Ultra-processed products make up nearly half of low-income South African adults’ diets

Low-income South African adults consume, on average, 40% of their calories from ultra-processed products, according to a new study published this month in Public Health Nutrition. Meanwhile, only 7% meet the World Health Organization’s recommendations for daily fruit and vegetable intake, and only 19% meet fiber recommendations.

Researchers at the University of the Western Cape in South Africa, the University of North Carolina at Chapel Hill, and the University of Sydney examined the diets of over 2,000 low-income South Africans reported in a 24-hour dietary recall collected in 2017–2018. They classified all the foods people reported eating according to their level of processing, using the NOVA classification system.

“South Africa is facing a rising tide of obesity and non-communicable diseases that is driven in part by the proliferation of ultra-processed products,” said Tamryn Frank, PhD, researcher and dietitian at the School of Public Health at the University of the Western Cape in South Africa and the study’s first author. “Consuming these ultra-processed products is associated with numerous health risks, such as obesity, diabetes, heart disease, certain cancers, and increased risk of early death. This puts a strain on our already burdened health care system.”

Of particular concern to the researchers is that younger consumers appear to be getting more of their calories from ultra-processed products than older consumers—a concerning trend given the increase in nutrition-related diseases in South Africa.Among 18- to 29-year-olds, ultra-processed products accounted for just over 40% of daily calories, compared to 22% for 40- to 50-year-olds.

South Africa is one of many countries actively working to implement policies that could help improve the food supply and the population’s dietary quality. In 2018, for example, the country began taxing soft drinks based on their sugar content under a Health Promotion Levy. This led to the beverage industry significantly reducing the amount sugar in products, as well as drops in purchases and intake of taxable beverages. For example, young adults in Langa, South Africa reduced their intake of taxed beverages by 37%, drinking 9 grams less sugar per person per day. In Soweto, Johannesburg, black adolescents and adults reported decreasing their frequency of drinking sugary beverages by 7 times per week among high-intake consumers and 2 times per week among medium-intake consumers.

To build on the success of the Health Promotion Levy, last year the National Department of Health released a draft front-of-package warning label regulation, designed and written based on scientific evidence from focus groups and randomized controlled trials in South Africa. The Department is currently reviewing public comments and working on finalizing the regulation. This policy aims to provide South Africans of all literacy levels with clear guidance on which products are high in nutrients of concern (sugar, saturated fat, and salt) or contain non-sugar sweetener.

Warning labels reading WARNING: High in SUGAR, High in SATURATED FAT, High in SALT, and CONTAINS ARTIFICIAL SWEETENERS — Examples of South Africa’s proposed front-of-package warning label designs.

Research is also underway to identify how and to what extent ultra-processed, unhealthy foods are marketed to South Africans, particularly children and adolescents. Restricting such marketing is a policy approach prioritized by the World Health Organization.

South Africa faces the double challenge of limiting consumption of ultra-processed and nutritionally harmful foods while also ensuring low-income populations have enough to eat. Of those surveyed for this study, 14% reported experiencing moderate to severe hunger.

“This challenge of addressing both under- and over-nutrition will require a combination of policies to ensure equitable access, availability and affordability of healthy foods,” said Frank. “A start would be using revenue raised from the Health Promotion Levy to subsidize the cost of fruits and vegetables, particularly for low-income populations,” said Frank.

This study was funding by The International Development Research Centre (IDRC), Bloomberg Philanthropies, and US National Institutes of Health.

AUTHORS

Tamryn Frank
Shu Wen Ng
Caitlin M. Lowery
Anne-Marie Thow
Elizabeth C. Swart

Learn more about ultra-processed foods and the NOVA classification system.