South Africa is confronting a double burden of food poverty and diet-related disease, as households grapple with limited access to diverse, nutritious food while diabetes and other non-communicable diseases continue to rise.
As the country marks National Nutrition Week from October 9 to 15, the figures expose a public health challenge that extends beyond hunger, revealing that people can consume enough food to feel full while missing essential nutrients needed for healthy growth and long-term wellbeing.
Statistics South Africa’s (Stats SA) latest mortality data show that diabetes mellitus accounted for 6.1% of registered deaths in 2024, up from 5.8% in 2023. It was the leading cause of death among people aged 45 to 64, accounting for 7.9% of deaths in that age group.
The International Diabetes Federation estimates that 2.32 million South African adults aged 20 to 79 were living with diabetes in 2024, representing a prevalence of 7.2%.
Meanwhile, UNICEF reports that 23% of children under five in South Africa experience severe child food poverty. Its latest data also shows that 21% of children and adolescents aged five to 19 were overweight in 2022.
Dietitian Zeenat Simjee said financial and practical pressures often shaped what families ate, with the priority being to ensure food lasted across meals rather than to achieve nutritional variety.
“When household budgets are under pressure, the first response is not always the healthiest diet but rather food choices to ensure there is enough food to feed the household, stretch across meals, and be less time-consuming to prepare.”
Simjee said meals built largely around staple foods could provide sufficient energy without supplying adequate protein, fibre, and essential micronutrients, including iron, zinc, calcium, vitamin A, and folate.
“Therefore, a meal may provide fullness but may be nutritionally incomplete,” she said.
She said the consequences could be particularly serious for children, whose bodies and brains require sufficient nutrients for healthy development.
The first 1 000 days, from pregnancy until a child’s second birthday, are especially important, with nutritional deficiencies during this period potentially having lasting effects.
Simjee said South Africa faced a triple burden of malnutrition, with undernutrition and micronutrient deficiencies coexisting with overweight, obesity, and diet-related diseases.
The relationship between diet and chronic disease, however, is not as simple as blaming individual foods. Simjee said the concern was the overall dietary pattern when energy-dense foods high in refined carbohydrates, added sugars, saturated fats, or sodium consistently displaced more nutrient-rich options.
“An individual food does not cause diabetes, obesity, or hypertension by itself. The concern is the dietary pattern when these foods consistently displace more nutrient-dense foods,” she said.
The National Department of Health acknowledged that access to affordable, nutritious, and diverse foods was an important determinant of health and was closely linked to preventing non-communicable diseases.
Department spokesperson Foster Mohale said the National Strategic Plan for the Prevention and Control of Non-Communicable Diseases 2022–2027 identified unhealthy diets as one of five major modifiable risk factors.
“The department therefore views food affordability and the availability of healthier food choices as issues that extend beyond individual choice,” Mohale said.
The department said its interventions included sodium reduction regulations, controls on industrially produced trans fats, food fortification, nutrition education, and measures to promote healthier food environments. It also acknowledged that education alone could not overcome structural barriers affecting what people eat.
Foster also revealed the forthcoming National Dietary Intake Survey 2022 was expected to provide updated evidence on dietary patterns, nutrient intake, and nutritional status across socioeconomic groups.
Dr Karen Heath, senior researcher at The Noakes Foundation, said National Nutrition Week should not become a checklist of instructions directed at individuals.
“National Nutrition Week cannot be reduced to a list of rules for individuals,” she said. “The evidence points to a far more complex task, which is to make nutritious choices more accessible and affordable, helping people interpret information they can trust, and taking the prevention of chronic disease seriously.”
The foundation will host the World Nutrition Summit in Cape Town from October 14 to 16, bringing together South African and international contributors to discuss nutrition research, clinical practice, prevention, and food environments.
Professor Tim Noakes said scientific debate was essential to improving health outcomes.
“Scientific progress depends on asking difficult questions and being willing to change our minds,” he said.