Obesity rates in sub-Saharan Africa are shooting up fast. With many countries’ health systems ill-equipped to tackle the diseases that accompany excess weight, a major health crisis is looming. As international fast-food chains take hold across the continent, Kenyans are weighing up their options, reports Kabugi Mbae.
On the afternoon of 12 August 2011, a motley group of diners began trickling into one of the most popular shopping malls in Nairobi, the Kenyan capital. In less than an hour, this gathering formed into long queues outside the Kentucky Fried Chicken restaurant (KFC) which was opening its first branch in East Africa that day. The excitement was palpable. KFC’s opening had been hyped in the media as an important development that would inaugurate a new era in the fast-food industry. Everyone queued up to get a taste of the deep-fried chicken known the world over.
As the new outlet thronged with people, it was clear that for the majority this was their introduction to KFC. A minority were already familiar with American fast-food and had been before to a KFC restaurant outside Kenya. All were proud that the global food chain had chosen their country over other East African nations. It showed that Kenya was ‘an investment destination’, in the words of the Kenya National Chamber of Commerce and Industry.
‘When I was growing up, foods such as cakes and sodas were special. You only ate them on birthdays – if your parents remembered,’ recalls Constance Gewa, an associate professor at George Mason University in the United States. For the past 15 years, the Kenyan academic has focused on uncovering the causes of undernutrition, overweight and obesity among African populations. It’s her belief that the continent is witnessing an obesity epidemic.
Gewa says the shift in diets taking place in Kenya and other African countries is partly linked to childhood. ‘If later in life you do better than your parents economically, you aspire to eat the foods you were unable to eat,’ she explains.
Long before KFC came to Kenya, various South African fast-food brands, including Steers and Debonairs, had been in existence. But it was with the arrival of KFC that the landscape of the fast-food industry began to change dramatically. Using South Africa as its base, where it had operated since 1971, KFC launched in Kenya and became a beachhead for numerous other fast-food international brands mainly from the US.
In 2013, the sandwich-chain Subway opened its first outlet at The Junction Mall, where KFC had opened two years earlier. In the following year, Cold Stone Creamery and Domino’s Pizza set up shop. Then came Pizza Hut and Burger King, in 2015 and 2016 respectively. By this time, KFC already had 11 branches in Nairobi including a drive-through, and one branch outside the capital. Thereafter, KFC aggressively expanded its presence in East Africa and by 2019 boasted of 22 restaurants in Kenya, eight in Uganda and five in Tanzania.
KFC’s rapid expansion was fuelled by the growth of the middle class with disposable income. ‘At the time, it looked so cool going to a KFC or Subway restaurant,’ remembers Nic Odhiambo, vegan chef and author. ‘But we never gave thought to the impact.’ From Odhiambo’s perspective, Kenyans were being handed down a gunky diet – which they eagerly accepted. ‘It was like in the family setup, where if the first born outgrows their shoes they are given to the second born, who gladly receives them without a care about their quality,’ he says.
Yum! Brands, the American corporation that owns KFC, bragged about the progress it was making in Africa, ‘a continent with endless opportunities where we clearly have first-move advantage’
In its 2012 Annual Report, Yum! Brands, the American corporation that owns KFC, bragged about the progress it was making in Africa, ‘a continent with endless opportunities where we clearly have first-move advantage’. As Kenyans continued to indulge their appetite for KFC and other international brands, only a handful of keen observers like Odhiambo and Gewa noticed how the fast-food juggernauts were entrenching themselves in Kenya’s food system, nudging out traditional tastes and prompting unsuspecting consumers to binge on low-nutrient but energy-dense foods high in sugar, salt and fat.
Among the KFC devotees was Humphrey Mullah, a rugby player on the Kenyan national team. Mullah grew up in the countryside and was introduced to fast-food when he moved to the city. The New Internationalist found him hanging out at The Junction Mall’s KFC restaurant with a work colleague. Mullah traces his love for KFC largely to peer pressure from friends, especially his rugby teammates.
But Mullah understands the impacts of fast-food on health and has been cutting back. He is also returning to the food he grew up eating: arrowroots (tubers known locally as nduma), maize, pulses and fresh vegetables. ‘Traditional food gives more energy for longer periods of time,’ he explains. He worries that junk food is working its way into the diets of many families. ‘If today I place arrowroots and a Kentucky Fried Chicken before my children, they will pick the latter without hesitation,’ he says.
But Mullah’s concerns have yet to be picked up by wider society. ‘If I visit such an outlet once in a month, does it mean I’m endangered?’ poses Stephen Mutoro, the Secretary General of the nonprofit Consumer Federation of Kenya (COFEK). While he says it’s important to promote awareness of healthy foods, he declines to comment on the impact of consuming unhealthy food on health.
The causes of obesity are complex. They include changing lifestyles and your genetic inheritance, as well as eating fatty, sweet and salty food. But the marketing of unhealthy food and drinks – particularly to children – has been highlighted by the World Health Organization (WHO) as a major factor in driving up the numbers of those who are overweight and obese in the Global South.
‘You see someone on TV advertising chips, chicken and Coca-Cola as a very nice meal. And because people are inclined to believe that whatever goes on TV is correct, they adopt it,’ says Emmanuel Atamba, a policy analyst at Route to Food, a Kenyan advocacy initiative. He believes children are the most vulnerable to fast-food adverts. ‘These companies recruit customers from a tender age, some of whom remain loyal throughout their lifetime,’ he says.
Atamba says powerful campaigns by global fast-food outlets have already contributed to the change in the eating habits of Kenyans. Some of the international brands’ marketing strategies include partnering with gas stations, app services such as Uber and online retailers like Jumia.
Companies also offer discounts and offer some items on their menu with a local flavour. KFC, for instance, offers ugali, a Kenyan staple made from maize flour. ‘We developed ugali nuggets and now we have got a few loyal customers who love them,’ Justin Melvin, KFC local franchise’s then-general manager told a South African business-news site in 2016. Chef Odhiambo sees this ‘localization’ as a tactic to lure new customers. ‘Once they come through your door, you can give them the full extent of what you offer,’ he says. ‘What matters [to KFC] is how many people you are able to sell to either on a daily or weekly basis’.
The fast-food outlets have subtle ways to encourage consumers to buy soft drinks. For some brands on the online platform Jumia, Coca-Cola is cheaper than water. More generally, the financial clout of global brands means that Coke is also ubiquitous in Nairobi, something that riles Ann Mbugua, the owner of two healthy food eateries in the city’s central business district. ‘It’s easier for me to get a bottle of Coke than water when I’m thirsty,’ she complains.
Mbugua founded Bridges Organic Restaurant in 2006 after losing both parents and a close relative to type 2 diabetes – which is closely associated with a high body mass index (BMI). ‘I realized I would suffer the same fate if I didn’t make lifestyle changes,’ she says. Traditional Kenyan cuisine – such as black beans, ugali, vegetables, fresh juice, chicken and fish – dominates the menu, which is pitched at a middle-class clientele. Her calling card is that this food is unprocessed and free from chemicals and pesticides but she says she feels she is swimming against the tide.
‘Going by my business plan, I would have had four outlets by now,’ she says, blaming low demand for healthy food and a hostile business environment for her minimal growth. ‘Our expenses alone, including rent, amount to nearly $5,000 per month. That’s nothing to companies like KFC,’ says Mbugua, who feels she is in a David and Goliath-style contest.
It can feel like a losing battle, and no wonder. Not only is fast-food ever more freely available, it’s also addictive, clouding consumer choices. As US journalist and author Michael Moss explains in his 2013 bestseller Sugar Salt Fat: How the Food Giants Hooked Us, processed-food corporations have engineered products that are ‘immensely alluring’ and designed to make our brains want to eat more and more. Food corporations have added 60 types of sugar to things that did not used to be sweet, because humans intuitively love sweetness. Tricks like these come with brilliant marketing campaigns that ‘push our emotional buttons’ to make us eat when we are not even hungry.
In his latest update, Hooked, published earlier this year, Moss has explored the notion of addiction further, looking at how food manufacturers have exploited our evolutionary vulnerabilities, wielding salt, sugar and fat in a ‘concerted effort to reach the primeval zones of our brain where we act by instinct rather than rationalization’.
Now the products that produce these formidable cravings are spreading worldwide. In step, obesity and excessive weight gain are taking root in even the world’s least developed countries.
Kenya is one among many countries that are grappling with an uptick in obesity, which is rising fastest in some of the world’s low- and middle-income countries (see map, previous page). While absolute numbers are still small in comparison to the rich world, the direction of travel is alarming. In Africa, between 1990 and 2014, the number of children who were overweight or obese nearly doubled from 5.4 million to 10.6 million, according to WHO. A Kenyan study found a total of 28 per cent of adults aged 18-69 years were either overweight or obese, with women the worst affected at 38 per cent and men at 17.5 per cent.1 (This compares with 63 per cent in the UK, 67 per cent in Australia or 73 per cent of Americans). The Kenya demographic survey showed obesity among women increased from seven per cent to 10 per cent in the six years from 2008.
The prevalence of hunger means that many Kenyans do not see the looming obesity crisis that will blindside them in the near future.
Meanwhile the problem of hunger, and a lack of calories, has not gone away. While Kenya has made progress on many fronts – including bringing down levels of stunting and improving maternal health – one in three Kenyans experience chronic food insecurity every year, according to the 2019 Global Hunger Index. In addition, close to a third of the population fails to meet the minimum dietary threshold for sustaining a healthy and productive life. The prevalence of hunger means that many Kenyans do not see the looming obesity crisis that will blindside them in the near future.
Kenya now finds itself facing a double burden of malnutrition. ‘We haven’t even sorted out our communicable and infectious diseases yet,’ sighs Hellen Guchu, a cardiologist who runs a wellness programme in Nairobi. Guchu interacts daily with patients suffering from non-communicable diseases (NCDs) linked to a high BMI: cardiovascular problems (strokes, heart disease, high blood pressure), cancers and chronic respiratory diseases as well as diabetes, which now affects around six per cent of Kenyans. As of 2016, NCDs accounted for more than 50 per cent of total admissions and over 55 per cent of hospital deaths.
When it comes to tackling NCDs, Kenya has stalled, according to the latest Global Nutrition Report. Guchu believes the high prevalence of fast-food outlets will only make things worse. Through her programme, Guchu has successfully helped hundreds of Kenyans lose weight through diet and lifestyle changes. But – as with other addictive substances like tobacco or alcohol – she has also witnessed many others relapse. ‘There are some who, after their diabetes went into remission, have gone back to their bad lifestyle and revived it,’ she says.
These kinds of diseases are new to many Kenyans. Guchu says when people make their first visit to the doctor, they have often been sick for a while without their knowledge.
Analysts report that the outbreak of Covid-19 has helped bring the topic of healthy eating into the public conversation. ‘When the pandemic broke out, the Ministry of Health advised Kenyans to eat more traditional vegetables,’ says Atamba. ‘But where do we get them all of a sudden when the Ministry of Agriculture has not been keen to support the sustainable production of indigenous food?’
In the past few years, there has been a growing awareness among Kenyans about both the quality and safety of food. The Route to Food initiative, where Atamba works, was among organizations which, in 2019, petitioned the Kenyan parliament to withdraw harmful chemical pesticides – many of which are already banned in Europe – from the market. The chef Odhiambo also challenges Kenyans to stop viewing health as a secondary aspect of their lives. ‘Most of us eat just to fill our stomachs and give no thought to the nutritional benefit our bodies receive,’ he says.
The government has begun to take notice of Kenyans’ expanding waistlines. In July 2018, then-Health Minister Sicily Kariuki cautioned against consuming sugary diets and leading sedentary lifestyles and the country has since developed several policies aimed at controlling the spread of non-communicable diseases, including national guidelines for healthy diets and a five-year national strategy to tackle NCDs.
‘We are fed by a food industry that’s not aware of our health and treated by a health industry that’s not aware of our food’
But, so far, the different government interventions have failed to dent a steady rise in deaths from non-communicable diseases. Odhiambo attributes this to the failure to understand the root causes of the problem and a consequent misguided approach to solutions. ‘We are fed by a food industry that’s not aware of our health and treated by a health industry that’s not aware of our food,’ he says.
There are some signs that this is starting to change. Kenya’s Ministry of Agriculture has an agri-nutrition division, which collaborates with the Ministry of Health. And the two ministries have co-published various resources, including food composition tables and recipe books.
The problem will not be solved by better diets alone. Gewa says multiple factors, including behavioural change and urbanization, are responsible for Kenyans’ weight gain. The number of city-dwellers jumped from around 8 per cent in 1961, to 25 per cent in 2013 and 28 per cent by 2019. The World Bank predicts that Kenya’s urban population will hit 22 million by 2030 and 40 million by 2050.
City living brings new ways of getting around. Gewa views overreliance on motorized transport as a key culprit in eroding fitness. She witnessed this while visiting relatives in Kisumu, western Kenya. When they were young, she and her sister would have walked 30 minutes into town but now her sister prefers to travel by motorbike taxi. ‘Our parents didn’t have a car while raising us; we now aspire to have one in order to make life more comfortable for ourselves and our children,’ Gewa notes.
When KFC opened its first drive-through outlet in Nairobi, its manager remarked to Business Daily Africa that Kenya was ‘catching up with the rest of the world.’ Figuratively speaking, Kenya was also at the heels of countries that were bearing the brunt of the impact of unhealthy diets and so-called ‘lifestyle diseases’, such as South Africa, which has the highest rate of obesity in sub-Saharan Africa.
For now, unhealthy diets in Kenya are correlating with affluence. Research conducted by Gewa in 2019 into the numbers of overweight and obese children in public primary schools in Nairobi and Kisumu across low-, middle- and high-income households revealed that wealthy children were more likely to be overweight – the opposite of contemporary trends seen in the Global North. ‘I look at some of those schools [in high-income areas] and what’s available to the children: sweets, soft drinks and a lot of processed juices. The healthy options such as fresh fruits are very limited or lacking,’ Gewa notes.
If you can’t afford to eat highly processed food or go to a KFC, copycat fast-food is still readily available from local eateries and street vendors
However, children from low-income households are also at risk. The high cost of living and low wages means that Kenya’s urban poor already spend more than half their income on food. But even if they can’t afford to eat highly processed food or go to KFC, copycat fast-food is still readily available from local eateries and street vendors. French fries, now a popular dish, can go for as little as $0.50. For some of the residents of Kenya’s informal housing settlements – who make up around a fifth of its population – the consumption of fast-food symbolizes the higher economic status to which they aspire.
‘I have always desired to take my family there for a treat. Perhaps I will do that one day when there are offers,’ says Geoffrey Arumba, a street-food vendor who works near the Junction Mall’s KFC restaurant in Nairobi. For all the proliferation of shiny complexes in Kenya’s capital, the informal economy accounts for 80 per cent of all jobs.2 Arumba’s days are punishing, and typical of many slumdwellers in the capital. He works 13-hour stints selling roasted maize and, on a good day, takes home $5 to his wife and two children. This amount, which would buy a single meal at the KFC outlet, feeds his family, pays rent and school fees for his children.
Arumba’s customers, many of whom are students from a nearby university, hardly go to the KFC restaurant. Once in a while, when business is good, Geoffrey buys his family soft drinks, especially on birthdays.
In 2018, Coca-Cola reduced its 500 millilitre bottles of soda and Minute Maid fruit juice respectively to 425 millilitres. The move targeted low-income consumers such as Arumba. According to COFEK’s Stephen Mutoro, the soft drinks giant acted well within the law. ‘That is their business strategy with which we have no quarrel. Our problem is when you reduce the quality and maintain the price, or retain a big container but the volume is not what you have labelled on the package,’ he says. Just six countries in Africa have a sugar tax (of the like introduced in the United Kingdom on soft drinks to combat child obesity in 2016) and eight others restrict marketing to children.
Westernized imports are encroaching unimpeded. ‘Today if you walk into a grocery store, you will find entire aisles of breakfast cereals that have a lot of added sugar. We didn’t see that before,’ says Gewa. These sugary imports are displacing traditional breakfasts, which usually include staples such as sweet potatoes, arrowroots, bananas, bread or pancakes. ‘These [processed] products are becoming more and more available and accessible to people with disposable incomes,’ she notes. ‘It’s vital that we learn how to make better decisions.’
A different path
Kenyans have no shortage of ideas for how to halt the spread of junk-food diets. Gewa believes in enacting zoning laws that would restrict the number of franchises that can be set up in a certain area. ‘They are part of the food system and here to stay. But that doesn’t mean they can do whatever they want even though it is harming the community,’ she says.
The vegan writer Odhiambo and restaurant owner Mbugua like to think that if more Kenyans demanded healthy food, there would be a sharp increase in the number of restaurants that serve it. ‘The international fast-food outlets would begin to shut down because there would be no business for them,’ puts forward Odhiambo, hopefully.
Rather than focusing on international brands, there is evidence to suggest that Kenya’s government could be investing more in its own informal sector. Researchers such as Niti Ban have highlighted the value of the ‘indigenous economy’, pointing to the daily flow of fresh vegetables direct from farmers to the majority-female roadside traders (so-called mama mbogas, or women traders) as the best place to stimulate a post-Covid-19 recovery for the lowest earners.3
Advocates at Route to Food, where policy analyst Atamba works, have a wider vision for government to adopt food systems that are good for the environment, and good for Kenyans. They suggest: supporting local supply-chains, lifting up Kenyan food cultures and making sure that nutritious food is available and affordable.
There are some positive signs from government. Kenya has recently announced plans to provide kitchen garden kits to a million households to boost food security. The starter kits will include seeds such as kale, amaranth, cowpeas and spinach.
Route to Food is working to build an alliance of Kenyans armed with the right information to lobby for a better food system. That way, likeminded citizens, people who are passionate about effecting lasting change, can start to make a difference.
Meanwhile, KFC and other international fast-food brands continue to proliferate in Kenya and across Africa.
- The Kenya STEPwise Survey for Non-Communicable Diseases, 2015, aphrc.org/publication/kenya-stepwise-survey-for-non-communicable-diseases-risk-factors-2015-report/
- ‘Informal enterprises in Kenya’, World Bank, 2016, documents1.worldbank.org/curated/en/262361468914023771/pdf/106986-WP-P151793-PUBLIC-Box.pdf
- ‘A Kenyan Covid-19 notebook: the “mama mbogas” and the path to recovery’, The New Humanitarian, August 2020.