The impact of booming online food delivery industry on our health

As natural as light would bend when it passes through water, Don Wafula’s craving for Kenyan food was quite obvious. He had stayed in the United States for about five years and his longing for home only arose when he thought of local delicacies.

Late last year, he came back to the country with a mission to satisfy his five-year craving and vowed not to eat any other food but healthy traditional food.

He would call his folks informing them that he was coming home, and assigned them the duty of preparing brown ugali and traditional vegetables. He had missed kienyeji chicken and chapati, and didn’t want anything to do with fries and burgers or worse, broiler chicken.

“I wanted real food,” he tells Healthy Nation.

When he went home in Bungoma, his food script was strictly followed for a week until he moved back to Nairobi and joined the order-and-eat bandwagon.

He downloaded all the food apps in the country to add on what he already had on his phone. He now has about five different apps, which dictate his menu just from the comfort of his seat.

“I opted to order food online because I moved to a neighbourhood that barely had any grocery shop nearby. I didn’t want to line up in the supermarket to get such items so I opted to go the easy way — ordering food and waiting for it to be delivered at my doorstep,” he says.

But every ding of his door bell for food deliveries meant one thing; more calories. He says he has never ordered anything healthy online. “I always go for Pizza, fries, chicken, soda or burgers.”

When he came to the country, he estimates that he weighed about 70 kilogrammes at the time. In about four weeks, he had gained three kilos.

For Winnie Mboya, cooking for one person is not inspiring. She’d rather order food online than spend time cooking.

Before moving to the city, she lived with her parents in Kisumu and she tells Healthy Nation that she never used any food applications at the time.

“At home, we have different kinds of vegetables in our kitchen garden and food is quite cheap and readily available. You cannot second guess the quality because most food comes from people’s farms. Anytime I think of buying vegetables in the city, I think of tell-tales of its source and opt not to buy,” she says.

Her work also contributes to her overusing of the food applications.

“I mostly work at night and I stay at home during the day. The first thing I think of when I get home is sleep and then house chores thereafter. I rarely get time to prepare a good meal for myself,” she says.

Winnie, however, has not gained weight. Her only worry is the bulging of her potbelly, which has started bothering her.

Unlike Don, once in a while, Winnie orders food such as rice and beef as well as vegetable salads that she believes are quite healthy. However, she says, “come to think of it, I have been eating a lot of junk, no wonder this potbelly keeps growing but my weight is unchanged.”

During the pandemic, public health protocols whose aim was to minimise the spread of Covid-19 meant that most hotels’ cosy tables and chairs had no occupants to make them useful.

In the background, there was a booming industry of online food delivery, one which the World Health Organization (WHO) in its latest report on obesity has now said is a great contributor to the condition.

A study conducted by Pew Research in 2017 found that 30 per cent of Kenyan adults own a smartphone. The number is now even higher.

The WHO report whose findings are mostly skewed to the European region highlight that there was prevalence of overweight and obesity as well as the increase of people’s body mass index in children and adolescents during the pandemic.

A study conducted in South Africa last year showed the extent of proliferation of fast foods by using geospatial Google data to map the various joints, most of which have online delivery options.

“The global burden of obesity and non-communicable diseases is increasingly shifting from high-income to low- and middle-income countries. Likewise, the most rapid dietary changes are currently observed in low- and middle-income countries,” said the study.

The results from South Africa are consistent with earlier research in other countries of Africa showing that modern retailers contribute to higher consumption of processed and energy-dense foods.

The study showed the need for understanding the links between modernising food systems and health outcomes which are instrumental in contributing to the economic development, but researchers say that it should not lead to the deterioration of public health and life expectancy.

The WHO report released this month shows that there were unfavourable shifts in food consumption and physical activity patterns during the Covid-19 pandemic.

“Environmental drivers of obesity have accelerated with population-level prevention measures especially during periods of restricted movements (for example, restrictions related to work; school closures; restrictions in access to sport clubs, public and recreational space; and scaling back of preventive and health promotion services by health services),” said the WHO.

While the report has not directly linked digital marketing strategies of the food delivery apps to luring people to salivate for their products, it says there is a likelihood that when children are exposed to unhealthy food advertisements, they tend to demand for such foods.

The report says that the pandemic also sparked a new interest in digital marketing especially in the food industry, which in turn promoted unhealthy products.

People’s health

“Digital marketing increased significantly during the pandemic, and use of increased virtual interaction and digital marketing was observed. Social media also became an influential platform that was increasingly used during the pandemic. While some companies changed their brand logos and packaging into Covid-19-related illustrations (such as lungs), others addressed health-care workers directly by providing food and drinks, donated money to aid organisations or supported Covid-19-related health interventions,” explained the WHO report.

The report, however, recommends that instead of promoting unhealthy food that affects people’s health, the digital marketing teams of online companies should use their platform to educate people on healthy living.

“The extension of the physical food environment through online supermarkets and meal delivery apps also provides opportunities to promote healthy behaviours. The role of health literacy and obesity is also discussed, including misconceptions among both the public and health professionals, which can lead to weight stigma, and the disparity in access to health information,” said the WHO.

In other countries like Portugal, there is a law that has been put in place to restrict advertising of foods that have a lot of calories.

The law applies to non-broadcast and online media such as websites, social media platforms and mobile applications where the content is intended for children under 16 years.

While the people Healthy Nation spoke to are based in the urban setting, the South African study says that obesity is not confined to urban environments and even people in rural areas are slowly embracing fast foods that lead to obesity.

The latest World Obesity Atlas report released in March showed that over one million children are likely to live with obesity by 2030.

Kenya ranked 143 out of 183 countries in the report on preparedness for dealing with obesity-related illnesses such as diabetes and hypertension.

Studies from different countries demonstrate that interventions such as taxes, subsidies, changes of in-store placements of healthy and less healthy foods, and regulation of information and advertisement campaigns can influence consumer food choices.

Clinical Nutritionist Sofia Mwakio who works at the Mombasa Hospital says that when people continuously rely on food apps for their meals, they are likely to take in almost four times their caloric needs.

Zero balance

WHO recommends that healthy eating consists of taking in about 10 per cent energy intake from free sugars (sugar added in soft drinks), less than 30 per cent total energy intake from fats and less than five grammes of salt in a day.

“There are an array of food apps that people use because they are easily accessible but they are not good for their health. Most of such people live sedentary lives and you know when there is a lot of energy taken in and rarely taken out, there will be zero balance, which contributes to high amounts of calories,” Ms Mwakio tells Healthy Nation.

She explains that it goes beyond the calories intake but the type of calories people take in from the food they buy online.

“The type of calories in such foods is the biggest problem because they are mostly high in carbohydrates, sugar and fats and those three combinations are likely to cause metabolic syndromes stemming from insulin resistance, which in turn leads to diseases like diabetes and heart diseases and some cancers. This is because such syndromes change how your body breaks down food,” she explains.

She says it is not safe to say that you consume foods that are low in carbohydrates and so you will automatically be safe from the effects of unhealthy eating. She advises that you can still take carbohydrates only if you know the correct type needed for your body.

“If say you get your carbohydrates from naturally, little processed foods, then your health will not be negatively affected. Alternatively, if your carbohydrates are high in calories and not in nutrients, then they become energy-dense instead of being nutrients-dense then that means you are storing way too much fat that you may not use,” she explains.

She adds that storing a lot of fat is a cycle that triggers insulin response, which stores everything away, mostly the fat and makes you hungry again even before the insulin goes down. This then means that you will feel hungry and eat more food.

“Most fat that comes from deep fried food is saturated and ends up raising one’s low-density lipoprotein cholesterol, which is the bad fat in one’s body. Such fats are likely to clog people’s arteries. When people consume such foods and do not grow fat, they feel ‘safe’. Sometimes such fats do not need to be visible by weight gain, it could be ‘inside fat’ which clog your arteries. Such people are called metabolically obese normal weight ,” she explains.

WHO recommends that people take in unsaturated fats such as those in avocados, nuts of fish compared to saturated fats found in cheese, ghee and all kinds of trans-fat foods like French fries.

Stephen Ogweno, who works with WHO’s Global Coordinating Mechanism for Non Communicable Diseases and an obesity awareness champion, points out that the proliferation of food apps in the country is worrying because of their ‘aggressive’ marketing, which targets young people.

“People think it is a cool thing to do so they tend to buy food online instead of cooking at home. The food may be cheap because it is being produced in bulk and that means that it has trans-fats, which are the most dangerous components in food,” he says.

“We should be worried about the proliferation of food apps especially now that they are targeting younger people. This is the most sensitive age since when they develop obesity, or unhealthy eating habits, then in five to 10 years, such people are likely to develop complications such as diabetes,” he warned.

Mr Ogweno suggests that the government should come up with food regulations by implementing the WHO Replace Framework for trans-fats. This means that any processed foods should have below 2 per cent of trans-fats.

“We should also control the amount of salts found in these foods. The reason fast foods are sweet is because of the heavy content of salt and oil that goes into that. We know that a lot of salt is dangerous to our health as it leads to hypertensive complications. Sugar is also dangerous and needs regulation,” he explains.

He advises that the regulation has to start from the manufacturers who have to clearly label their food so that the consumers know that the food they are taking is either healthy, medium or not good for their health.

“The government should ensure that the font of food labelling is improved, clear, straight forward and easy to understand. We should also have mass public understanding on food; it should start with the basics on what food is, what counts as healthy food and what unhealthy food is as well as its effect on their bodies,” he says.

Mr Ogweno believes that regulation of the food applications to include the nutritional profile of the food they sell can help.

“The nutritional profiles should start at the source where these foods are being produced, proper nutritional standards have to be followed so that it meets the threshold of what counts as healthy food.”

He agrees with the WHO report on healthy advertising and adds that governments should give incentives and also ask food application managers to engage nutritionists to advise them on healthy ways of selling their food.

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