oa South African Health Review - Assessment of food environments in obesity reduction: a tool for public health action - review

Volume 2018 Number 1
  • ISSN : 1025-1715



The nutrition transition in sub-Saharan African countries has contributed to increased incidence of overweight and obesity, which constitutes a major public health risk. This is especially the case where dietary patterns are influenced by the ready availability of fast foods, resulting in a high intake of fat, sugar and salt. This low-quality diet increases the risk of non-communicable diseases (NCDs). By measuring the food environment geographically, healthy food access gaps can be identified and nutrition-sensitive preventive interventions can be developed.

Addresses of food retailers were geocoded to quantify the total number of grocery stores (healthy options) and fast-food outlets (less-healthy options) within wards across Gauteng, the most densely populated province in South Africa. The Modified Retail Food Environment Index (mRFEI) was then computed, representing the percentage of ‘healthy’ food retailers in the area.

The mRFEI was widely heterogeneous across Gauteng, ranging from a minimum of 5% to a maximum of 100%, with an average of 33%. The index was highest in the most affluent wards and lowest in the poorest wards, with the latter including a high number of informal settlements. This diverse result was consistent with the high levels of socio-economic inequality that have been observed in Gauteng.

For countries such as South Africa currently undergoing rapid nutritional transition, it is imperative to be creative in finding cost-effective ways to identify the structural drivers of NCDs. Through supporting healthy food environments, the public health goals of reducing and preventing obesity and improving nutrition can be reached in settings with a high and increasing burden of obesity.

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