Crisis looms as 22% of Kenyan children under five years are overweight

Swollen stomachs, visible ribs, dry rusty hair, sunken eyes and brittle bones of helpless crying children. That is the picture that comes to mind for many people when they think of the word malnutrition.

However a less known form of malnutrition that is slowly creeping into the urban areas of low and middle income countries such as Kenya is overnutrition. Overnutrition occurs due to the excessive consumption of energy dense (high in fats and sugars), and nutrient-poor foods and drinks and limited physical activity.

Prevalence of overweight and obesity in children

Globally, about 38.2 million children under the age of five are either overweight or obese. A further 340 million children and adolescents between the ages of five and 19 are overweight or obese.

For a long time, areas of Sub-Saharan Africa were not associated with overnutrition, but a report from the World Health Organization (WHO) shows that the rate of overweight children under five years in Africa has risen steadily by a staggering 24% since the beginning of the millennium.

38.2 million - the number of obese/overweight preschoolers globally.

22% rate of obesity/overweight among children under five in Kenya.

Closer home, studies indicate that about 18% of children under five years are overweight while 4% are obese. This essentially means that in a class of 50 preschoolers, nine are overweight and one is obese.

This is no longer a Western problem, overnutrition is here with us, and the current generation of children and adolescents are most at risk.

Around the world, more people die from issues related to overnutrition than those caused by undernutrition. This is because being overweight and obesity are linked to increased risk of non-communicable diseases such as type II diabetes, hypertension, cardiovascular diseases and certain cancers.

These risks are more heightened when the affected person is a child. Data from the Ministry of Health shows that cancers, diabetes, cardiovascular diseases and chronic respiratory diseases account for two fifths of deaths annually, and the number may rise to three out of every five children by 2030 if the rates of overweight and obesity continue to grow.

So, the big question we need to ask ourselves is why are more and more children becoming over weight and obese? Scientific evidence points to an increase in the consumption of ultra-processed foods which contain saturated and industrial trans fats, sugar, sodium and carcinogens.

Rise of fast food outlets in urban areas

A quick look in the busy streets of Nairobi, along fuelling stations or in the shopping malls of any Kenyan city paints a grim picture of the reality of the ever growing fast food industry in Kenya.

The entry of global fast food players in the country over the last 10 years has significantly shifted how Kenyans view fast food.  However, these global players are not alone with smaller local fast food outlets sprouting in towns and residential areas to cater for the lower income population.

It is safe to say that local favourites such as french fries and fried chicken are easier to access and much more affordable for many town dwellers than healthier options. This, coupled with online food-tech retail platforms are making access to fast food even more accessible through delivery services and aggressive advertising.

Fast food, especially those offered in popular food chains, is often seen as “cool”. This takes the conversation on nutrition further from food to a developing culture where fast food sits on a pedestal higher than more nutritious foods, enticing children and young people to want to be associated with it.

The proliferation of these food chains in the market and the culture of fast food high in sugars, fats and salt may reverse the gains made in eliminating non-communicable diseases.

Besides fast food outlets, supermarket shelves and retail stores are lined with ultra-processed foods, snacks and soft drinks also high in sugars, fats and salts.

Nutritionist Elizabeth Nyawira explains that highly processed foods and drinks pose a unique challenge in that they are highly palatable and therefore addictive, especially for children and adolescents.

“Fast foods contain high levels of fat, sugar and sugar which makes them highly palatable. This palatability can make people constantly develop cravings for these foods, thus slowly getting addicted to them,” says Nyawira.

Marketing of ultra-processed foods to children

Given the increase in global numbers of children who are overweight, obese or suffering from diet related non-communicable diseases, health stakeholders have raised alarm over the direct marketing of ultra-processed foods and beverages to children.

In Kenya, The Code of Advertising practice and direct marketing restricts advertising and marketing that targets children and that might result in harming them mentally, morally, physically or emotionally.

The code also recognises that children are more gullible therefore likely to interpret advertisements in a literal manner. The code however makes no mention of fast foods or beverages that are often advertised directly to children.

It is not uncommon to find fruit juices, milk shakes, highly processed snacks and candy whose packages have images of animated characters and popular cartoons or Disney and Marvel characters.

Children are therefore drawn to these snacks and many parents have found themselves handling toddler tantrums in stores as their children desperately beg for these snacks or drinks that all their friends are carrying to school.

Maureen Nduku, a mother to a 4-year old boy and a 2-year old girl explains that she no longer goes to the supermarket with her children.

“You pass one aisle at the supermarket with the children and they insist on wanting a particular snack. You buy it for them and once they see another snack on the shelves they want it too and that is where the tears begin,’’ says Nduku.

She is not alone as school going children often complain to their parents that they feel left out when their peers carry snacks such as crisps and sodas to school and they do not.

“My son came from school and told me his friends bring crisps from school while he only brings fruit,” Patricia, a parent complains.

The marketing goes beyond the packaging. TV advertisements for ultra-processed snacks and drinks during children shows and family times that are particularly targeted to children are also increasing the popularity of these products to children especially those who are in pre-school age.

The Kenya National Strategy for prevention and control of non-communicable disease monitoring framework recommends the development of policies to reduce the impact on children of marketing of ultra-processed foods and non-alcoholic beverages.

As it stands, no country in Africa has a comprehensive national policy regulating food marketing to children through broadcast, non broadcast means or limits persuasive marketing techniques targeted towards children.

Kenya could emulate the likes of Chile and Portugal who are implementing strict regulations when it comes to the marketing of unhealthy foods to children.

Deceptive marketing techniques

Another apparent issue that presents itself especially in the marketing of fruit juices targeted towards the parents of young children is the nutritional claims made in the front of packages of some of these products. Claims such as natural, 100% juice, non caloric or containing fruit are problematic as they hide the presence of high sugar and high calories content.

While many of these products do contain nutritional information or guideline daily amount information also known as GDA, many parents or consumers in general are unable to make sense of these numbers and therefore believe the claims made on the packaging.

A closer look in the ingredients of these fruit drinks show that many do not have fruit or fruit juice as one of the first two or three ingredients and some do not even contain any trace of the fruit pictured on the packaging. These unverified nutritional claims may mislead parents who purchase the products with the intention of offering their children healthy options. 

The Sugar Sweetened Beverage Tax

Many countries in the world are putting up policies to reduce sugar consumption within their populations. One of these is the introduction of a sugar sweetened beverage tax often abbreviated as SSB tax. In Africa, Mauritius, Morocco, Seychelles and South Africa have already put different tiers of the tax in place.

While similar policies have been proposed in the country by the Ministry of Health to reduce the amount of sugar consumption, none has been effected to date.

Fast food as reward or punishment

Parents and guardians also contribute to an increase in the consumption of ultra-processed foods among children by using fast foods and soft drinks as tools to condition behaviour. Incentives such “ nitakununulia sweet ukiwa number one” ( I'll buy you a sweet if you top your class) or “ukiendelea kufanya hivyo sitakununulia chips” ( I won’t buy you french fries if you don’t stop doing that.) create the image of unhealthy food as a privilege and children either yearn for them or grow aspiring to have them on a more frequent basis.

Regulations on fast foods in schools

Schools have not been left out as grounds for the marketing of unhealthy foods and drinks to children. While the Kenya School Health Policy of 2018 acknowledges overweight, obesity and non-communicable diseases resulting from poor diet as a concern for children and adolescents, it only recommends that parents and guardians offer nutritional support to their children and that the private sector makes responsible food labels to enable both children and parents to make informed decisions.

It does not however give direction on the kind of activities that food manufacturers can engage in around schools. 

Children and adolescents are often offered sodas and snacks, popularly referred to as zero diet, especially during school activities such as music and drama festivals and sporting activities.

Food manufacturers go as far as sponsoring some of these school activities, allowing them a chance to market unhealthy products to children directly in schools. The lack of policies to guide these activities or government regulations means food manufacturers have an unregulated playing field when it comes to their presence in schools.

Responsible government agencies have failed to come up with comprehensive policies that restrict when, where, how and to whom companies promote unhealthy products.

The development of these policies requires a multi-sectoral approach that involves government, parents, the fast food industry, media and educators. A failure to do these may see the deepening of a problem that’s already more deeply entrenched than we are ready to admit as a society.

As a country, we need to come to terms with the double burden of malnutrition we are facing. We are still struggling to deal with infectious diseases and undernutrition due to food insecurity.

We are also now struggling with non-communicable diseases heightened by overnutrition. This, coupled with a struggling health care system, weakened further by the Covid-19 pandemic and the rising cost of living, signals a health crisis building up in the country.

Children are the most affected population and if urgent action is not taken, we will end up with an ailing generation in the next few years.

Winny Kiprono, a fellow at the Africa Data Hub Data Journalism Fellowship