South African Adolescents’ Perspectives on Healthy and Unhealthy Foods and the Drivers of Their Food Choices in Their School Food Environment

Objective: To investigate South African adolescent school-going learners’ knowledge and understanding of healthy and unhealthy foods and the drivers of their food choices in their school food environment (SFE). Design: Qualitative participatory research methods including workshops, photovoice and focus group discussions (FGDs). Setting: Two public high schools, 1 non-metropolitan and 1 metropolitan, within 2 separate provinces (Eastern Cape and Gauteng) in South Africa. Participants: Adolescents 14-18 years (n=42). Results: Unhealthy ultra-processed foods (UPFs) were found to be rampant in the SFE, and healthy foods were scarce, limiting learners’ choices. Taste preference was a major driver of adolescent food choices as were satiety, value for money, affordability, convenience, visual appeal and seeming “cool or “rich” by purchasing branded franchise fast foods. Learners had some general nutrition knowledge, but this did not transpire into healthy food choices. Banning unhealthy foods in the SFE and providing affordable and satiating healthy foods in the SFE were proposed as solutions. Conclusion: UPFs such as packaged foods and fast foods were considered tasty but unhealthy yet preferred. Interventions are needed to promote healthy diets by changing the SFE, and eventually adolescent food choices. This will require government regulation banning the sale of unhealthy food and beverages (F&Bs) in the SFE and subsidizing healthy satiating foods to change dietary behaviour.