Fried chicken and sugary drinks: Tanzania battles a growing obesity problem

By Harry Johnstone

In early 2025, Said Shukuru, 31, was experiencing life-threatening health concerns. He weighed 150 kg; his body mass index (BMI) was over 40 and he had a blood pressure of 190/100.

“It was very serious,” says Shukuru. In April last year, he underwent a successful mini gastric bypass operation at the Aga Khan Specialised Polyclinic in Masaki, Dar Es Salaam. His weight has since halved.

Shukuru’s case may be extreme, but his story serves as a warning. Overweight and obesity levels are increasing fast across East Africa, and particularly in Tanzania. Unless the government responds properly, the country faces a looming public health crisis.

Overweight and obesity in Tanzania have grown over the past 40 years because of economic development and liberalisation, urbanisation and increasingly sedentary lifestyles. Traditional diets, based on whole foods, are being replaced by refined and processed products. To make matters worse, chicken and chips, known as kuku chips, and sugary drinks are everywhere.

“When you live in an urban area like Dar [Es Salaam],” says Shukuru, “junk food is cheaper than groceries.”

The origins of these developments lie in Tanzania’s economic history. During the colonial period, fruits and legumes were exported while high-energy, starchy foods like maize were produced for domestic consumption, says Joyce Kinabo, professor of nutrition at Sokoine University.

“Food security was considered as having a lot of maize,” says Kinabo.

In the late 1980s, under President Ali Mwinyi, Tanzania moved towards a free-market economy. Tanzania opened itself up to processed consumer imports while continuing to export nutrient-rich commodities.

The country’s wealthier middle classes began eating the likes of Kellogg’s Frosties, Brookside UHT milk and Korie cooking oil.

Processed foods “flooded the market”, says John Msuya, an associate professor of nutrition at Sokoine University. “You’d go to a rural area,” he says, “where there is no school and no health facility, but Coca-Cola would be there.”

Tanzania is not alone. Across Africa, liberalisation, urbanisation and weak regulation have created attractive markets for food and beverage multinationals like Nestlé, Unilever and PepsiCo.

There is a historical precedent here. As regulation became tighter in richer countries from the 1990s, tobacco and alcohol companies spent decades promoting consumption in markets in the developing world, where governance was weaker.

The food and beverage industry is now facing scrutiny for adopting a similar strategy in aggressively marketing “unhealthy commodities” across Latin America, Africa and Asia.

Since the 1990s, adult obesity levels have more than tripled in Tanzania. The prevalence of overweight (meaning a BMI of over 25) has grown even faster. This has led to a rise in diabetes, strokes, cardiovascular diseases, cancers and other non-communicable diseases (NCDs). These ailments can also render people more susceptible to infectious diseases like malaria.

“It’s a problem that is killing the population,” says Kinabo. “It’s just happening slowly.”

It’s also costly: treating NCDs can eat up a large share of a household’s income. Nationally, the combination of healthcare needs and productivity losses derived from obesity and overweight are likely to cost the Tanzanian economy $1.26 billion annually by 2030.

For governments and partners, this raises a difficult question: should the response focus on persuading individuals to make healthier choices, or should it change the commercial environment in which those choices are made?

In Tanzania, the focus is currently more on the former. Helping people change their lifestyles is the “foundation” of the Aga Khan Polyclinic’s work, says Dr Hanifa Mbithe, a physician at the clinic in Dar Es Salaam. Patients like Said Shukuru have benefitted from the hospital’s fitness club.

Tanzania’s government is promoting physical exercise as the best response to overweight and obesity. It is creating youth clubs and temporarily closing roads in Dar Es Salaam so residents can go jogging.

“The main message from the Ministry of Health is eat a balanced diet, exercise for 30 minutes a day and go for regular check-ups,” says Dr Zainabu Tindi, a nutritionist at the Muhumbili Orthopaedic Institute. But the government is nonetheless “struggling a lot to fight this issue of obesity,” says Dr Tindi.

Public awareness should be the number one priority, says Joyce Kinabo. In schools, the government is behind classroom efforts to educate children on improved diets. The Ministry of Health is also promoting its Food-Based Dietary Guidelines.

But on changing individual behaviour, more can be done. The national media, for example, could be more engaged in making the public understand the dangers of processed or fast food and the benefits of a balanced healthy diet.

And while the government is building playgrounds at schools, there needs to be a complete transformation in urban infrastructure. Cycle routes, walking lanes, leisure areas, parks and buses accessible by foot are all essential to support a more physically active and healthy population.

The glaring gap, however, remains in the second response: transforming the commercial environment. Msuya believes the government should do more to regulate the marketing of "cheap calories", citing limited action to curb advertising and sales of foods high in fat, sugar and salt.

One option is to tax cheap calorie products. Tanzania is now considering a sugar tax, or “nutrition promotion levy” on sugar-sweetened beverages (SSB).

“The main challenge is often not the absence of a tax,” says Dr Laetitia Ouédraogo Nikiema, a nutrition lead at the World Health Organization. “But whether the tax is designed around a clear public health objective, covers the right products, is set at a meaningful level, is adjusted regularly and is effectively enforced.”

Other measures could include tighter restrictions on marketing unhealthy foods, particularly to children, clearer front-of-pack nutrition labelling and limits on the sale of unhealthy products in and around schools. Such policies would shift some of the burden away from individuals and towards the companies that manufacture, market and distribute these products.

“We still have a long way to go,” says Msuya.

From a policy perspective, the case for greater action is strong. Tanzania and governments across the continent simply cannot afford not to tackle this issue. Public finances are at stake, as are the lives of millions like Said Shukuru. Donors, civil society, business and governments must step up.

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Harry Johnstone is a freelance journalist, whose reporting has appeared in the Financial Times, The Guardian and The Telegraph. He covers topics ranging from climate change and food security to cultural heritage.

This article was first published in The Telegraph.