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Ultra-processed food intake in South Africa at concerning levels, study suggests

As South Africa considers introducing front-of-pack warning labels and strict marketing limits for unhealthy foods, research has found that low-income South Africans get around half of their calories from ultra-processed foods (UPFs) – “a cause for concern”, say the researchers.

The study, conducted by researchers from the University of the Western Cape, University of North Carolina at Chapel Hill, and University of Sydney, analysed the diets of 2,521 low-income South Africans aged 18-50 years. Using 24-hour dietary recall data collected between 2017 and 2018, researchers classified the foods based on the NOVA system — a categorisation of foods according to their level of processing.

The researchers found that an increasing number of younger consumers, aged 18-29, consumed 40% of their daily calories from UPFs. In contrast, for those aged 40-50, UPF consumption comprised 22% of their daily intake.

Only a small fraction, 7%, of participants met the World Health Organization's recommendations for daily fruit and vegetable intake, while just 19% met fibre recommendations.

Convenience of UPFs, but at what cost?

The research comes at a time when South Africa faces the dual challenge of addressing under- and over-nutrition. The country is reported to have one of the highest rates of obesity in the world, with more than 20 million overweight adults. At the same time, many people suffer from micronutrient deficiencies and undernutrition.

Seventy-six percent of packaged foods sold in South African supermarkets are classified as UPFs. These can be appealing options, as they are often priced lower than fresh foods and they commonly contain preservatives and emulsifiers, making them a convenient option due to their long shelf life. However, they often contain high levels of saturated fat, salt, sugar, and artificial colours and flavours.

Consuming UPFs has been linked to various health risks, including obesity, diabetes, heart disease, certain cancers, and an increased risk of premature death. The researchers highlighted the urgent need “for the South African government to implement better strategies to protect South Africans against the proliferation of UPFs, and more importantly to protect low-income South Africans who are most vulnerable to the economic shocks of poor health outcomes from undue influence towards UPF consumption”.

Draft regulations for front-of-packet warning labels still under review

In an effort to address public health concerns, South Africa has taken steps to improve the food supply and dietary quality. Initiatives such as the 2018 Health Promotion Levy on sugary drinks have shown promising results, leading to reductions in sugar content, purchases, and intake of taxed beverages.

Building on this progress, in 2023, the National Department of Health introduced draft regulation R3337. This draft aims to enforce stricter restrictions on food labelling, marketing, and health claims for packaged foods and drinks. By providing consumers with more accurate information and clear guidance on high-risk nutrient content in foods, these measures are aimed at empowering individuals to make healthier choices.

Key features of the regulation include mandatory black-and-white triangular warning labels on packaged foods high in added sugar, salt, unhealthy fats, and artificial sweeteners, alongside restrictions on marketing unhealthy foods to children.

In June 2023, after the draft regulations were published, Ingredients Network reached out to Petronell Kruger, senior researcher at Wits Centre for Health Economics and Decision Science to get her take on the draft. She said: “As expected, there is already a clear pushback. We have seen industry claim the regulations will hinder jobs, will be ineffective, will impact international trade obligations, and be too costly to implement. We have also seen quite a number of ‘info sessions’ held by industry-funded bodies, which does lead me to believe that there is an understanding that front-of-pack labelling, in some form, is inevitable.”

As of March 2024, the draft regulations remain under review. The process has been prolonged due to an extension of the deadline, with the Department of Health in South Africa still collating and verifying submissions.