09 February 2011

SA kids are not healthy or active

The second Healthy Active Kids Report Card highlights concerning trends in healthy eating, physical activity, tobacco and alcohol use in children and adolescents in South Africa.


In 2007 the first Healthy Active Kids Report Card published by a panel of health scientists gave South African children an overall health grade of C- with lower marks for unhealthy eating, tobacco use and physical education. Promising initiatives included the school feeding scheme, anti-tobacco legislation and curriculum-based strategies.

Sadly these initiatives were not enough to change behaviours as the latest report, the 2010 Healthy Active Kids Report Card again scores the health of South African kids with an overall C-.

"The 2010 Healthy Active Kids Report Card shows that there has been little or no improvement in the areas of tobacco use, nutrition, physical activity and obesity in our kids over the last three years. These are worrying trends as these lifestyle factors give rise to serious preventable diseases such as heart disease, diabetes, lung disease and certain cancers, which are responsible for over half the adult deaths worldwide.

 "In order to give our children a healthier future we have to change their behaviours now, but we have to understand which factors drive these destructive behaviours,” says Dr Craig Nossel, Head of Vitality Wellness at Discovery.

In order to get a better understanding of the state of health and health behaviour of South African kids, the 2010 Healthy Active Kids Report panel was expanded to include partners from the Health Sciences Research Council, the Medical Research Council, several academic institutions, and health-related non-governmental organisations, along with the private sector. 

"The Healthy Active Kids South Africa Report Card 2010 had a much broader scope, and was able to draw on more than 95 published, peer-reviewed studies or reports, the National Youth Risk Behaviour Survey 2008, published last year, and key studies, such as the Birth-to-Twenty cohort, to assess the current state of healthy eating, physical activity, tobacco and alcohol use in kids from primary school up to high school.

"We also revised our approach, to consider not only the behaviours and indicators, but also those factors which shape health behaviour in our children and youth. 

"We can think of these influences in layers, beginning with family and peers, neighbourhood, communities and school, social norms, the built environment, policy and legislation," says Prof Vicki Lambert from the MRC/UCT Research Unit for Exercise Science and Sports Medicine, based at the Sports Science Institute of South Africa.

In short, the findings of the panel were:

Physical activity/inactivity 

  • Decline in physical activity levels with only 42% of youth participated in sufficient vigorous physical activity to be considered health-enhancing (2007: 45%)
  • Less than one-third of youth surveyed participated in moderate activity and nearly 42% did little or no physical activity.

The 2010 report card shows that there has been a 3% decline in levels of sufficient vigorous physical activity to be considered health enhancing from 45% in 2007 to 42% in 2010.

The report shows children from single-parent homes, or who come from more disadvantaged circumstances are less likely to participate in leisure-time physical activity. On the other hand, educational attainment, of mothers in particular, is positively associated with physical activity.

Less than 70% of high-school learners have regularly scheduled Physical Education, and physical education classes in disadvantaged primary schools are even less frequent, with participation showing a downward trend from 2002-2008. 

“The fact that levels of physical activity have declined among South African youths is very worrying. However, it is promising to note than over half of adolescents and young adults between the ages of 16-20 yrs participate in some form of sport or recreational activity, with participation increasing along with socio-economic status. Social networks, family and friends are instrumental in determining levels of physical activity” says Dr Nossel.

Overweight, obesity and stunting

  •  Increase in overweight and obese children to 20% and  5% respectively

The paradox of obesity coupled with stunting continues to be a major problem in South Africa. There has been a 3% increase in overweight children (from 17% to 20%) and obesity increased by 1% (from 4% to 5%). 

Stunting is prevalent in 13% of teens surveyed (up from 11% in 2002) and over 25% of rural and about 12% of urban primary schools

“Because we have not managed to reverse the trends for our nutritional indicators, South African children score a C- for overweight and obesity, and our mark for stunting remains the same (D-),”says Prof Lambert.

 Unhealthy eating 

  • Nearly 30% of teens consumed fast food 2 –3 time a week
  • Healthy foods, for example, in rural settings cost almost twice as much as the unhealthy equivalent

From a practical perspective, fast food intake is very common in teens and young adults.  In a recent survey, nearly 30% of those interviewed consumed fast food between two and three times per week.  This was highest in young men, and in persons from a lower socieconomic background. 

However, despite this pattern, one of the major barriers to healthy eating, is affordability of healthy food.

There is no indication that tuck shop intake and food choices have changed since 2007, however, there have been promising changes to the school feeding schemes to include fresh fruits and vegetables.

Screen time

“Research shows that 30% of South African adolescents are watching more than three hours of television daily, “says Dr Nossel. “This is problematic because not only does this substantially increase children’s sedentary time, but also, nearly 20% of advertising on South African television was related to food of which over half was of poor nutritional value.”

Media and advertising also play a role at school level. In a recent survey of over 100 schools, soft drink advertising was twice as prominent as posters related to healthy eating or physical activity.

Tobacco Use 

  • Nearly 30% of adolescents say they have ever smoked
  • 21% admit to being current smokers (this is double that of global prevalence estimates)
  • Majority of smokers start before the age of 19, with 6.8% starting under the age of 10

Prevalence of smoking amongst SA adolescents has remained constant since the last report card, although the levels remain concerning, particularly in light of SA’s strong smoking legislation. 

"Smoking is more prominent in boys than girls, higher in urban areas, and most kids start before they are 19 years old. Nearly 30% of teens surveyed report having ever smoked, with one in five admitting to being current smokers.  This is well above the global prevalence for children and youth, and we again score a D for smoking," says Lambert. 

Lambert stresses further that parents and peers are important factors in smoking behaviour and that children whose parents smoke are more likely to start smoking as well. 

"South Africa remains one of the leading countries in its anti-tobacco legislation. Its legislation to prevent smoking received an A grade with significant improvements prohibiting the sale of tobacco to children and youth (amended from 16 years to 18)," says Dr Nossel. 

Although the panel expressed their grave concern regarding these harmful health trends, there were some positive findings as well: 

  1. There are increasing examples of private-public sector partnerships to address the need of teachers for support in implementing physical education and nutrition education.
  2. The policy environment is changing from the school-feeding scheme to the curriculum, to the re-inclusion of regular physical education.
  3. Global sports events, and programmes in sports for development and sports for all may provide opportunities for children from disadvantaged backgrounds to participate in physical activity at a community level.

“By getting a better idea of the state of health and health behaviour in South African kids, and the factors which impact on healthy eating and physical activity, we can become better advocates for health in children across a variety of settings, from home to school, in the media, in supermarkets, the built environment, and in policy-making. We can give our children a healthier future" concluded Nossel.  

(Press release, Health24, February 2011)

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