Double trouble: Addressing stunting and obesity via school nutrition

Abstract

Background. South Africa (SA), as a middle-income country, faces the nutrition transition and associated double burden of undernutrition and obesity. School feeding programmes are one way of ensuring that malnutrition in children is addressed, but questions remain about whether they can address both undernutrition and obesity. 

Objectives. To compare the obesity and stunting outcomes for children receiving different combinations of school feeding programmes in a rural district of SA. 

Methods. The evaluation involved a comparative design that compared the stunting and obesity levels of three groups of children. Group 1 received one lunch meal a day for a prolonged period, group 2 both lunch and breakfast, and group 3 had started receiving a daily lunch shortly before the commencement of the research. 

Results. Group 1 had stunting levels in line with the national average. Group 2 had lower stunting levels than those receiving only the lunch meal. Children from group 3 had lower stunting levels than groups 1 and 2. Rates of obesity and overweight were markedly different between the groups. Group 3 had very high rates of overweight and obesity – above the national average of 28%. In contrast, group 1 had far lower rates of overweight and obesity, and group 2 exhibited the lowest levels. There was a significant decrease in the percentage of learners classified as overweight in group 3 over the 6-month period, from 26.1% to 19.2%. 

Conclusion. One lunch meal a day is associated with positive outcomes in relation to rates of stunting and obesity, and the lowest rates of obesity were measured when a breakfast meal was added. The addition of a breakfast meal to a lunch feeding programme shows promise, but this requires further investigation to understand whether causal linkages exist.