Exploring Eating Patterns Associated with Increased Prevalence of Diabetes Among Malawian Families Using Photovoice
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Consumption of calorically dense foods with high levels of harmful fats and sugars is a key factor in the increased prevalence of diabetes. Diabetes, a disease previously associated with affluent nations, is increasing globally and is now becoming an important public health problem in developing countries. With a global adult prevalence of over 422 million, diabetes is a priority noncommunicable disease for global action. In Malawi, diabetes and other noncommunicable diseases are on the increase amid high rates of pre-existing communicable diseases, such as HIV/AIDS, malaria and tuberculosis. This double burden of communicable and noncommunicable diseases puts pressure on the already compromised healthcare provision and funding available. The current prevalence of diabetes among adult Malawians is estimated at 6%, an increase from less than 1% in the 1980s. Although research indicates that dietary changes in sub-Saharan Africa have increased the risk of diabetes, there is little to no research on the epidemiology or causes of this increase, including on eating patterns in Malawi. This study explored the food Malawian families eat to see if this has changed over time and how this might relate to the increased diabetes prevalence. Underpinned by a critical public health perspective, the study utilised photovoice with four purposively selected families residing in the semi-rural areas of Blantyre district in Malawi. Photovoice was used to capture visually the food eaten, as a useful means of describing and analysing the elements of typical meals and snacks. The study also used the Honest Food Model to analyse and discuss the wider food system that affects eating patterns. The study explored eating in the family because most eating in Malawi takes place in the context of the home and family. The findings indicate that the shift away from a traditional diet observed in current eating patterns is a major factor in the increased prevalence of diabetes in Malawi. It is important to note that Malawian diets have not undergone total modification as staples, such as maize and sorghum, are still being consumed. However, this research provides evidence of increased consumption of obesogenic foods, such as refined sugars, salty processed snacks, saturated fats and sweetened beverages, in the general population. All these foods are associated with an increased risk of type 2 diabetes. Considering the role of obesogenic products in the epidemiology of type 2 diabetes, the current eating patterns in Malawi are in line with nutrition transitions that heighten the risk of diabetes in sub-Saharan Africa. Using the Honest Food Model, this study examines some of the key factors associated with changing dietary patterns, and consequentially makes preliminary observations on potential policy approaches. The study recommends further research on the food Malawians are eating and the resultant health effects, exploring the implications for the food system, and the need for important related micro and macro policy steps, community and societal actions, including important roles for private sector and media.