Stunting and sugary snacks part of a deadly food crisis, say child experts

We live in a country where some children can’t get access to water but unhealthy snacks abound, fuelling a nutrition crisis that has not abated in more than two decades of democracy.

One in three children who die in hospital are malnourished, one in four are stunted and one in eight are obese. The obesity rate for under-fives is double the global average. 

This crisis was described as a form of “slow violence” and sits at the heart of the latest Child Gauge - entitled: Food and Nutrition Security - launched on Thursday by the University of Cape Town’s Children’s Institute.

According to the weighty document, which comes out annually, one in four young children are stunted or too short for their age “because they are not getting enough nutrients for healthy growth and development”. 

One in eight are overweight or obese because they’re getting the wrong types of food.

“They are too fat because they eat foods low in nutrients and high in energy from sugar and fat,” according to the report.

Co-editor Lori Lake said we need to shift our perception from saying, “if only people ate the right things and got enough exercise”, to seeing the broader context of food systems and living conditions.

Dr Tracey Naledi, deputy dean of health sciences at UCT, said even among children under  two, one in four consume “unhealthy sugary food” such as processed breakfast cereals, snack bars, processed meats, biscuits, crisps, fast foods and many other such products.

“This sets dietary habits and preferences which are difficult to change later,” she said.

Marketing drives play a huge role in this. “Billboards advertising these products are deliberately close to schools, and nearby vendors are conveniently placed to provide unhealthy snacks,” said Naledi.

“This mega food production system has brought in bad food in general and has destroyed local, vibrant markets and access to fresh food. It is a form of exploitation for profit and it is a form of slow violence.

“If you look at all the core tenants in big malls built or being built in townships, you have your fast-food franchises.”

But even after more than 25 years of democracy, the poverty behind this mega food production has not changed.

“Stunting and malnutrition have remained unchanged for 20 years - but this is hardly surprising, since SA is one of the most unequal countries in the world, where 10% own 93% of the wealth,” said Naledi.

Incomes had not grown with food prices and more and more households were struggling, with opportunities to escape from poverty still racially determined.

UCT vice-chancellor Prof Mamokgethi Phakeng said there had been a significant rise in non-communicable conditions such as diabetes, obesity and heart disease.

“Even in remote areas of our country, where people don’t have access to something as basic as water, children have access to unhealthy food.”

In wealthier western countries, too, the same patterns had emerged: as soon as fast-food outlets mushroom and unhealthy snacks and cold drinks become available, these diseases proliferate.

According to first lady Dr Tshepo Motsepe, poor access to sufficient and healthy food was there “long before the disruption of the pandemic”.

“Our national demographic health survey confirmed that the proportion of children who are stunted has not changed since 1993,” she said.

“Covid's impact on household earnings paints a very dim picture ... We cannot turn our eyes away from images that show the hunger in this country - long, winding queues for food. Malnutrition remains significant as a cause of child mortality. One third of children die in hospital deaths.”

According to Chantell Witten, chairperson of the Child Health Priorities Association, the pandemic and lockdown have only worsened an already-existing crisis.

“Already in 1999 we knew stunting was affecting a quarter of our children, [and] in 20 years we have not been able to change that stat, which now stands at 27 out of 100.

“It means an entire generation of children in our studies in 1999 are now 22 and are having children of their own, so this slow violence has been described as invisible - but for the nutrition community it has not been invisible.

“We have known for a very long time that food is unaffordable for most South Africans - especially healthy food - and this problem is increasing.”

Research has also shown that fewer than 30% of South Africans can identify a healthy diet.