Try to recall what you ate in the last 24 hours. Most probably you had sugared tea, bread with margarine for breakfast; you probably did not have any lunch or just had a snack; then had fries and sausages for dinner. Now that is what we call unhealthy choices. Scientific evidence has shown that consuming at least five portions of fruit and vegetables a day can prolong your life and reduce your risk of developing non-communicable diseases (NCDs). Yet with modern life on the fast lane, many people are cutting off these vital items from their diets. Sly Atieno\u2019s habit is a typical example. The mother of two, who resides in Shauri Moyo, says her schedule does not allow her to cook a proper meal for her family. \u201cMost mornings, we have doughnuts and tea for breakfast. I eat a muffin and soda for lunch at the office while my children have chips mwitu (street fries) or smokies with processed juice when they get home from school,\u201d Atieno, a clerk with the government, describes. Her husband, Obed Munialo, doesn\u2019t eat at all during the day; he only has breakfast and dinner. He says, overall, decent food in the city is expensive and he does not trust vendors near his office. \u201cSanitation and hygiene at the food kiosks close to my workplace are wanting, I\u2019d rather stay hungry,\u201d he explains. Africa is experiencing a nutritional transition. Dietary patterns are changing as globalisation contributes to food environments filled with tempting, but unhealthy choices that were unavailable a few decades ago. The large and rapid shift of populations from rural areas to cities, where such foods are cheap and available on every corner, means it is easier than before to over-consume unhealthy foods, usually high in calories and low in nutrients.\u00a0 Experts warn that habitually filling up on processed, nutrient-poor foods high in salt, sugar and trans-fats (unsaturated fats) are a significant driver of obesity and a major risk factor for developing diet-related Non-Communicable Diseases (NCDs), including cancer, diabetes, and stroke. The World Health Organisation statistics indicate that deaths from NCDs are concentrated in low- and middle-income countries, and rates are steadily rising. Kenya, unfortunately, exemplifies this trend, with diet-related NCDs accounting for 27 per cent of deaths suffered by Kenyans aged between 30 and 70 years, equivalent almost 370,000 people per year, reducing productivity, curtailing economic growth and trapping the poorest people in chronic poverty. Overweightness and obesity have increased by almost tenfold over the last six years and are higher among urban dwellers. A new survey, Dietary Transitions in Kenyan Cities: Leveraging Evidence for Intervention and Policy to prevent Diet Related Non-Communicable Diseases, conducted between September and December last year by the African Population and Health Research Centre (APHRC) in Makadara sub-county in Nairobi, has found widespread consumption of unhealthy food in the city. The pioneering study involving 144 people in the low- and middle-income, and densely populated surburb looked at how food and beverages are embedded in everyday life in urban Kenya. It observed high consumption of sweetened beverages at 78.5 per cent, Energy Dense Nutritionally Poor (EDNP) food at 89.9 per cent, energy dense nutrient-rich food at 84 per cent, sweet foods at 57.6 per cent and fried foods at 42.4 per cent. EDNP foods include chapati, mandazi, fries, smokies, cakes, pastries, carbonated beverages, among others. Ironically, these are readily available in neighbourhoods and are less costly compared to the nutritionally rich alternatives. Energy dense, but nutritionally rich foods include leafy greens, grass fed liver, salmon, eggs, avocado, almonds, grass fed beef, potatoes, among others. Of the three main meals people had each day, sweet foods were consumed more in the morning, fried foods were common in the evening, with limited snacking between meals. Eating episodes in most households lasted 10 to 29 minutes during dinner in company of family members. The survey highlights that quick eating episodes encouraged consumption of EDNP foods. It recommends families create more time to eat together and talk with each other. According to the study, eating alone was quite common at 41.7 per cent, but eating with friends was much less common at 8.8 per cent. Sweet foods and energy dense nutritionally rich foods were eaten with friends. Street eating, which stood at 12.2 per cent, appeared to be most common in the afternoon, which researchers thought coincided with leaving work. The study also identified social and environmental factors that effected food choices, including family and friends, poor sanitation and the cost of food. These were determined by asking participants to take photos of their environment and influences known as photovoice. Food vendor services, prices and friendliness including credit services and packaging influenced where food is bought. Paula Griffiths, a professor of population health at APHRC said in the family, children, spouses and parents\u2019 preferences were specifically noted as key considerations in food purchase, preparation and consumption. \u201cSince family and food vendors largely influence individual food choices, they should be considered when developing strategies and interventions to enhance healthy individual dietary practices,\u201d she said. Sanitation Poor hygiene, sanitation and food contamination were highlighted as major concerns about food sold in neighbourhoods as a potential health hazard. They were thought to be among the causes of cholera outbreaks and diarrhoea in the community. While there were more healthy foods available, such as grains at 37 per cent, vegetables at 38 per cent and eggs at 37 per cent, they were less common as people feared they are not handled hygienically. \u201cWhat stood out for us in this study is that even though healthier food options were cheaper, residents preferred processed food options because of\u00a0 lack of clean water,\u201d said principal investigator of the study, Professor Michelle Holdsworth, from the University of Sheffield\u2019s School of Health and Related Research. \u201cThey don\u2019t have free clean water, so they have to buy clean water to drink, and if they\u2019re going to have to buy something, they prefer soda,\u201d she added. \u00a0 This was further asserted by the study, which found out that energy dense foods, particularly fried and processed food, were sold in outlets at 36 per cent as were sugar sweetened beverages at 37 per cent. One in every four outlets, posters were the most common form of advertising followed by paintings, with sugar-sweetened beverages most advertised at 48 per cent. Milka Njeri, a research assistant at APHRC in her presentation of how food is sold and advertised in the city, noted that there is need to regulate the location of advertisements of unhealthy food options. \u201cSince healthy foods are widely available, addressing availability alone might not be enough; financial accessibility also needs addressing,\u201d she said, adding that exploring how accessibility of foods sold and advertised is associated with dietary behaviour is vital. Besides sanitation, financial access was highlighted as a barrier to quality and healthy food. Fast food, fruit and vegetables were thought to be cheap and easily available while fish and meat products were said to be more expensive. \u201cPeople in informal settlements spend a lot of their time working, therefore, they get exhausted and this, in part, drives food choices. Often the last thing people want to do at the end of a long day is cook, so cheap takeaway meals are appealing,\u201d says Njeri.\u00a0 She adds that people on low incomes are more likely to buy EDNP foods instead of fruit or vegetables because they are more filling. But while a chapati might fill you up for longer than an apple, it is bad for your health. Interventions Dr Gershim Asiki, the associate research scientist at APHRC, said poor hygiene, environmental sanitation and food adulteration reveal continuing challenges of the urban nutrition transition, with infection due to poor food hygiene alongside unhealthy eating associated with NCDs. Enforcing legislation to promote healthy and safe food is essential in lowering these risks. These can be done through integrating health and nutrition in all stages of government planning and budgeting to ensure high impact on nutrition. \u201cLocal authorities have the power to help shape our environment and support people in making healthier choices. They need to question whether these fast food hotspots are compatible with their work to help families and young children live healthier lives. Do poor people often eat unhealthily because they are surrounded by fast food shops?\u201d he offered. Asiki said Kenya is performing relatively well in only four policy areas; restricting marketing of breast milk substitutes, demonstrating political leadership, having comprehensive implementation plan linked to national need and ensuring all policies are sensitive to nutrition. Also recommended were empowering street food vendors to provide healthy and safe food to the community since they are common sources of food for urban dwellers; and promoting urban farming, identified as having potential to provide greater access to affordable, healthy and safe foods at low or no cost.