Bundling of unhealthy food products in Johannesburg, South Africa: an exploratory study.

South Africa has high levels of obesity and overweight, which contribute to non-communicable diseases and are associated with poor diets high in ultra-processed foods. Bundling occurs when two or more products are packaged and sold together, often at a discount and is a marketing strategy for unhealthy foods. Given the paucity of data on bundling of unhealthy foods, this exploratory study sought to document how unhealthy foods are bundled together to be more attractive to consumers in Johannesburg, South Africa. Fifty food outlets were included and compared across two regions. In-store photos were taken of bundles and individual items, and data were captured on the costs of the bundle and of individual components. Descriptive analysis and the contents of the bundles based on the photographs and promotional material were conducted. Almost half of all outlets had more than five bundles and nearly a quarter had bundles targeting children. Most children's meals were burgers, and all had fries as part of the bundle. The average savings per bundle when compared to the combined cost of individual items was R21,39 overall, or 18%. The study demonstrated that unhealthy food bundling is a common practice in food outlets in Johannesburg, often with cost advantages and promotional appeal. Policy options for promoting a favourable food environment include regulating portion sizes of bundles and offering healthy options as part of a bundle. Marketing food to children by bundling unhealthy food with toys is of particular concern and is prohibited in the recently gazetted Regulations Relating to the Labelling and Advertising of Foodstuffs.