Additionally there is a high per capita consumption of soft drinks in Southern Africa, with per capita consumption of Coca-Cola products at 249 servings of 8 fluid ounces per year in 2009 for all South Africans (higher than in the United Kingdom or Canada for the same year) (Coca-Cola Company, 2010). Physical inactivity is part of the problem with 66.5% of men and women in Swaziland being physically inactive (CSO Swaziland & Macro International, 2008). The prevalence of obesity is exceedingly high in adults, particularly women, with 62.9% of Swazi women overweight and 32.4% obese (CSO Swaziland & Macro International, 2008). Meanwhile, for the same age group, 10.8% are obese and 13.9% in the highest income wealth quintile. Approximately 29% of children under five have problems of stunted growth, an indicative measure of chronic malnutrition, and 10.3% are considered severely stunted (have a height-for-age <3 SD below the mean) (Central Statistical Office Swaziland & Macro International, 2008). Swaziland, a small country of approximately 1 million people in Southern Africa, has both undernutrition and overnutrition in children. Southern Africa includes the countries of South Africa, Lesotho, Swaziland, Mozambique, Namibia, and Zimbabwe. Obesity in children is associated with future risk for obesity in adulthood and co-morbidities including diabetes mellitus, hypertension and dyslipidemia and other alterations in lipid metabolism (Black et al., 2013). While prevalence is increasing in all income groups in developing countries, the overall prevalence is higher in the richest quartiles than the poorest and in urban versus rural areas based on WHO data (Black et al., 2013). In sub-Saharan Africa the prevalence of overweight children increased from 4% in 1990 to 7% in 2011, and it is anticipated it will reach 11% in 2025 (Black et al., 2013). Most overweight children under 5 years of age live in low and middle income countries. However, in 2011, an estimated 43 million children younger than 5 years (7%) were overweight worldwide, which was a 54% increase from an estimated 28 million in 1990. Meanwhile, there is less attention paid to these issues in the developing world, particularly in sub-Saharan Africa, where there is a much greater focus on problems of undernutrition and malnutrition which are common features of HIV/AIDS and tuberculosis infections and other infectious disease processes.
In the United States and other industrialized countries, there is much focus on childhood overweight and obesity because of the high prevalence of these problems in all population groups (Ogden, Carroll, Bit, & Flegal, 2012 National Center for Health Statistics, 2012).
As such, certain research relating to food in schools may not be relevant today. Please note that this study was published before the SY2014-15 implementation of the Smart Snacks Nutrition Standards for Competitive Food in Schools, as required by the Healthy, Hunger-Free Kids Acts of 2010.
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