To identify factors associated with food purchasing decisions and expenditure of South African supermarket shoppers across income levels.

Intercept surveys were conducted, grocery receipts collated and expenditure coded into categories, with each category calculated as percentage of the total expenditure. In-supermarket food quality audit and shelf space measurements of foods such as fruits and vegetables (F&V) (healthy foods), snacks and sugar-sweetened beverages (SSB) (unhealthy foods) were also assessed. Shoppers and supermarkets were classified by high-, middle- and low-income socio-economic areas (SEA) of residential area and location, respectively. Shoppers were also classified as “out-shoppers” (persons shopping outside their residential SEA) and “in-shoppers” (persons shopping in their residential SEA). Data were analysed using descriptive analysis and ANOVA.

Supermarkets located in different SEA in urban Cape Town.

Three hundred ninety-five shoppers from eleven purposively selected supermarkets.

Shelf space ratio of total healthy foods v. unhealthy foods in all the supermarkets was low, with supermarkets located in high SEA having the lowest ratio but better quality of fresh F&V. The share expenditure on SSB and snacks was higher than F&V in all SEA. Food secure shoppers spent more on food, but food items purchased frequently did not differ from the food insecure shoppers. Socio-economic status and food security were associated with greater expenditure on food items in supermarkets but not with overall healthier food purchases.

Urban supermarket shoppers in South Africa spent substantially more on unhealthy food items, which were also allocated greater shelf space, compared with healthier foods.

We sought to validate questionnaires concerning body image perception, body size dissatisfaction and weight-related beliefs in multi-ethnic South African mothers and their daughters.

Settings and subjects: Girls attending primary school (ages 9–12 years, n = 333) and their mothers (n = 204) were interviewed regarding their demographics and body image. Weight, height and skinfold thicknesses were measured. Body image questions and body mass index (BMI) were compared with silhouettes adapted from the Pathways Study for girls and Stunkard's body image figures for mothers. A Feel–Ideal Difference (FID) index score was created by subtracting the score of the silhouette selected by the participants as ‘Ideal’ from the one selected as most closely representing their current appearance or ‘Feel’. We hypothesised that a higher FID index score would be associated with greater body size dissatisfaction.

BMI percentiles in girls (r = 0.46, P < 0.05) and BMI in mothers (r = 0.68, P < 0.05) were positively correlated with the selected silhouettes based on size. Participants who reported feelings of being ‘fat’ and those who perceived that their family and friends were more dissatisfied with their body size had significantly higher FID index scores. Scores were lower in black than white girls (all P < 0.05). No differences were found in FID index scores between ethnic groups of mothers. Internal reliability of the ‘thin’ and ‘fat’ belief constructs for girls was demonstrated by standardised Cronbach's α values ≥0.7.

Silhouettes, FID index, ‘fat’ and ‘thin’ belief constructs (in girls) are age-appropriate, culturally sensitive and can be used in further intervention studies to understand body image.

To review data on the prevalence, causes and health consequences of obesity in South Africa and propose interventions to prevent and treat obesity and related outcomes.

Data from existing literature were reviewed with an emphasis on changing eating and activity patterns, cultural factors, perceptions and beliefs, urbanisation and globalisation. Results of studies on the health consequences of obesity in South Africans are also reviewed.

Shifts in dietary intakes and activity patterns to higher fat intakes and lower physical activity are contributing to a higher prevalence of obesity. Few overweight black women view themselves as overweight, and some associate thinness with HIV/AIDS. Glucose and lipid toxicity, associated with insulin resistance, play roles in the pathogenesis of the co-morbid diseases of obesity. Elevated free fatty acids in the black population predispose obese black patients to type 2 diabetes.

Obesity prevention and treatment should be based on education, behaviour change, political support, intersectoral collaboration and community participation, local actions, wide inclusion of the population, adequately resourced programmes, infiltration of existing initiatives, evidence-based planning, and proper monitoring and evaluation. Interventions should have the following components: reasonable weight goals, healthful eating, physical activity and behavioural change. Genes and mutations affecting susceptibility to the development of co-morbidities of obesity and vulnerable periods of life for the development of obesity should be prioritised. Prevention should be managed in community services, identification of high-risk patients in primary healthcare services and treatment of co-morbid diseases in hospital services.