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Background and Aims Many low- and middle-income countries are undergoing epidemiological and health transitions. South Africa has one of the highest prevalences of overweight and obesity in Sub-Saharan Africa. This research examined neighbourhood and household socio-economic influences on the risk of overweight and obesity in terms of anthropometric status and dietary intake among urban South African adolescents. A further aim was to conduct a qualitative study on the potential for religious groups such as Churches to be used as community-based organisations for obesity intervention. Methods A secondary analysis of neighbourhood and household socio-economic status (SES), anthropometric and dietary data was carried out on adolescents aged 17-19 years from the Birth to Twenty Plus cohort study in Johannesburg-Soweto. Qualitative data were collected through focus groups discussions and a community readiness survey with church leaders. Results No significant associations were observed between SES (household and neighbourhood) and energy, protein, fat, or carbohydrate intakes in males. Some significant associations were found between SES and dietary intake in females. Females had a higher prevalence of overweight and obesity than males (26.2% vs. 8.2%, p<0.0001). In males, poor household SES was associated with lower odds of overweight, fatness and high waist-to-height ratio (WHTR). For females, household SES was not significantly associated with overweight, fatness and high WHTR. The qualitative research showed that there was a very low level of community readiness among church leaders for obesity prevention programmes. Conclusions The dietary results suggest that the diet of these adolescents is transitioning to that seen in high income countries. It also highlights that even within the same relatively small urban area, nutrition transition does not affect different groups in uniform ways. The qualitative results indicate that programmes should focus around raising awareness of the problem of overweight/obesity in this community.

Background: The aim of this mixed methods PhD was to explore the healthiness and environmental impact of the dietary behaviours of rural and urban Ugandan women of reproductive age (WRA) and identify factors influencing these behaviours. Methods: In study one, principal component analysis was used to explore evidence for dietary transitions and describe Ugandan women's dietary patterns using secondary data. In study two, dietary data collected using a qualitative 24hr recall, were used to assess the healthiness and environmental impact of the dietary intake of WRA using nutrient profiling and greenhouse gas emission data. In study three, multiple correspondence analysis and cluster analysis were performed on data from study two to compare current dietary patterns with those from study one and categorise participants into dietary typologies. Study four established factors influencing women's dietary practices using Photovoice. Findings: In study one, urban residency was associated with the 'transitioning, processed, low environmental impact' (β=1.19 [1.06, 1.32]) and 'animal-based high environmental impact' (β=0.45 [0.28, 0.61]) dietary patterns, but not with the 'plantbased low environmental impact' pattern (β=-0.49 [-0.62, -0.37]). Some consistency was observed in dietary patterns identified from studies one and three. Study three identified four dietary typologies: 'urban, low-impact, early-stage transitioners', 'urban, medium-impact, mid-stage transitioners', 'rural, low-impact, early-stage transitioners' and 'rural, low-impact, traditionalists'. Study two suggested that urban and better educated WRA were more likely to consume healthy, lower impact foods. Study four identified convenience, meal balancing, perceptions, family, friends, food vendor reputation, availability and economic and physical access as key factors influencing dietary practices. Conclusion: Ugandan WRA are experiencing early-mid stages in the nutrition transition. Family provides an avenue through which interventions aimed at impressing positive perceptions towards healthy and lower impact dietary practices can be targeted. Home gardens, urban farming and improved transportation can address challenges in availability and access to healthy, lower impact foods.