African Journal of Public Health and Health Systems | 24 October 2009
The Urban Foodscape and Childhood Obesity in Cape Town: A Systematic Review of Fast-Food Outlet Density and Health Outcomes in the South African Context
T, h, a, n, d, i, w, e, N, k, o, s, i, ,, P, i, e, t, e, r, v, a, n, d, e, r, M, e, r, w, e
Abstract
Childhood obesity is a significant public health concern in South Africa. The urban food environment, particularly the density of fast-food outlets, is considered a potential driver, but the specific relationship within local contexts requires clarification. This systematic review aimed to synthesise evidence on the correlation between fast-food outlet density and obesity prevalence among school-aged children in the City of Cape Town, South Africa. A systematic search of multiple academic databases was conducted following PRISMA guidelines. Peer-reviewed studies, reports, and theses investigating fast-food outlet density and child health outcomes in Cape Town were included. Studies were screened, selected, and their quality assessed using standardised tools. The review identified a limited but consistent body of evidence. A positive association was found between higher fast-food outlet density and increased odds of childhood obesity. This was particularly evident in lower-income neighbourhoods. The spatial distribution of outlets was inequitable, with a higher concentration in townships and areas of socioeconomic disadvantage. The available evidence suggests that the urban foodscape in Cape Town, characterised by a high density of fast-food outlets, is correlated with adverse childhood obesity outcomes. This relationship appears to be mediated by neighbourhood socioeconomic status. Public health policy should consider zoning regulations to limit new fast-food outlets near schools, especially in areas of high density. Further longitudinal and mixed-methods research is needed to establish causality and inform targeted, context-sensitive interventions. food environment, built environment, non-communicable diseases, nutrition transition, health equity, urban health This review consolidates the evidence specific to Cape Town, highlighting environmental determinants of obesity and providing a foundation for local policy discussion within the South African urban context.