Urban South African Adolescents’ Perspectives on Healthy and Unhealthy Foods and the Drivers of Their Food Choices in Their School Food Environment: A Pilot Study

BACKGROUND: Childhood obesity is on the rise in South Africa and adolescents spend a substantial amount of time in the school food environment (SFE), which plays a role in shaping their food choices and provides a critical setting to improve diets. OBJECTIVE: To investigate South African adolescent school-going learners' knowledge and understanding of healthy and unhealthy foods and the drivers of their food choices in their (SFE). DESIGN: Qualitative participatory research methods including workshops, photovoice and focus group discussions (FGDs). SETTING: Two urban public high schools, one non-metropolitan and one metropolitan, in two separate provinces (Eastern Cape and Gauteng) in South Africa. PARTICIPANTS: Adolescents 14-18 years (n = 42). RESULTS: Unhealthy ultra-processed foods (UPFs) were found to be rampant in the SFE, and healthy foods were scarce, limiting learners' choices. Taste preference was a major driver of adolescent food choices as were satiety, value for money, affordability, convenience, visual appeal and seeming "cool or "rich" by purchasing branded franchise fast foods. Learners had some general nutrition knowledge, but this did not translate into healthy food choices. Banning unhealthy foods in the SFE and providing affordable and satiating healthy foods were proposed as solutions. CONCLUSIONS: UPFs such as packaged foods and fast food were considered tasty but unhealthy, yet were preferred. Interventions are needed to promote healthy diets by changing the SFE, and eventually adolescent food choices. This will require government regulation banning the sale of unhealthy food and beverages (F&Bs) in the SFE and subsidising healthy satiating foods to change dietary behaviour.