Examining the relationship between socioeconomic status and obesity. A case study of Khayelitsha in the Western Cape province of South Africa
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Background: Obesity in South Africa is a critical public health issue. Previously considered a problem of the affluent, obesity is now reported among all populations in South Africa regardless of age, race, gender or geographical location. Although a body of literature suggests that sociocultural, environmental and behavioural factors are likely to explain the increasing levels of obesity in South Africa, few studies have examined the relationship between socioeconomic status and obesity. As such, there is dearth of evidence showing how socioeconomic status influences obesity in the country. Given the multiplicity of challenges associated with controlling obesity, understanding the link between socioeconomic status and obesity is critical for informing and developing effective prevention programmes. This study therefore examines the nexus between socioeconomic status and obesity by using Khayelitsha as a case study area. Goal and objectives: Guided by the conceptual framework of the Theory of Planned Behaviour, the overall goal of this study is to determine how education status and income level influence dietary and weight control behaviours in relation to obesity. The objectives are to 1) examine the role of social factors on food consumption behaviour; 2) investigate the influence of income levels on food consumption; 3) explore the relationship between education levels and food choices and 4) provide recommendations for policy review. Methods: This research is embedded within a larger study conducted by researchers from the Institute for Social Development on factors that influence food choices and eating habits of residents in Khayelitsha and Mitchells Plain. The epistemological position forming the basis of this research was guided by the concepts of positivist and interpretivist paradigms, as both perspectives were deemed relevant for achieving the study objectives. Moreover, the study combined both qualitative and quantitative research methodologies to analyze the gathered data. Results: The study identified cereals, bread, pasta, milk products, processed meat, fried chicken, fish and oil fat, soft drinks, fruit and vegetables as the main kinds of food consumed by residents in Khayelitsha. However, among these food groups, fruit and vegetables consumption was found to be low. In general, cost was identified as the main barrier for the frequent consumption of fruit and vegetables. The study also discovered a positive relationship between education and eating habits, with most educated individuals’ demonstrating high intentions to consume healthy foods compared to people with lower education. However, in contrast to the hypothesis of this study, the impact of education on dietary behaviour was found to be insignificant. Similarly, the impact of education on weight control behaviour was found to be insignificant although the relationship between these two variables was equally found to be positive. With regards to the association between income and food choices the study discovered an overall positive relationship between the two variables. However, the general effect of income on food choice was not statistically significant. Cost of food and low family income were found to be key barriers to the purchase and consumption of healthy foods. Conclusion and recommendations: This study has demonstrated that education and income status correlate positively with dietary lifestyle as well as weight management practices. However, contrary to the hypotheses outlined in this study, neither education nor income status was found to significantly impact on dietary and weight control behaviours. In general, other factors such as culture, price of foods, television advertisement and perception of weight status were found to also contribute to respondent’s dietary lifestyle and weight management practices. Given these findings, a multidisciplinary approach involving the promotion of proper dietary patterns as well as physical activity are recommended. Specifically, the strategies should focus on 1) the development of policy measures that regulate the high cost of healthy foods, 2) the roll-out of food voucher interventions that promote frequent consumption of fruit and vegetables and 3) the promotion of physical exercises in religious and health centers.