The Challenges of Underweight and Overweight in South African Children: Are We Winning or Losing the Battle? A Systematic Review

Abstract

Underweight and overweight are adverse effects of malnutrition and both are associated with negative health consequences in children and adolescents. In South Africa, the burden of economic and social disparity coexists with malnutrition in children. The purpose of this study was to review available South African studies regarding the comprehensive summary of prevalence of underweight and overweight and evaluates government policies in addressing undernutrition and overnutrition in South African children and adolescents. We searched subject-specific electronic bibliographic databases of observational studies published on malnutrition, undernutrition, overnutrition, underweight and overweight in South African boys and girls from birth to 20 years of age in studies published on or after 1990. A total of sixteen cross-sectional, three longitudinal studies and one report met the criteria for inclusion in this review. Descriptive data synthesis revealed the small number of longitudinal studies highlights the dearth of research in tracking undernutrition and overnutrition in South African children. In this review, 0.7%–66% of underweight was reported among children in rural areas compared to a 3.1%–32.4% of overweight in urban areas. All studies reported a higher rate of underweight in boys than girls who were significantly more likely to have higher body fat. The data indicated that both underweight and overweight were positively related with health-related physical activity and psychological health problems such as low activity, low fitness, low self-image and self-esteem. Numerous recommendations were made in the reviewed studies, however effective strategic programs in eradicating both underweight and overweight are minimal. It is evident from the reviewed studies that the burden of underweight and overweight are still a problem in South African children. The most highly affected by underweight are rural children, while children in urban areas in transition are faced with burden of overweight. There is little evidence to suggest that government strategic programs are effective in addressing underweight and overweight in South African children. Based on these findings, sustainable school-based feeding schemes and physical education programmes are needed for optimal benefits in children and adolescents.

Cardiovascular Risk Factors and their Relationship with Endothelial Dysfunction in Rural and Urban South African Children

“…In addition, urban children showed higher anthropometric measures compared to rural children. This is in agreement with a study conducted by Monyeki and colleagues [29] who reported that the prevalence of obesity among South African children was higher in urban (6.1%) than in rural (3.7%) children aged 0-18 years old. The high prevalence of obesity in urban children could be as a result of the availability of inexpensive processed and lower nutrient foods in urban areas as it has been reported by McKersie and Baard [26] to be linked with the incidence of childhood obesity.…”

The (Possibly Negative) Effects of Physical Activity on Executive Functions: Implications of the Changing Metabolic Costs of Brain Development

“…Rather, the logical extension of these ideas would suggest that these efforts should carefully consider the unique (and possibly different) needs of the children being targeted. To illustrate, lowand middle-income countries including South Africa, 58 India, 59 and Brazil 60 face a double burden of over-and under-nutrition. These burdens can occur within the same community, as both under-and over-nutrition are associated with social and economic inequalities.…”

“…These burdens can occur within the same community, as both under-and over-nutrition are associated with social and economic inequalities. 58,61 In settings such as these, it is therefore essential to promote physical activity as a means of preventing and/or managing overweight and obesity in early childhood and later life. At the same time, it is also important to understand the potential physiological consequences of promoting dramatic energy expenditure increases with early childhood populations in which under-nutrition is more prevalent.…”

Child Electronic Growth Monitoring System: An innovative and sustainable approach for establishing the Kaduna Infant Development (KID) Study in Nigeria

“…14 Among these few in SSA, not all assessed childhood growth for more than a year and were mostly conducted in only five African countries. [15][16][17][18][19][20] Urban residence has been identified as a risk factor for intrauterine and postnatal malnutrition in Africa, the continent with the highest urbanisation rate in the world. 21,22 A number of the existing longitudinal data collection systems on the continent are located in rural areas with relatively homogenous populations, which are unsuitable for addressing the complex interaction of sociodemographic and economic factors with growth faltering and urbanisation.…”