A new study published in Public Health Nutrition  examining the snack food environment in South African supermarkets reveals that ultra-processed, high-sugar, and high-sodium snacks are overwhelmingly available and aggressively marketed to consumers.

Conducted by researchers at the University of the Western Cape in South Africa and the University of North Carolina at Chapel Hill, this cross-sectional study evaluated nearly 4,000 snack products across major supermarkets in three suburbs of Cape Town. They found that 89% of these products were high in nutrients linked to negative health outcomes, including added sugar, saturated fat, and sodium. The study also highlights the role of in-store marketing strategies in driving consumer exposure to unhealthy snacks. Researchers found that supermarkets strategically position products throughout the store, including at entrances, checkout counters, high-traffic areas, and displays to encourage impulse purchases and drive sales. Ultra-processed packaged snacks were found at the checkout counters in all eight stores included in the study.

These findings underscore a pressing need for regulatory action to curb the in-store marketing of ultra-processed snacks in South Africa, where the prevalence of unhealthy snack options could contribute to rising diet-related health issues. By spotlighting the current supermarket environment, which prioritizes the accessibility and appeal of nutrient-poor snacks, the researchers make a case for policies that would encourage healthier dietary choices through targeted restrictions on unhealthy product promotions. This work is essential for informing policy changes that would create a more health-supportive food environment for South African consumers.

“Our research highlights a troubling reality in South African supermarkets: Ultra-processed snacks, which are often high in sugar, salt, and unhealthy fats, are not only widely available but also prominently marketed in ways that drive consumer demand,” said Sharna Lee Solomon, MPH, researcher and dietitian at the School of Public Health at the University of the Western Cape in South Africa and the study’s first author. “By implementing policies to reduce exposure to these products, we can work toward a healthier food environment that supports better health outcomes across communities.”

Interviews with store managers demonstrated that they held a common view that their stores encouraged consumers to make healthy decisions, which contrasted with the study’s findings. It is evident that there is a gap between their perceptions and scientific recommendations on what constitutes a healthy food environment. Additionally, researchers found that many store managers receive incentives from manufacturers, such as free stock or cash, in exchange for prioritizing the display of specific products in prominent locations. This practice, known as “slotting fees,” often gives ultra-processed foods an unfair advantage over healthier options, shaping consumer purchasing patterns and ultimately influencing dietary choices in low-income communities.

Draft regulation R3337 from the National Department of Health, which would mandate front-of-package warning labels on products high in nutrients of health concern, could be an effective tool for steering consumers toward healthier choices. This regulation aims to help consumers quickly identify products high in unhealthy ingredients and encourage companies to reformulate their offerings. However, this new research suggests that labeling alone may not be enough. A holistic approach, including reduced in-store marketing of unhealthy products and greater incentives for healthy choices, could be essential for more meaningful change.

“Improving the food environment in South Africa’s supermarkets requires a unified effort from policymakers, retailers, and consumers alike,” said Solomon. “Reducing the visibility and marketing of ultra-processed snacks, while making healthier options more accessible, can lead to significant progress in addressing diet-related health issues.”

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This research was funded by Bloomberg Philanthropies. Financial assistance in the form of a master’s bursary of the National Research Foundation is also acknowledged.

STUDY 1 AUTHORS

Sharna Lee Solomon
Tamryn Frank
Shu Wen Ng
Elizabeth C. Swart

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Read more in Public Health Nutrition

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MORE RESEARCH FROM SOUTH AFRICA:

Ultra-processed products make up nearly half of low-income South African adults’ diets Read more…

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Nutrient warning labels work in South Africa: Results from a randomized controlled trial Read more…

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Most South African breakfast cereal feature child-directed marketing Read more…

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The study from authors at UNC-Chapel Hill’s Gillings School of Global Public Health and the Carolina Population Center found that about half of parents they surveyed about the drink had previously purchased toddler milk and that Latino parents were not only more likely than non-Latino parents to report purchasing toddler milk, but they had also positive perceptions of its nutritional value.

These findings were published in “Toddler Milk Perceptions and Purchases: The Role of Latino Ethnicity,” in Public Health Nutrition on February 25, 2021. For this study, researchers analyzed results of an online survey that assessed toddler milk perceptions, behaviors and interpretations of nutrition-related claims among Latino and non-Latino parents. They found about half of parents (51%) had previously purchased toddler milk and few (11%) perceived toddler milk as unhealthy.

“Our study adds to the growing body of evidence that parents consider toddler milk to be healthy, and many believe it is healthier than regular milk. We also found that the claims present on toddler milk may be creating a health halo effect; whereby parents misinterpret a claim about a particular aspect of the product to mean that toddler milk is generally healthy,” says the paper’s lead author Emily Duffy, MPH, a doctoral student in nutrition at the Gillings School who is also part of the Global Food Research Project at UNC, which evaluates food and nutrition policies across the globe to develop in-depth, longitudinal research on large-scale obesity prevention efforts.

This is particularly concerning for young Latino children, who, when compared to non-Latino white children, are more likely to have obesity and worse diet quality, including higher consumption of infant formula, juice and sugary drinks. Previous research also suggests that consumption of toddler milk may be an emerging issue in early childhood diet quality among Latino children, and this new research adds to the growing evidence around the use of toddler milk in Latino children.

The American Academy of Pediatrics recommends breast milk, water or cow’s milk for young children and explicitly advises against offering toddler milk, as it often contains added sugar and can displace more nutrient-dense foods key to the development of healthy eating habits.

“Despite these recommendations, the formula industry is drastically increasing their ad spending on toddler milk in the U.S. alongside a decrease in infant formula ad spending, and we have seen evidence of targeted marketing to Latino parents, such as Spanish language on packaging and large ad expenditures on Spanish-language TV,” says Marissa Hall, PhD, assistant professor of health behavior at the Gillings School and senior author of the paper.

The majority (57%) of parents surveyed who reported purchasing toddler milk listed “to provide nutrients” as a reason for buying the products.

“This raises the questions of whether parents who feed their children toddler milk are aware that children can receive sufficient nutrients from complimentary foods beverages that lack the harmful levels of added sugars in toddler milks, and whether parents who provide toddler milk face barriers, such as food insecurity, to providing sufficient nutrients from other food sources,” says coauthor Lindsey Smith Taillie, PhD, an assistant professor of nutrition at the Gillings School.

The authors say that findings can inform targeted public health interventions to improve diet quality and reduce obesity disparities in early childhood.

“Pediatricians and public health nutrition educators should consider providing guidance to Latino parents about toddler milk, and advocates for public health policy can work to encourage the formula industry to reduce targeted marketing of toddler milk to Latino communities,” says Duffy.

Additional UNC authors on the paper include Ana Paula Richter, MPH, and Isabella Higgins, MPP.

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These are the findings of a new study led by GFRP researchers in collaboration with the Duke-UNC USDA Center for Behavioral Economics and Healthy Food Choice Research. The study, titled “No Fat, No Sugar, No Salt….No Problem? Prevalence of ‘Low-Content’ Nutrient Claims and their Associations with the Nutritional Profile of Food and Beverage Purchases in the United States Low-Content’ Nutrition Claims on Packaged Goods Misleading for Consumers,” published online March 15 and will appear in the upcoming issue of the Journal of the Academy of Nutrition and Dietetics.

Dr. Lindsey Smith Taillie and her fellow researchers undertook the study to better understand how low-content nutrient claims featured on food and beverage packages relate to purchasing habits, as well as what association these claims have to products’ actual nutritional content. Investigators also examined what demographic groups purchased greater proportions of foods and beverages with low-content claims.

Find out more about the study in the UNC Gillings School of Global Public Health press release, or read the full study here.

This work was conducted at the UNC-Duke USDA Center for Behavioral Economics and Healthy Food Choice Research (BECR) and funded by Healthy Eating Research, a national program of the Robert Wood Johnson Foundation.

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