Twala argues that there is now an opportunity through advocacy and civil society mobilisation to make sure that the principles are used to counteract policy and programme decisions that contravene them. For example, the principle on removing the pre-existing right could be applied to other feeding programmes for children or vulnerable members of society, significantly curtailing the ability of government to stop these.</p>
<p>Taking up these principles (and especially the second principle) through advocacy and mobilisation also aligns well with a growing consensus that <a href="http://www.ci.uct.ac.za/cg-2020-food-and-nutrition-security">children (and mothers)</a> should be the focus of right to food campaigns. This ties in well with existing high-profile campaigns, such as the ones coordinated by Black Sash for the full retention of the Social Relief of Distress grant introduced during the pandemic, and to <a href="https://www.dailymaverick.co.za/article/2022-02-25-black-sash-report-highlights-need-for-child-support-grant-to-be-increased-to-combat-hunger-and-destitution/">increase the Child Support Grant</a> and extend this to <a href="https://theconversation.com/south-africas-child-support-grant-should-start-in-pregnancy-heres-why-70106">pregnant women</a>.</p><img src="https://counter.theconversation.com/content/187734/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Camilla Adelle receives funding from the DSI-NRF Centre in Excellence in Food Security. </span></em></p><p class="fine-print"><em><span>Florian Kroll receives funding from the DSI-NRF Centre of Excellence in Food Security. </span></em></p>Removing a pre-existing right like cancelling the school nutrition programme is a retrogressive measure, and should only be done under very specific circumstances.Camilla Adelle, Research Fellow, Department of Political Sciences, University of PretoriaFlorian Kroll, PhD candidate with the Institute for Poverty, Land and Agrarian Studies (PLAAS), University of the Western CapeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/883712017-12-12T23:15:20Z2017-12-12T23:15:20ZIs your child’s school an obesity risk?<figure><img src="https://images.theconversation.com/files/198867/original/file-20171212-9389-mwxdjq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Elementary schools provide excellent targets for interventions to prevent obesity as children spend much of their day and consume many of their calories at school.
</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p><a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32129-3/fulltext?elsca1=tlpr">Child obesity rates are skyrocketing</a> globally. Young children spend the lion’s share of their time in school, consuming a large portion of their daily calories there and developing lifelong eating habits and food preferences with their peers.</p>
<p>Do the schools attended by children influence their weight? As a child development researcher interested in child education, health and poverty, I recently had the unique opportunity to work with epidemiologist <a href="http://www.epi.inrs.ca/?page_id=538">Tracie Barnett</a> to examine this question. </p>
<p>Our <a href="https://www.nature.com/articles/ijo201739">resulting study, published in the International Journal of Obesity</a>, found that schools with the unhealthiest food environments were more likely to be located in disadvantaged communities.</p>
<p>We also found children between the ages of 10 and 12 who attended schools with lower-quality food environments had higher amounts of central body fat (or “central adiposity” in technical terms) after two years than children attending healthier schools. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/22437560">Central body fat is fatty tissue that is stored around the waist and abdomen</a>. It poses a greater risk to long-term health than fat stored elsewhere on the body.</p>
<h2>Food environments in schools</h2>
<p>To understand how a school may influence a child’s weight, we analyzed information on 431 elementary school students attending 246 schools. </p>
<p>All schools were located in urban areas of the province of Québec and were followed as part of <a href="https://www.ncbi.nlm.nih.gov/pubmed/21785124">Québec Adipose and Lifestyle and Investigation in Youth</a> (QUALITY) — a larger study investigating the evolution and course of childhood of obesity. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/198836/original/file-20171212-9389-18et7rr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/198836/original/file-20171212-9389-18et7rr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/198836/original/file-20171212-9389-18et7rr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/198836/original/file-20171212-9389-18et7rr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/198836/original/file-20171212-9389-18et7rr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/198836/original/file-20171212-9389-18et7rr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/198836/original/file-20171212-9389-18et7rr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Reducing childhood obesity requires understanding the complex genetic, psychological and socio-economic causes.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
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<p>In this sample, we studied the proximity and quality of food that students can easily access at school. </p>
<p>We identified three different school types: 1) those with unhealthy food environments inside the school; 2) those with unhealthy food environments inside and surrounding the school; and 3) those with healthy food environments inside and surrounding the schools. </p>
<p>We assessed the healthfulness of the food environment inside a school using interviews with the school principal, who answered questions about the food sold on the premises and the quality of the school menu. </p>
<p>We measured the food environment surrounding a school by the geographical density of fast-food restaurants and convenience stores within walking distance. </p>
<p>Finally, central body fat was <a href="http://europepmc.org/abstract/med/1559514">assessed using X-ray technology</a>. This provided us with precise measures of children’s lean and fatty body mass. </p>
<p>Our analyses took into account several potentially confounding factors, including family socioeconomic status and parental weight.</p>
<h2>Reducing child obesity</h2>
<p>A great number of countries — including <a href="http://www.edu.gov.on.ca/eng/healthyschools/policy.html">Canada</a>, the <a href="http://www.edu.gov.on.ca/eng/healthyschools/policy.html">United States</a> and <a href="https://www.gov.uk/school-meals-healthy-eating-standards%E2%80%8B">the U.K.</a> — have put in place policies to ensure that high-quality foods are offered and sold within elementary and high schools. </p>
<p>Nevertheless, our research suggests considerable inequality exists among the school food environments available to children. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/198870/original/file-20171212-9410-6o6mgh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/198870/original/file-20171212-9410-6o6mgh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=284&fit=crop&dpr=1 600w, https://images.theconversation.com/files/198870/original/file-20171212-9410-6o6mgh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=284&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/198870/original/file-20171212-9410-6o6mgh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=284&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/198870/original/file-20171212-9410-6o6mgh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=357&fit=crop&dpr=1 754w, https://images.theconversation.com/files/198870/original/file-20171212-9410-6o6mgh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=357&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/198870/original/file-20171212-9410-6o6mgh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=357&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Percentage of central body fat according to school type attended.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Researchers, health-care practitioners and stakeholders recognize preventing and reducing childhood obesity requires a multi-faceted approach — one that takes into account its biological (e.g. <a href="http://science.sciencemag.org/content/312/5771/279">genetic</a>), psychological (e.g. <a href="http://onlinelibrary.wiley.com/doi/10.3109/17477166.2011.615996/full">stress levels</a>) and social-environmental causes (e.g. the influence of factors such as <a href="http://ajcn.nutrition.org/content/79/1/6.long">neighbourhood and poverty</a>). </p>
<p>Even though biological and psychological factors contribute to obesity in important ways, there’s been increasing interest in social and environmental causes. That’s because they can offer cost-effective and modifiable targets for interventions. </p>
<p>Indeed, the school food environment is a particularly attractive target for intervention since the vast majority of children spend so much of their time in school.</p>
<h2>The family context of fitness</h2>
<p>Our study is not without limitations. First, our measurement of the school food environment inside schools was solely based on interviews conducted with school principals. </p>
<p>It is possible their reports were affected by their ability to recall certain details. In addition, principals’ reports could have been biased by their desire to present their schools in a more positive light. </p>
<p>Our findings are also limited by the use of a correlational design. We cannot rule out the possibility that some characteristics of children’s family lives might have determined the type of school they attended and their level of fitness. To reduce that possibility, all of our analyses took into account parents’ education and income, two important determinants of socioeconomic status and health. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/198862/original/file-20171212-9426-1hnps6c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/198862/original/file-20171212-9426-1hnps6c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/198862/original/file-20171212-9426-1hnps6c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/198862/original/file-20171212-9426-1hnps6c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/198862/original/file-20171212-9426-1hnps6c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=498&fit=crop&dpr=1 754w, https://images.theconversation.com/files/198862/original/file-20171212-9426-1hnps6c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=498&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/198862/original/file-20171212-9426-1hnps6c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=498&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">In schools without a lunch program, children are restricted to food from home, vending machines or food outlets in the vicinity.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Finally, our sample was restricted to Caucasian children with one or two obese parents. The risk for developing <a href="https://www.ncbi.nlm.nih.gov/pubmed/12948432">cardiometabolic diseases</a> (including obesity) is considered higher for those with two obese parents than for those with only one. </p>
<p>In order to assess whether our findings applied to a wider population of children, replications with lower-risk youth and ethnically diverse populations are needed.</p>
<h2>Winning the battle against obesity</h2>
<p>There is evidence carefully designed and implemented interventions aimed at improving the food environments in schools <a href="https://ijbnpa.biomedcentral.com/track/pdf/10.1186/1479-5868-8-7?site=http://ijbnpa.biomedcentral.com">can improve the quality of children’s diets</a>. </p>
<p>Our results suggest the food environments around schools should also become a target for intervention and social policy. </p>
<p>Finally, according to our analyses, schools in disadvantaged communities may have the most difficulty providing healthy foods to their students. </p>
<p>Future research could help identify some of the barriers that prevent schools from implementing successful healthy food policies in order to better support their efforts in the future.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/198815/original/file-20171212-9451-1coa28u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/198815/original/file-20171212-9451-1coa28u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/198815/original/file-20171212-9451-1coa28u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/198815/original/file-20171212-9451-1coa28u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/198815/original/file-20171212-9451-1coa28u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/198815/original/file-20171212-9451-1coa28u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/198815/original/file-20171212-9451-1coa28u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Food environments inside schools include cafeterias and vending machines.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Our best chances for winning the battle against obesity and cardiometabolic disease lie in our ability to implement preventive interventions as early as possible. </p>
<p>We recommend increasing efforts to create healthier food environments in elementary schools where children spend much of their time, consume a large portion of their daily calories and acquire the basis of lifelong eating habits and preferences.</p><img src="https://counter.theconversation.com/content/88371/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Caroline Fitzpatrick does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Research shows that children attending schools with low-quality food environments, in poorer neighborhoods, gain more central body fat – putting them at risk of obesity and cardiometabolic disease.Caroline Fitzpatrick, Researcher at Concordia's PERFORM center and Assistant Professor of Psychology, Université Sainte-AnneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/820042017-08-24T19:29:02Z2017-08-24T19:29:02ZCould breakfast and lunch at schools reduce stunting?<figure><img src="https://images.theconversation.com/files/183270/original/file-20170824-13916-1msmeux.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">TigerBrands Foundation</span></span></figcaption></figure><p>Stunting –- a condition in which children are shorter than the recommended height for their age –- is a key indicator of long-term malnutrition. It has severe effects on a child’s cognitive growth and development. </p>
<p>South Africa continues to have a high prevalence of stunting. This is despite the fact that it’s a middle income country, which should put it on a par with countries like Brazil, which has a stunting prevalence rate of <a href="https://www.wfp.org/stories/10-facts-about-food-and-nutrition-brazil">just 7%</a>. In South Africa nearly <a href="https://www.dailymaverick.co.za/article/2016-05-17-suffer-the-children-sas-inequality-strikes-hardest-where-it-hurts-the-most/">a fifth</a> of children under the age of 14 are stunted, showing persistently high levels of food insecurity in households. </p>
<p>The traditional dominant thinking about stunting suggests that it’s an issue set in early childhood and that after the age of two there is limited opportunity to correct it. But research has started to <a href="http://ajcn.nutrition.org/content/97/5/911.full">disrupt this conventional wisdom</a>, suggesting that there are opportunities to “catch up” in middle childhood – that is around the age of 7 years – and later again in puberty. </p>
<p>Our <a href="https://www.uj.ac.za/faculties/humanities/csda/Documents/TBF%20Nutrition%20Report%202015%20FINAL%20WEB%20VERSION.PDF">research</a> builds on this new thinking. It suggests that the physical effects of stunting can be reduced up until the age of 14 and that there is an association between lower stunting levels and serving children a combination of a breakfast and lunch meals at school.</p>
<p>Our findings are only preliminary and require further verification in different settings. But our study lays the ground for a possible solution to consistently high rates of stunting among children in South Africa. </p>
<h2>A meal on arrival</h2>
<p>All children attending 60% of the poorest schools in South Africa receive a lunch meal as part of the <a href="http://www.education.gov.za/Programmes/NationalSchoolNutritionProgramme.aspx">National School Nutrition Programme</a>. The meal consists of a protein, starch and vegetables.</p>
<p>Schools in South Africa are classified into five quintiles (categories): quintile one and two schools are the poorest while quintile five are the wealthiest. The nutrition programme targets schools in quintiles one to three.</p>
<p>Children at some quintile one and two schools are also being given breakfast when they arrive at school through partnerships that the education department enters into with corporates and foundations.</p>
<p>Our study assessed the effects of children between the ages of six and 14 receiving a combination of breakfast and lunch against those who only received lunch. We looked at 39 schools. At eight of them, children received breakfast and lunch while at the other 31 they only got lunch. The schools were in the Lady Frere district of the Eastern Cape, the <a href="http://www.hsrc.ac.za/en/review/june-2012/the-people-matter-policy-population-dynamics-and-policy">country’s poorest province</a>. Lady Frere is a largely rural area. </p>
<p>We measured the childrens’ height and weight and found that the stunting rate among children who received lunch was 14%. This compared with a rate of 19% for the province. The lower stunting rate could be explained by the age range of the children in our study. While the provincial average is for children from the age of 0 to 15 our sample does not include pre-school children who are more vulnerable to stunting. Stunting rates in Lady Frere may also be lower than in other parts of the Eastern Cape.</p>
<p>But more significantly, among the pupils who received two meals the stunting rates was even lower – at 9%. This is despite these children being from arguably poorer households. Similar results were found in <a href="https://www.uj.ac.za/faculties/humanities/csda/Documents/Evaluation%20of%20the%20Tiger%20Brands%20Foundation%E2%80%99s%20Pilot%20School%20Breakfast%20Feeding%20Scheme.pdf">the urban leg</a> of the study. </p>
<h2>Counter-intuitive stats</h2>
<p>Our findings counteract conventional wisdom about stunting but they are not without precedent. Research in Brazil, Guatemala, India, Philippines, and the Gambia show that there are opportunities for <a href="http://ajcn.nutrition.org/content/97/5/911.full">height-for-age catch up</a> after the first 1000 days of a child’s life.</p>
<p>Our findings suggests that for our sample of children between the ages of six and 14, there are opportunities for catch up and that there is an association between providing an additional meal at school and lower stunting rates, although this does not mean that the programmes cause these effects. </p>
<p>But we believe our findings need to be subjected to further assessment. This is because the study was not designed to assess impact and there could therefore be other possible reasons for the reduction in stunting seen in Lady Frere. We also do not know whether the physical effects observed in our study would also result in positive cognitive effects, although <a href="https://www.ncbi.nlm.nih.gov/pubmed/26399543">some research suggests</a> it would not.</p>
<h2>Policy initiatives</h2>
<p>The National School Nutrition Programme is one of three initiatives by the South African government to address malnutrition in children. The other two are <a href="http://www.sassa.gov.za/index.php/social-grants/child-support-grant">child support grants</a> as well as the <a href="http://www.daff.gov.za/daffweb3/Programme/Integrated-food-Security-and-Nutrition-Programme">Integrated Food Security and Nutrition Programme</a> - a process aimed at ensuring an integrated approach across agriculture, social development, education and health to ensuring delivery of food security programmes.</p>
<p>These programmes amount to massive state investments in alleviating the effects of childhood poverty. But the consistently high stunting levels suggest that they aren’t enough to address the effects of household food insecurity. </p>
<p>Our findings echo international research which shows that stunting can be shifted in middle childhood and puberty. This suggests that a great deal might be gained from providing children with two meals at school, although further research is required. Nevertheless it does show that there is potential for South Africa to disrupt the high stunting levels its school children face.</p><img src="https://counter.theconversation.com/content/82004/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lauren Graham received funding from the Tiger Brands Foundation for this study. </span></em></p><p class="fine-print"><em><span>Lauren Stuart received funding from Tiger Brands Foundation for this study.</span></em></p>South African learners receiving two meals, despite being from arguably poorer backgrounds, had statistically significantly lower stunting levels than children receiving only one meal.Lauren Graham, Associate professor at the Centre for Social Development in Africa, University of Johannesburg, University of JohannesburgLauren Stuart, Researcher in Social Development, University of JohannesburgLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/573792016-04-14T03:26:33Z2016-04-14T03:26:33ZFor poor children, two healthy meals a day can keep obesity away<figure><img src="https://images.theconversation.com/files/118562/original/image-20160413-22081-58dwv9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">School nutrition programmes help reduce the risk of children developing obesity.</span> <span class="attribution"><span class="source">Tiger Brands Foundation</span></span></figcaption></figure><p>Schoolchildren who receive a nutritious lunchtime meal are less likely to be overweight or suffer from childhood obesity. And those who receive both breakfast and lunch are three times less likely to suffer this fate. </p>
<p>Tackling childhood obesity is important because it may result in adult obesity and these children developing non-communicable diseases such as diabetes, hypertension and heart disease later in life.</p>
<p>Obesity is not necessarily driven by overeating, as is commonly thought. Children can also develop obesity when they are eating poor quality and inexpensive food that may be high in fats and refined carbohydrates. </p>
<p>Globally, about 44 million children are overweight or obese. In South Africa, about 28% of children between the ages of two and 14 are <a href="http://www.hsrc.ac.za/en/research-outputs/view/6493">overweight or obese</a>.</p>
<p>Our <a href="http://www.uj.ac.za/faculties/humanities/csda/Documents/TBF%20Nutrition%20Report%202015%20FINAL%20WEB%20VERSION.PDF">study</a> has shown that childhood obesity is relatively easy and cost effective to prevent. Two in-school nutrition programmes – one of which included both breakfast and lunch – had a marked effect on reducing overweight and obesity levels among schoolchildren.</p>
<h2>Effects of in-school nutrition programmes</h2>
<p>Our findings are from a comparative study at schools in the Lady Frere and Qumbu districts of the Eastern Cape province.</p>
<p>We wanted to independently assess the relative effects of an in-school breakfast programme and the Department of Basic Education’s <a href="http://www.education.gov.za/Programmes/NSNP/tabid/632/Default.aspx">National School Nutrition Programme</a>. The impact of these programmes has never been assessed before. </p>
<p>Children receiving the National School Nutrition Programme get a mid-morning lunch meal consisting of a protein, carbohydrate and vegetables. The breakfast is made up of a fortified cereal before the school day starts. </p>
<p>We compared the height and weight measurements of children at three types of schools:</p>
<ul>
<li><p>those who started receiving the lunchtime meal shortly after the study started; </p></li>
<li><p>those who had been receiving the lunchtime meal for some time; and </p></li>
<li><p>those who received both the lunchtime meal and an in-school breakfast.</p></li>
</ul>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/118563/original/image-20160413-22078-1uwu77x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/118563/original/image-20160413-22078-1uwu77x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/118563/original/image-20160413-22078-1uwu77x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/118563/original/image-20160413-22078-1uwu77x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/118563/original/image-20160413-22078-1uwu77x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/118563/original/image-20160413-22078-1uwu77x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/118563/original/image-20160413-22078-1uwu77x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">As part of the study some students received breakfast and lunch at school.</span>
<span class="attribution"><span class="source">Tiger Brands Foundation</span></span>
</figcaption>
</figure>
<p>Almost 35% of learners at schools that had not been receiving the lunchtime meal were either overweight or obese when they were measured against the <a href="http://www.who.int/childgrowth/standards/bmi_for_age/en/">Body Mass Index-for-age</a> recommendations made by the World Health Organisation. </p>
<p>In comparison, only 17% of learners at schools that had been receiving the lunchtime meal were classified as overweight or obese. </p>
<p>And of the children at the schools that received both the breakfast and the lunch, only 11.5% of learners were overweight or obese.</p>
<p>The effects of the school nutrition programmes can be seen more dramatically at the schools that started receiving the lunchtime meal in the course of the study.</p>
<p>When the children were first measured, the overweight and obesity levels were alarmingly high. By the end of the year – after the children had been receiving the lunchtime meal for at least three terms – the overweight and obesity levels had dropped by 8%.</p>
<h2>A good return on investment</h2>
<p>According to <a href="http://www.statssa.gov.za/publications/Report-03-19-00/Report-03-19-002012.pdf">Statistics South Africa</a> 30% of children live in households that have inadequate or severely inadequate access to food. These children therefore experience moderate or persistent hunger. </p>
<p>With the current drought and increased food prices, it is becoming more and more expensive and difficult for families, especially those in poor communities, to afford and opt for healthier food baskets.</p>
<p>As a result, poorer people are more likely to consume the foods that drive obesity. This in turn contributes to increased risk for non-communicable diseases. Children who grow up in these communities have no option but to consume food that lacks the right balance of nutritious meals. They are at high risk for obesity and “hidden hunger”. Hidden hunger is a micronutrient deficiency related to consuming low quality, nutritionally deficient meals.</p>
<p>Obesity – including childhood obesity – places a heavy cost burden on the health-care system of a country, given its association with heart disease and other non-communicable diseases.</p>
<p>But the lunchtime meal costs R2.73 per primary school learner per day. The breakfast has a similar cost. Although these are relatively low cost, the significant drop in obesity rates shows that they are high-impact interventions that could protect children from later obesity. </p>
<p>Taking into account the likely cost savings for the health-care system, interventions such as these represent an excellent return on investment. </p>
<p>With high levels of poverty that result in food insecurity and increasing food costs, in-school nutrition programmes are not only an important poverty alleviation mechanism that taps into the moral duty we have to ensure that children are fed; they have also been shown to deliver longer-term health benefits for the children, and for the country as a whole.</p><img src="https://counter.theconversation.com/content/57379/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The study was funded by the Tiger Brands Foundation which provided the in-school breakfast at selected schools,</span></em></p>In-school nutrition programmes can reduce the chances of children suffering from childhood obesity.Lauren Graham, Senior Researcher at the Centre for Social Development for Africa, University of JohannesburgLicensed as Creative Commons – attribution, no derivatives.