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dc.contributor.advisorWentzel-Viljoen, Prof. E.
dc.contributor.authorWicks, Mariaan
dc.date.accessioned2018-02-16T10:04:09Z
dc.date.available2018-02-16T10:04:09Z
dc.date.issued2017
dc.identifier.urihttp://hdl.handle.net/10394/26361
dc.descriptionPhD (Dietetics), North-West University, Potchefstroom Campus, 2017en_US
dc.description.abstractGlobally the childhood obesity prevalence has increased dramatically and appears to be rapidly increasing in low-income and middle-income countries as well. In South Africa the rates of childhood obesity have increased by 7% during the last decade. The ‘obesogenic’ food-environment which promotes the consumption of foods and non-alcoholic beverages high in fat, sugar and/or salt (HFSS) has been recognized as a key driver in this global pandemic. The World Health Organization has called for governments to improve children’s food environment by implementing restrictions on the marketing of HFSS foods and non-alcoholic beverages to children. Nutrient profiling is defined as the science of categorizing foods according to their nutritional composition for the purpose of preventing disease and promoting health. Internationally, nutrient profiling has recently proliferated, specifically in the context of restricting the marketing of HFSS foods and non-alcoholic beverages to children. Aim :This study aimed to develop a framework for regulating the marketing of HFSS foods and non-alcoholic beverages to children in South Africa with the support of an appropriate nutrient profiling model. The framework will be submitted to the South African Department of Health for consideration to be implemented into the child-directed food marketing regulations. Methods : The appropriateness and validity of the South African nutrient profiling model (SANPM), originally designed to screen food for the eligibility of a nutrient and/or health claim, for regulating the marketing of foods to children was established. The SANPM was compared to four global non-industry developed models for the purpose of regulating the marketing of HFSS foods to children. Comparisons between the models were done by classifying the ‘healthiness’ of 197 individual foods according to each of the nutrient profiling models’ classification criteria. Then, registered dietitians in South Africa were requested to categorize 120 foods on a 6-point Likert scale in one of six positions on the basis of their ‘healthiness’ via an online survey. The classification of the 120 foods by the included nutrient profiling models was then compared to the views of the dietitians. Finally, the scientific evidence supporting the absolute exclusion criteria used by the nutrient profiling models were evaluated for inclusion into the suggested framework. Results : The percentage of foods permitted for child-directed food marketing according to the different models ranged from 6% to 45 %. The majority of the pairwise comparisons between the models yielded kappa statistics greater than 0.4 indicating a moderate agreement between the models. An almost perfect pairwise agreement (kappa = 0.948) existed between the SANPM and a model extensively tested and validated for such regulations, the United Kingdom Food Standards Agency model (Ofcom). Four of the included nutrient profiling models displayed a medium correlation with the views of dietitians (Spearman’s correlation = 0.38-0.68, p = 0.001). The SANPM was the only model displaying a strong correlation with the views of dietitians (Spearman’s correlation = 0.71, p = 0.001). The SANPM was included as the first step in the suggested framework and the inclusion of an absolute exclusion criterion for non-nutritive sweeteners was found to be scientifically sound. Conclusion : This study provided valuable information regarding the use of a nutrient profiling model for child-directed food marketing regulations. The appropriateness and construct validity of the SANPM for regulating the marketing of foods to children in South Africa was established. A suggested framework for regulating the marketing of foods to children in South Africa was developed by including a non-nutritive sweetener absolute exclusion criterion. We recommend that this framework is legislated to regulate the marketing of foods to children in South Africa to support the Strategy for the Prevention and Control of Obesity in South Africa. Key terms: marketing of foods, food marketing regulations, childhood obesity, nutrient profiling, obesity prevention strategies Agtergrond : Die voorkoms van kinderobesiteit het wêreldwyd drasties toegeneem en blyk ook in lae-inkomste en middel-inkomste lande toe te neem. In Suid-Afrika het die voorkoms van kinderobesiteit met 7% gedurende die laasste dekade toegeneem. Die ‘obesogeniese’ voedselomgewing wat die inname van voedsels en nie-alkoholiese dranke hoog in vet, suiker en/of sout (HVSS) bevorder, is erken as ʼn sleuteldrywer in hierdie globale pandemie. Die Wêreld Gesondheid Organisasie het ʼn beroep op regerings gedoen om die voedselomgewing van kinders te verbeter deur beperkings op die bemarking van HVSS-voedsels aan kinders te implementeer. Nutriëntprofilering word omskryf as die wetenskap van kategorisering van voedsels volgens hul nutriëntsamestelling met die doel om siektes te voorkom en gesondheid te bevorder. Internasionaal het nutriëntprofilering onlangs veld gewen, spesifiek in die konteks van beperking op die bemarking van HVSS-voedsels aan kinders. Doel : Die oogmerk van hierdie studie was om ʼn raamwerk te ontwikkel vir die regulering van die bemarking van HVSS-voedsels aan kinders in Suid-Afrika met die ondersteuning van ʼn gepaste nutriëntprofielmodel. Die raamwerk sal aan die Suid-Afrikaanse Departement van Gesondheid voorgelê word vir oorweging om te implementeer in die voedselbemarkings-regulasies gerig op kinders. Metodes : Die geskiktheid en geldigheid van die Suid-Afrikaanse nutriëntprofielmodel (SANPM), oorspronklik ontwerp om voedsel te sif vir geskiktheid vir ʼn nutriënt- en/of gesondheidsaanspraak, is vasgestel vir die regulering van bemarking van voedsels aan kinders. Die SANPM is met vier globale nie-industrieël-ontwikkelde modelle vergelyk met die doel om bemarking van HVSS-voedsels aan kinders te reguleer. Die modelle is met mekaar vergelyk deur die ‘gesondheid’ van 197 individuele voedsels te klassifiseer volgens elk van die nutriëntprofielmodelle se klassifikasie kriteria. Daarna is geregistreerde dieetkundiges in Suid-Afrika versoek om 120 voedsels op ʼn 6-punt Likertskaal te kategoriseer in een van ses posisies op die basis van hul ‘gesondheid’ in ʼn aanlynopname. Die klassifikasie van die 120 voedsels deur die ingeslote nutriëntprofielmodelle is daarna met die opinies van die dieetkundiges vergelyk. Ten slotte is die wetenskaplike bewyse wat die absolute uitsluitingskriteria gebruik deur die nutriëntprofielmodelle ondersteun, geëvalueer vir insluiting al dan nie in die voorgestelde raamwerk. Resultate : Die persentasie voedsels vir bemarking gerig op kinders toegelaat volgens die verskillende modelle het van 6% tot 45% gewissel. Die meerderheid van die gepaarde vergelykings tussen die modelle het kappa-statistiek groter as 0.4 gelewer, wat op ʼn matige ooreenstemming tussen die modelle dui. ʼn Feitlik perfekte gepaarde ooreenstemming (kappa = 0.948) het bestaan tussen die SANPM en ʼn model wat ekstensief getoets en gevalideer is vir sulke regulasies, die ‘United Kingdom Food Standards Agency’ model (Ofcom). Vier van die ingeslote nutriëntprofielmodelle het ʼn medium korrelasie met die opinies van dieetkundiges getoon (Spearman korrelasie = 0.38-0.68, p = 0.001). Die SANPM was die enigste model wat ʼn sterk korrelasie met die opinies van dieetkundiges vertoon het (Spearman korrelasie = 0.71, p = 0.001). Die SANPM is as die eerste stap in die voorgestelde raamwerk ingesluit en die insluiting van ʼn absolute uitsluitingskriterium vir die teenwoordigheid van nie-nutriënt versoeters in ʼn voedselproduk is wetenskaplik begrond gevind. Gevolgtrekking : Hierdie studie het waardevolle inligting verskaf wat betref die gebruik van ʼn nutriëntprofielmodel vir voedselbemarkingsregulasies gerig op kinders. Die geskiktheid en geldigheid van die SANPM vir regulering van die bemarking van voedsels aan kinders in Suid-Afrika is vasgestel. ʼn Voorgestelde raamwerk vir die regulering van die bemarking van voedsels aan kinders in Suid-Afrika is ontwikkel deur die insluiting van ʼn nie-nutriënt versoeter absolute uitsluitingskriterium. Ons beveel aan dat hierdie raamwerk in wetgewing opgeneem word om die bemarking van voedsels aan kinders in Suid-Afrika te reguleer om die Strategie vir die Voorkoming en Beheer van Obesiteit in Suid-Afrika te ondersteun.en_US
dc.language.isoenen_US
dc.publisherNorth-West University (South Africa) , Potchefstroom Campusen_US
dc.subjectMarketing of foodsen_US
dc.subjectFood marketing regulationsen_US
dc.subjectChildhood obesityen_US
dc.subjectNutrient profilingen_US
dc.subjectObesity prevention strategiesen_US
dc.subjectBemarking van voedselsen_US
dc.subjectVoedselbemarkingsregulasiesen_US
dc.subjectKinderobesiteiten_US
dc.subjectNutriëntprofileringen_US
dc.subjectObesiteitvoorkomingstrategiëeen_US
dc.titleA framework to regulate the marketing of foods and beverages to children in South Africaen_US
dc.typeThesisen_US
dc.description.thesistypeDoctoralen_US


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