Background: In South Africa, similar to other populous countries, the taxi industry is an important form of transportation that contributes to the country's development. As a result, minibus taxi driving is an occupation characterized by strenuous activities such as long hours of driving, limited rest, and challenges related to securing passengers, among several others. Consequently, to combat stress, some commercial drivers resort to smoking, overeating unhealthy food sold at transportation interchange areas (i.e., taxi ranks), and participating in sedentary behaviors. Most of these activities are risk factors for metabolic syndrome (MetS).

Aim: Therefore, this study aimed to investigate the sociodemographic and lifestyle factors that predispose South African taxi drivers who work in the Cape Town Metropole area to the risk of developing MetS.

Methods: This cross-sectional study used a convenient sampling method that included 185 male minibus taxi drivers aged 20 years or above. The participants were interviewed using a validated questionnaire to gather information regarding their sociodemographic characteristics and lifestyle practices. They also underwent physical and metabolic assessments, and the International Diabetes Federation (IDF) criteria were used to diagnose people with MetS.

Results: Overall, the mean age and driving experience of the taxi drivers were 40.0 years (SD: 10.7) and 9.1 years (SD: 7.4), respectively, with those with MetS being significantly older and having more driving experience than those without. Older participants were 3 and 2.9 times more likely to be diagnosed with MetS than the younger participants. Most taxi drivers (70%) met the IDF diagnostic criteria for MetS. Smokers, those who spent more than 100 ZAR (USD 5.9) and those who spent less than 1.4 MET-minutes per week on physical activity were 1.96, 2.0, and 13.6 times more likely to suffer from MetS that those who were nonsmokers, those who spent less than 100 ZAR and those who spent <1.4 MET-minutes per week on physical activity. Consumption of alcohol and sugar-sweetened beverages (SSBs), as well as takeaway and fried foods, snacks, and sold by the SF vendors, increased the likelihood of developing MetS, abnormal HDL-C, TG, and hypertension, while avoiding takeaway and fried foods decreased this likelihood. Taxi drivers who also avoided consuming fresh fruits had abnormal HDL-C.

Conclusion: These findings have significant public health implications, highlighting the need for South African policymakers to adopt a system-level approach to promote lifestyle changes among taxi drivers within the taxi industry. This can help reduce the health risks faced by these drivers and improve their overall health profile.