Drivers and solutions to unhealthy food consumption by adolescents in urban slums, Kenya: a qualitative participatory study

Abstract

OBJECTIVE: To explore the perceptions, drivers and potential solutions to the consumption of unhealthy, ultra-processed foods (UPF) and foods high in fat, salt and sugar (HFSS) and their contribution to the double burden of malnutrition among adolescents living in urban slums, Kenya. DESIGN: Qualitative participatory research, through Photovoice, group discussions and community dialogues. Inductive, thematic analysis was undertaken. SETTING: Three major slums, Nairobi. PARTICIPANTS: Adolescents 10-19 years (n 102: 51 boys, 51 girls) and adults (n 62). RESULTS: UPF/HFSS consumption emerged as a predominant theme on foods commonly consumed by adolescents, and the causes of undernutrition and overweight/obesity. Adolescents described UPF/HFSS as junk, oily, sugary or foods with chemicals and associated UPF/HFSS consumption with undernutrition, obesity and non-communicable diseases. They perceived UPF/HFSS as modern, urban, classy and appealing to young people and minimally processed foods as boring and primitive, for older people, and those in rural areas. Individual-level drivers of UPF/HFSS consumption were organoleptic attributes (taste/aroma), body size/shape, illicit drug use, convenience and adolescents' autonomy. Social environment drivers were peer pressure and social status/aspirations. Physical environment drivers were UPF/HFSS availability and accessibility in the slums. Education on healthy eating and the adverse effects of consuming UPF/HFSS, through existing structures (youth groups, school, community health strategy), was proposed as a potential solution to UPF/HFSS consumption. CONCLUSION: UPF/HFSS were perceived as associated with poor nutrition and health, yet were preferred over unprocessed/minimally processed foods. Interventions to promote healthy diets beyond raising awareness are important, while addressing the underlying perceptions and drivers of UPF/HFSS consumption at the individual level and in the social and physical food environments.