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

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.