Neighbourhood and household socio-economic influences on diet and anthropometric status in urban South African adolescents

Background and Aims Many low- and middle-income countries are undergoing epidemiological and health transitions. South Africa has one of the highest prevalences of overweight and obesity in Sub-Saharan Africa. This research examined neighbourhood and household socio-economic influences on the risk of overweight and obesity in terms of anthropometric status and dietary intake among urban South African adolescents. A further aim was to conduct a qualitative study on the potential for religious groups such as Churches to be used as community-based organisations for obesity intervention. Methods A secondary analysis of neighbourhood and household socio-economic status (SES), anthropometric and dietary data was carried out on adolescents aged 17-19 years from the Birth to Twenty Plus cohort study in Johannesburg-Soweto. Qualitative data were collected through focus groups discussions and a community readiness survey with church leaders. Results No significant associations were observed between SES (household and neighbourhood) and energy, protein, fat, or carbohydrate intakes in males. Some significant associations were found between SES and dietary intake in females. Females had a higher prevalence of overweight and obesity than males (26.2% vs. 8.2%, p<0.0001). In males, poor household SES was associated with lower odds of overweight, fatness and high waist-to-height ratio (WHTR). For females, household SES was not significantly associated with overweight, fatness and high WHTR. The qualitative research showed that there was a very low level of community readiness among church leaders for obesity prevention programmes. Conclusions The dietary results suggest that the diet of these adolescents is transitioning to that seen in high income countries. It also highlights that even within the same relatively small urban area, nutrition transition does not affect different groups in uniform ways. The qualitative results indicate that programmes should focus around raising awareness of the problem of overweight/obesity in this community.