Barriers to a just, sustainable dietary transition

As world leaders meet to discuss grand global challenges, like climate change, over champagne cocktails this week here in NY, my friend and colleague, Chris Barrett and company asked to write about what I think are the main barriers or challenges to a just, sustainable dietary transition. Hmmmm. Where to even start?

The overarching major challenge is the inequities in the ability of many people to access (physically, economically, and socially) what is considered healthy, safe, and sustainable diets. Ironically, many of these same people are the food producers for the world. Accessing these diets and adapting will only get more complex if we stay on a business-as-usual course in the context of climate mitigation and adapting to climate-related extreme weather events.

There are many reasons for this lack of access that could cut across inefficiencies across food supply and environments and demands for specific kinds of food that put the world on a dangerous course. However, there are a few barriers that I would like to highlight. This summary focuses on food systems. However, many systems and sectors are responsible for meeting this goal, such as health, economics, education, and urban/rural development.

The first challenge is unrealistic goal and recommendation setting. Goals such as the Sustainable Development Goals provide a universal road map for how we want the world to be in seven years. Still, not every goal is relevant, meaningful, or a priority for every country. Recommendations for food system transformation are often made as generalities, not articulating who is responsible, for what, and by when. They also do not indicate how these recommendations can be translated into action ‘on the ground’ in the context of established interests and constrained budgets.

The second challenge is data gaps. High-quality analytical methods and tools to collate, curate, and analyze data across food systems; integration of data sets across disciplines; and new empirical research to solve the grand challenge of sustainable development (Fanzo et al., 2020). These data gaps bring about difficulties in navigating unintended consequences or trade-offs. While there are many gaps across food systems science, I focus on diets here.

We remain unclear on what people consume, why, and their barriers to accessing healthy, sustainable diets. Global dietary intake data that are nationally and subnationally representative remain sparse. Most countries do not consistently and systematically collect individual dietary intake data, and the existing data are often based on models relying on household expenditure and consumption survey data, food balance sheet data, or data from subpopulation nutrition surveys. Although these modeled estimates may give us a sense of dietary intake and patterns of consumption, they are an uncertain substitute for robust, representative individual dietary intake data reflecting recent consumption patterns at a national level, particularly in low- and middle-income contexts. Collecting robust longitudinal dietary data would allow researchers and policymakers to understand better how diets change over time and why.

The third challenge is the politics across food systems governance. As one example, the United Nations Food Systems Summit (UNFSS) and its stock take in July 2023 is not without uncertainties and controversies, with rumblings of it all being grandiose political wonk talk. With summits, there are always questions about impact. Will all stakeholders be included? Will the needs of the vulnerable and marginalized be prioritized? Will there be a sense of urgency to scale up investment? Will there be any accountability mechanism to track commitments and hold those to account who fall behind? If this is the mechanism for food systems change and for governments to engage, these questions are critical to understand and act on.

While addressing effective governance is a sticky issue, more and more, we as researchers must engage in this space if we are to see evidence come to bear in policy- and decision-making.

The Future of Food

Growing, producing, and shipping food are big contributors to climate change. According to the UN Food and Agriculture Organization, about one-third of the global greenhouse gas emissions come from the world's food systems. Food is "an instigator of climate change and it's a victim of climate change," said Jessica Fanzo, director of the Johns Hopkins Global Food Ethics and Policy Program and author of Can Fixing Dinner Fix the Planet?, in an interview with Mike Walter of CGTN.

One of the solutions is changing individuals' diets, what Fanzo and fellow food researchers from the EAT-Lancet Commission call a "planetary health diet." The diet is high in fruits and vegetables, as well as beans, legumes, nuts, and seeds, while food from animal sources, including meat, fish, and dairy, are low. Not only is this sustainable for the planet, "it's a very plant-based diet that meets nutritional needs, decreases your risk for non-communicable diseases like cardiovascular disease and diabetes and stroke, all these long-term, chronic, quite costly diseases," Fanzo said.

Time To Invest in Food Systems Science

President Biden’s first budget request when he came into office called for significant investment to science with increased budgets to the National Institutes of Health (NIH), the National Science Foundation, NASA and the National Oceanic and Atmospheric Administration, and the NIH office funding research on climate change and human health. The U.S. Department of Agriculture’s budget alone would increase from $647 million to $4 billion to be spent on research, education, and outreach. This is a signal that science will no longer be swept under the rug.

On February 23, 2021, the World Food Prize Foundation released a statement penned by 24 of its Laureates—considered some of the world’s experts on food security—urging the Biden Administration to focus on alleviating hunger, poverty, and malnutrition around the globe. The Laureates called for investments to improve food systems—which feed us—but also are responsible for 30% of greenhouse gas emissions and the generation of diets that are linked to 6 of the top 10 risk factors of the global burden of disease. They urged the U.S. to strengthen and leverage alliances, play a leadership role in the upcoming United Nations Food Systems Summit this September, and refresh evidence-based policymaking. Others have called for the U.S. to transform the food systems as well including the Rockefeller Foundation and renewed engagement marking the 50th anniversary of the 1969 White House Conference on Food, Nutrition, and Health. Some, including academics and former U.S. senators and the Secretary of Agriculture, has gone further to aim for a “moonshot” federal funding for nutrition research.

Can we now please stop using the word “moonshot”?

One way to do that is for the U.S. to invest more in food systems science and research. As several of us wrote in a recent Global Food Security Journal piece, research has a vital role in charting a positive and sustainable direction for global food security, nutrition, and health. At a time when facts, science, and evidence are under ever greater scrutiny, and even openly disregarded as suspect by some political and business leaders (we won’t mention any of the very obvious names), the rigors of research have never been more critical. Research can and does bring about wholesale changes in attitudes, political thought, and action.

Those of us who do research must see their role in terms of knowledge generation and the translation of this knowledge into a form that is relevant to decision-makers in government, business, and civil society.

Those who design, shape, and enact policies need to access the research they need in a digestible and accessible way. Failure to achieve this brings a very considerable risk of being ignored. Researchers must learn to sit at policy dialogue tables not set for them, but the table for the users of their research – that is, the policymakers. It is a table that many researchers are not accustomed to sitting at.

Food systems encapsulate the choices we make about which foods to consume and grow and how we transport, store, process, and market them. These choices profoundly affect outcomes we care about.  To date, the choices all stakeholders make, whether governments, foundations, businesses, civil society, or individual consumers, have relied on fragmented information on food systems, of variable quality, which is difficult to access or use. 

The Food Systems Dashboard is an open-access data platform to address these issues. Created by Johns Hopkins University, the Global Alliance for Improved Nutrition, the UN Food and Agriculture Organization, and many other collaborators, it launched in June 2020, to attempt to boost the evidence-based decision-making on food systems. The Dashboard is designed to inform decisions that have positive effects on multiple social and environmental challenges simultaneously. Different food choices have different impacts on health, the environment, and livelihoods. There are trade-offs and synergies which need to be surfaced, navigated, and mitigated. For example, different foods have different nutrition values, greenhouse emissions, and different natural resource use implications. In short, the Dashboard is the beginnings of an ambitious “Google Map” for food systems. Let’s hope we make it as navigable and useful over the next decade.

Food systems must adapt and transform to deliver sustainable, healthier diets, and durable livelihoods without decimating the planet. Yes, that is a lot to ask! To do that, we need investment in science, evidence generation, and decision-making tools, like the Food Systems Dashboard, that enable data-driven decision-making in food systems. The Biden Administration has taken a bold step forward to invigorate the various fields of science in the U.S. In turn, the research community should rise to this challenge, and we provide a platform to challenge the status quo and take food system transformation in a direction we may have imagined but are far from realizing.

Can Fixing Dinner Fix the Planet?

Two years ago, I embarked on the writing of my very first book. Coming from a field of expertise that values peer-reviewed scientific publications more than books, I did not think it was in the cards to consider authoring a book about my discipline and my experience working in that discipline. But here we are, and tomorrow, my JHU Press Wavelength series trade book, Can Fixing Dinner Fix the Planet? will be released. The pandemic helped, unfortunately. It nudged me to sit still and put pen to paper.

The book investigates the interactions among food systems, diets, human health, and the climate crisis. It draws on my experiences (along with my team and many colleagues) working and living in Africa, Asia, Europe, and the Americas. It describes how food systems must change to slow and reverse the stark trends we see with increased hunger and obesity, catastrophic climate change, and inequities. The book draws attention to the idea that the very nature of food and food systems can play a significant role in fixing these vexing challenges and bring communities together.

Food books abound—cookbooks by celebrity chefs (thanks Anthony Bourdain!), history of food and cuisines, and self-help diet books. My book does not delve into these areas much. Instead, it delves deep into politics and shows that if we take a “business as usual” path of how food systems have, are, and will operate, there will be significant negative consequences on human and planetary health. It provides examples of what can be done by the various actors like government and food and agriculture industries to promote healthy, sustainable, and equitable diets, sustain the earth’s biodiversity, and protect the environment and all species living on the planet. And last, it raises readers’ food and environmental literacy and empowers readers to take immediate and long-term changes by helping them make informed decisions when they walk into restaurants, grocery stores, farmers' markets, and their kitchens.

The book changed the way I communicate my work. It is not easy to write about a complex topic like food systems and ensure that it inspires eaters, global experts in governments, and those working in and shaping food systems to make better decisions. I tried my best to bring to life some of my experiences working in different countries—from very poor to prosperous—and the experiences of those I have worked with and shared time with in deeply rural and urban pockets of the planet. It provides a nuanced story that takes you away from computer and desk research to farmer’s fields, families’ kitchens, and United Nations’ working forums.

I hope the book shows readers how our everyday diets are the products of massive, interconnected, and highly complex food systems that extend from the seedlings in a farmer’s field to the global distribution and marketing networks that deliver food to our plates. These systems have direct and substantial impacts on poverty, the planet’s natural resources, the nutrition of individuals and populations, the composition of the atmosphere, and social equity. They also are incredibly vulnerable to the climatic changes that we have already seen and that will accelerate in the future.

Generating knowledge, dutifully and honestly

“Maybe working on the little things as dutifully and honestly as we can is how we stay sane when the world is falling apart.”

— Haruki Murakami

This quote by Murakami really speaks to researchers and scientists: Keep focused. Crowd out the noise. Discover. Be dutiful and honest.

But as Tony Fauci, head of the National Institutes of Infectious Disease of the United States gets the cold shoulder from our dear Potus, with attempts to undermine his evidence-based warning calls of a worsening COVID-19 pandemic here in America, it is hard to ignore the last part of that quote - the falling apart bit.

As researchers, we often keep our heads down and dig deep into the details with laser sharp focus to keep generating data and evidence for the greater good of science and knowledge. But we can no longer sit quietly behind our benches and laptops and blissfully hope that someone, anyone, will read that peer reviewed paper that you just published in Journal X. We need to be attuned to the political climate.

Speaking of publications, I was asked to contribute to an exciting, upcoming Johns Hopkins University Press publication COVID19 and World Order. In my piece, I make a series of technical recommendations on what it would take to achieve resilient food systems and potential measures to address our current pandemic and avoid catastrophic future zoonotic pandemics. I bring up this publication because none of the recommendations to fix food systems I made in the paper will stand on two legs with the current fractured and sclerotic global political enabling environment. In order for food systems to function effectively, equitably, and sufficiently during the pandemic and long after, the political environment must be one that embraces global cooperation and inclusion and minimizes political polarization and geopolitical competition. And we, as scientists and researchers, cannot remain silent, disengaging from the political process, however dismal it may be.

Politics matter for the world and for science, and now more than ever. Frank Fukuyama wrote: “Countries with dysfunctional states, polarized societies, or poor leadership have done badly, leaving their citizens and economies exposed and vulnerable.” It is not surprising that states led by populist, inward-facing leaders such as the United States, Brazil, and Mexico are not sufficiently addressing the pandemic. This has led to dire consequences for the citizens living in these countries with many who are struggling with food insecurity and high COVID-related morbidity and mortality.

The COVID-19 response has also displayed the weaknesses of the multilateral system and existing institutions. Within this, the “global food architecture” is often slow, outdated and needs 21st-century support and strategic know-how. One of those entities - the World Health Organization - has tragically and sadly just lost its support from the United States during a time in what may be one of the most crucial global health issues of the century. Multi-lateral cooperation looks perilous and science and the data that it bears is being undermined.

However, cooperation can happen in times of crisis - we have seen it before. Perhaps the UN Food Summit in 2021 can be a moment to create a global strategy for food governance that is nimble, modern, and inclusive, backed by an Intergovernmental Panel on Climate Change-like body that provides evidence and science to support actions.

As the Editor-in-Chief of the Global Food Security Journal, my co-editors and I share our perspectives on the food security challenges that face humanity and lay out our vision and call for stronger food systems research and science in the 2020s. I think this piece comes at a critical moment in food policy with COVID and climate change, because the challenges and opportunities for food systems research that lay ahead are significant, requiring that high-quality science be translated into policy faster than ever before.

“Our vision is one in which research and science, and the evidence stemming from their application, not only inform food and environmental policy, but are adopted and mainstreamed into actions at the national, regional, and global levels.”

In the paper, we write: “At a time when facts, science, and evidence are under ever greater scrutiny, and even openly disregarded as suspect by some political and business leaders, the rigors of research have never been more critical. It is also important not to become disheartened by the slow speed of change in policy and practice, even when the appropriate course of action is clear ‘to us.’ Research can and does bring about wholesale changes in attitudes, political thought, and action, but change takes time.”

We argue that the food systems have transformed, but with that transformation, we are left with profound and widening gaps to address sustainability and equity. These gaps will make future food security and continuity of life on the planet difficult to say the least. As researchers, we will have to fill in those gaps to ensure we meet the demands of a growing population sustainably while co-existing in amity with the planet.

We also need to find the stitched pockets of progress and small glimmers of hope as the basis of our knowledge to move forward - dutifully and honestly.

The COVID-19 Crisis and Food Systems: Addressing threats, creating opportunities

Lawrence Haddad, Jess Fanzo, Steve Godfrey, Corinna Hawkes, Saul Morris, and Lynnette Neufeld

With the spread of COVID-19, we find ourselves plunged into a global health crisis. By most accounts, we are only at the early stages of the pandemic so it is going to reshape economy, society, and politics, probably permanently.

Pre-COVID-19 crisis, many families the world over already spent a lot of time and energy thinking about getting access to food. During the crisis, the most vulnerable face the rapid loss of their income - spent mainly on food - and this is an immediate threat that should be prioritized. For many others, simple access to shops has also become very worrying and needs swift attention. Even the wealthy are increasingly thinking about food access at this time.

But are governments, businesses and civil society thinking enough about food access and the wider food system?

How will the crisis shape the food system if we do nothing? And what can we do in the context of the crisis to get the food system in better shape to improve the consumption of nutritious foods for all, especially the most vulnerable?

We desperately need to focus on the operation of food systems at the moment because we know that the quality and quantity of the food we eat is the number one risk factor in the prevention of general mortality and morbidity. If we forget the food system right now, the COVID-19 health crisis will unwittingly use the food system as a catapult to have an even bigger impact on the global burden of disease. If we think and act to change the food system right now, we can reposition it to be more effective at delivering affordable nutritious food during the crisis, and perhaps even after the crisis.

What are the probable effects of COVID-19 (and the efforts to control it) on the food system which shapes our access to nutritious food?

It is difficult to say for sure, but in this table we share some thoughts on the potential impacts throughout the food system of COVID-19 (and the response to it), and some ways of mitigating the impacts. We do this for high- and low-income contexts, which may well exist within the same countries. Many of our suggested actions are responses to immediate needs, but many would have positive impacts well after the crisis is under control.

What are the main threats? We are of course worried about food prices, especially for more nutritious foods, which are already more expensive than staples and unaffordable for many people, especially those on low incomes who already spend much of their money on food. More food staples will be consumed as a result of price hikes, but likely also more, unhealthy, highly processed foods that are cheaper, have longer shelf lives and may provide comfort in tough times. In addition, increased food price volatility (due in part to hoarding and cross border impediments) generates uncertainty and makes it more difficult for food system actors to take all manner of decisions.

We are also deeply worried about negative income shocks on the most vulnerable, through the loss of livelihoods as the demand for certain services collapses and certain production systems are disrupted due to affected workers. Farming, in particular, seems very vulnerable given the older age profile of farmers and the mortality pattern of COVID-19 as well as the sector’s common reliance on mobile workforces. This vulnerability, if realized, will mean less food produced and weaker non-farm rural livelihoods and higher food prices for all, wherever we live. Physical distancing will have an impact on the costs of moving food around, within countries and across borders leading to more food loss and emptier markets. Lapses in food safety, which potentially started all this in a wet food market in Wuhan, will likely exacerbate if no action is taken. 

What are the probable effects of COVID-19 (and the efforts to control it) on the food system which shapes our access to nutritious food?

But there are opportunities. Healthier foods build immune systems throughout life but especially among vulnerable ages, including early life and the elderly, and so there is a window of opportunity to make the case for safe nutritious food. Diabetes and other non-communicable diseases are risk factors for COVID19 mortality and additional attention should be given to preventing the former because of the latter. 

We expect to see food safety move strongly up the policy priority list because of the origins of COVID-19. Social protection programs should be more linked to promoting the consumption and production of nutritious food, not just preventing food insecurity. We expect the prevention of food loss, especially fresh food, during storage and transport to gain a greater profile. The aging of farming capacity will be treated more seriously, with efforts increasing to make farming more profitable and appealing to younger generations.

We can see opportunities for reshaping public sector messaging, not only about hygiene but about nutritious food consumption and preparation. Will there be new opportunities to disrupt food transport by using shared economy models capitalizing on any underutilized haulage capacity to lower costs? Will we see more financing facilities for investing in nutritious food production, processing, storage, distribution and retailing? Will civil society become more organized and active about the provenance of food and about the behavior of businesses and governments in ensuring the provision of affordable food? 

Social protection programs should be more linked to promoting the consumption and production of nutritious food, not just preventing food insecurity. © Unsplash

Finally, will we see greater collaboration between government and the private sector during the crisis spill over into a reshaped narrative post-crisis about how the two sectors - public and private - can work better together to improve access for all to safe nutritious foods?

This is the first of a series of blogs that we will put out in the coming months. We have asked Nutrition Connect to set up a COVID-19 and food systems site and we would like to encourage our partners, colleagues, friends, and fellow travelers to post blogs, opinion pieces and research reports and papers that are relevant to this topic on the site, with full organizational recognition and lots of cross-posting. 

The COVID-19 health crisis is here. Let’s work together to stop it turning into a food crisis and further exacerbating disease burdens.

Governments, communities, and businesses around the world are showing astonishing energy and innovation to cope with COVID-19. The short-term priority is to stabilize food systems and keep trade open – all people working in food systems from the farmer to the check-out supermarket agent are critical to keep the food system moving. But it is in times of great crisis that fundamental reforms are born. The United Nations, the World Bank, the International Monetary Fund and the advance of the welfare state were developed in the darkest days of the Second World War.

So let’s stand by our neighbors, critical workers, and communities today. Let’s also work to reshape our food systems for tomorrow - to deal with the new COVID-19 crisis as well as the much bigger diet-related health crisis; one that has been with us for decades. 

Download the mitigation and adaptation table here.

Food Bytes: July 8 - July 20

Food Bytes is a weekly blog post of “nibbles” of information on all things food and nutrition science, policy and culture.

Food environments seem to be on the tip of the tongue for everyone these days. Food environments are the “collective physical, economic, policy and sociocultural surroundings, opportunities and conditions that influence people’s food choices and nutritional status.” Or to put it more simply, it is the place where consumers go to buy or order food - a market, a restaurant, a cafeteria.

The UN Standing Committee on Nutrition, also known as UNSCN, has just published a collection of papers on the food environment. It splits up the food environment into two entry points - the food supply shaping these environments and the consumer demand side - and what it would take to make change, also known as the enabling environment. The publication is chock-full of case studies from all over the world. I like the ones on Mexico, the private sector last mile, the flathead reservation, cash transfers, and the digital influence.

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Food Environment Framework showing supply and demand. Source: Marshall et al 2019 UNSCN report

In South Africa’s Soweto hood, women struggle to be healthy. Food environments are pretty dismal (fries, fries and more fries), and exercising outside can be dangerous. It is not just about supply and demand of healthy foods, which the UNSCN publication focused on, but the whole built environment, the way women are treated in our society and urban safety. At the same time, its seems many South Africans are taking food security into their own hands. One study found that 2.2 million households have recently constructed food gardens at their homes in order to avert food insecurity.

While we are on the lovely UN, the UN Committee on Food Security is rolling out a series of regional consultations on what is known as the Voluntary Guidelines on Food Systems and Nutrition. This stems from the High Level Panel of Experts on Nutrition and Food Systems report which called for these guidelines to be developed by governments collectively and collaboratively. These voluntary guidelines are meant to create a global norm of reference in the governance of food systems and nutrition/diets. The guidelines outline principles and practices that governments can refer to when making laws and administering food systems. These guidelines should be seen as an internationally negotiated soft law or a set of guidelines in which all governments have reached a common ground. So, they can be important, and quite powerful. Anyone can comment on the zero draft - far from its final - here. The regional consultations started in Africa, Ethiopia. Then, Asia, Bangkok. Then Central and South America, Panama, North Africa, Egypt, Europe, Budapest and last but not least, North America. I had the pleasure of being at the Ethiopia meeting and it was quite fantastic to have so many African countries in one room talking about African food systems. Amazing stuff.

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Source and Copyright: Johnny Miller, NYT 2019

Speaking of Africa, the diversity of cuisines and culture is what makes the continent so amazing. Take Nigeria. Reading Yewande Komolafe’s recipes made me want to jump on a plane to Lagos and eat my way through it.

But it is not always a rosy picture for Africa. The continent is still struggling with food insecurity, while at the same time, obesity is creeping up, up and up. The FAO State of Food Insecurity (SOFI) 2019 report just came out, two months early. It was reasoned that it came out to line up with the High Level Political Forum. Yeah sure. I think it was timed to be released right before the Director General, José Graziano da Silva stepped down to celebrate his 8 years as the leader of FAO. However, the report is nothing to celebrate. I digress…The major findings of the SOFI were the following:

• More than a quarter of the world’s population now struggles to eat safe, nutritious and sufficient food.

• Hunger is on the rise in most of Africa, in parts of the Middle East and in Latin America and the Caribbean. The situation is most alarming in Africa, where since 2015 undernourishment has steadily increased in almost all subregions. In Asia, undernourishment has been decreasing in most regions, reaching 11.4 percent in 2017. In Latin America and the Caribbean, rates of undernourishment have increased in recent years, largely as a consequence of the situation in South America.

• Economic shocks are contributing to prolonging and worsening the severity of food crises caused primarily by conflict and climate shocks.

• No region is exempt from the rising trends of overweight and “obesity rates are higher in those countries where moderate food insecurity is also higher.”

We see this in the United States too. I just wrote a piece for Bloomberg Opinion (I didn’t choose the photo.) showing that food insecure adults in the U.S. are 32% more likely than others to be obese — especially if they are women. Poverty and unemployment have driven the dual rise in food insecurity and obesity since the 1960s, especially in rural America. But many city dwellers subsisting with inadequate social services and support structures are also susceptible. Every time I write a piece in Bloomberg Opinion, I always get lots of interesting email comments. For this piece, most commenters feel that if you are fat, it is your fault. If healthy foods are available, affordable and easy to access, “these people” will always make the wrong choice. My reaction? WOW. It is so hard to eat healthy in our perverse food environments. Blaming and shaming is not going to make things better. But it seems, consumers are catching on in the U.S. - diet quality is improving.

But what does the latest evidence suggest for those who are overweight and want to lose weight? I will soon dedicate a longer blog to this issue because the literature is confusing. Is it a keto diet? Is it intermittent fasting? Is it low-carb? Is it putting a teaspoon of oil in your coffee every morning? New evidence suggests that cutting 300 calories per day, from any food, can lead to substantial weight loss in adults (7.5 kilos over two years) compared to the control group. Tamar Haspel of the Washington Post, argues that eating ultra-processed foods comes down to increased calorie consumption. We consume more of those foods, and they are calorically dense. She wrote:

“In a nutshell: The root of obesity is palatability and calorie density, combined with ubiquity and convenience. Satiety hormones and other metabolic machinations have much less to do with it. We’re responding to cues from without, not from within. One new study doesn’t prove it, of course, but it’s the hypothesis that best fits the preponderance of the evidence.”

I really appreciate this article that “Being Fat is Not a Moral Failure.” Damn straight. This Scientific American article argues “Individual behavior change is ineffective in the face of social and structural barriers that constrain individual choice. These barriers are uniquely relevant among racial and ethnic minorities and impoverished adults who are more likely to be obese.”

A bunch of scientific papers and media articles came out this week on diets, nutrition, and food systems. Here are some highlights.

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Kathmandu food stall - healthy and unhealthy foods. Source and Copyright: Jess Fanzo

• “Ultra-processed” foods or what I call, junk food, are in the news again. This article outlines four dangers with food reformulation - redesigning an existing processed food product with the objective of making it healthier. This article argues that reformulation just tinkers around the edges, and isn’t really fixing the root problems of the food system, and what the authors say is food and beverage industries.

• Case in point? Nearly 10,000 cases of heart disease and stroke and 1,500 cases of cancer could have been avoided in England if the government had not switched to a voluntary deal (as opposed to mandatory) with the food industry to cut salt in food. England is doing so much good stuff in the food space right now, but man, there are potential setbacks with Brexit and political shifts. This BMJ post by Annie Purdie and colleagues is concerned about Boris Johnson’s recent decision to look at “sin taxes” and creating a nanny state. The authors argue that the public health community needs to “move beyond debating the cost-effectiveness of interventions, and engage with the underlying political nature of the issue.” We need to pay more attention to the language (sin, nanny, liberties etc) used to highlight the problem and the proposed solutions like taxes on soda and regulating the levels of salt and sugar in foods. As Bob Marley sang, “don’t let ‘em fool ya.”

• There is more and more coming out that nutritional sciences is “broken.” In this article, they use the “eggs are again bad for you” study that came out in JAMA. Waah. Is it? I disagree! Of course, when we focus on specific foods and nutrients, the data is not clear, but dietary patterns show basically the same thing. Give it a rest dudes.

• While these researchers argue that more evidence is needed, they did find that snack foods and sugar‐sweetened beverages are providing a substantial proportion of energy intakes (ranges from 13 to 38%!) among children below 2 years of age in Latin American and South‐east Asian low and middle income countries.

• A study in the capitol of Nepal, Kathmandu, showed just that consumption of unhealthy snack foods and beverages contributed 47% of total energy intake among the wealthiest consumers, compared with 5% among the poorest. This pattern of junk food consumption among young children was associated with inadequate micronutrient intakes. The reason that mom’s give these foods to their children? Convenience - they are easy to prepare and easy to feed. Makes sense. Looks like even among very poor countries, we are seeing the nutrition transition play out in real time. Ever try making dal bhat from scratch? Not easy and incredibly time consuming…

• I love that the Lancet is calling on oral health researchers to review the evidence and conflicts of interest of the impacts of what we eat on our dental health and the caries that come with sugar consumption. The lead scientist argues, and this goes back to the infant studies: “A particular concern is the high levels of sugar in processed commercial baby foods and drinks which encourage babies and toddlers to develop a preference for sweetness in early life. We need tighter regulation and legislation to restrict the marketing and promotion of sugary foods and drinks if we are to tackle the root causes of oral conditions.”

• New microbiome research shows that a specialized food made up of chickpeas, soy, peanuts, bananas and a blend of oils and micronutrients substantially boost microbiome health in severely malnourished children. Yummy.

• Do cookbooks need nutrition labels? Great question but sort of takes the fun out of cookbooks no?

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Some things have improved for food security and nutrition. Source: Byerlee and Fanzo, 2019 GFS Journal

Derek Byerlee and I wrote a piece looking back 75 years on commitment to hunger when the first international commitment to ending hunger was made at the UN Conference on Food and Agriculture, at Hot Springs, Virginia, USA in 1943. That conference set the goal of ‘freedom from want of food, suitable and adequate for the health and strength of all peoples’ that should be achieved ‘in all lands within the shortest possible time’ (US Department of State, 1943). It is sobering and shameful that 75 years after this clarion call, as well as the dozens of similar global declarations since 1943 for ending hunger, some 800 million persons are estimated to be undernourished and over 2 billion adults and children suffer from other forms of malnutrition be it obesity or micronutrient deficiencies. We remind readers of the significance of the Hot Springs conference and briefly trace the long road that has led us back to the original vision of ending hunger that recognized the several dimensions of nutrition, from undernourishment to micronutrient deficiencies. While there has been progress, this reflection over 75 years helps appreciate the fact that today for the first time, the links of agriculture, health and nutrition outlined in 1943 are again at center stage in the global hunger challenge as embraced in SDG2. Accordingly, SDG2 offers a better foundation for accelerating progress in reducing malnutrition in its several dimensions, although we recognize major gaps in knowledge, financing, and implementation capacity for realizing SDG2 targets.

Someone else is realizing the importance of agriculture. It seems Bill Gates has woken up to the fact that the CGIAR exists. His article is titled “You’ve probably never heard of CGIAR, but they are essential to feeding our future.” Hate to spoil it Billie Boy, but we have heard of the CGIAR…and I don’t confuse it with the word “cigar,” cigarillos, ciggies, or ziggie stardust.

Country ratios of fruit and vegetable availability to WHO age-specific recommendations. Source: Mason-D’Croz et al 2019

On the environmental and climate change front, lots going on. The World Resources Institute released a mother of a report - 564 pages - on Creating A Sustainable Food Future. You may have seen the abbreviated version released 6 months ago. But this one goes into great detail a 22-item “menu” which is divided into five “courses” that together could close the food, land and greenhouse gas gaps: (1) reduce growth in demand for food and agricultural products; (2) increase food production without expanding agricultural land; (3) protect and restore natural ecosystems; (4) increase fish supply (through improved wild fisheries management and aquaculture); and (5) reduce GHG emissions from agricultural production. Richard Waite and Janet Ranganathan are seriously my heroes in creating these action oriented solutions. Well done.

Following on the heals of that report, two Lancet Planetary Health papers came out. One paper shows that even under optimistic socioeconomic scenarios future supply of fruits and vegetables, central components of a healthy diet, will be insufficient to achieve recommended levels in many countries. Consequently, systematic public policy targeting the constraints to producing and consuming fruits and vegetables will be needed. The second paper shows climate change and increased atmospheric CO2 will impact the availability of protein, zinc and iron availability. The many countries that currently have high levels of nutrient deficiency would continue to be disproportionately affected.

This expose by the Guardian shows that Brazil’s huge beef sector, and the appetite for beef, continues to threaten health of world’s largest rainforest, the Amazon. This is just downright sad.

And while those of us in nutrition don’t really get to the larger social determinants of food insecurity and malnutrition, it is important to do so. This article in NPR’s Goats and Soda delve into the practice of trading sex for fish in Lake Chilwa in Malawi. This is driven by poverty and food insecurity and the impacts are catastrophic in this southern African country - HIV, violence and stigma - for these women.

Food Bytes: June 3 - June 30

Food Bytes is a weekly blog post of “nibbles” of information on all things food and nutrition science, policy and culture.

The month of June was filled with lots of food-related action - meetings, conferences, prizes and elections. Let me tell ya, it was hard to keep up. The question is, what is the result of all these meetings and the environmental footprint of moving all these bodies from meeting to meeting? Does it actually shift the agenda in positive directions? Are we all just talking to our friends? Is it just a way to keep us busy posting photos and videos on twitter? I wonder sometimes. I am not criticizing. I am a part of the problem. But I do think it is time to rethink what all this effort is amounting to, and for who.

The UN Food and Agriculture Organization, also known as FAO, hosted a Future of Food Symposium with some dynamo speakers, but not a lot of action coming out of it. FAO also just announced the election of their new Director General. His name is Qu Dongyu from China. He is currently the Vice Minister of Agriculture and Rural Affairs of China. Makes sense. China is a giant and is greatly shaping the world’s food system. Looking forward to seeing his vision. He has a lot of work to do…

The American Society of Nutrition @nutritionorg hosted their annual nutrition conference, right upon Johns Hopkins doorstep in Baltimore. Lots of diverse science being presented and also lots of controversy around sponsporship of events and significant presence by industry. I was only there for a day but that was about all I could take sitting in an over air-conditioned window-less conference center looking at powerpoint after powerpoint. That said, it is a great way to get caught up on the latest science. And Marie Ruel, a stellar international nutrition scientist at IFPRI, was awarded the Kellogg Prize for Lifetime Achievements in International Nutrition. Well deserved. Her talk is here. I highly recommend reading Marie’s incredible body of work. Much of it can be found here. You will see why she got the award - she accomplished so much over the last 30+ years. And she still has more to do!

The @EATforum Stockholm Food Forum, also an annual affair, took place. Glitz? Check. Grand? Check. Aspirational? Check. But what’s next? The impact of EAT is yet to be seen and it remains unclear on where they will go from here. Do they do advocacy? Policy? Science? I did the opener with Johan Rockstrom or also known as Johan Rockstar. It was fun. The video is below. One thing is clear to me, if they are advocating for a better food future for all, they need to take the show on the road.

Speaking of EAT, the EAT Lancet Commission fall-out keeps churning. Some of the authors of the Commission provide some explanation of issues raised by other scientists on the environmental targets here in a Lancet short response/commentary. Another study put the EAT-Lancet reference diet to the test among a large prospective cohort of British adults. The researchers found that the diet has beneficial associations for ischaemic heart disease and diabetes, but no association with stroke and no clear association with mortality. The media continues to churn out pieces on sustainable diets and mentioned the EAT Lancet report. Great that the work is garnering so much attention in the popular press but what now? Some highlights in the last few weeks:

• This Vox piece closely examines what our diets will look like in a hotter, drier climate. Lots of talk (literally - it is an interview style piece) on the future of food and technology.

• The Eater highlights the rise of the plant-based burgers in particular, the Impossible Burger, and how fast it went viral. Seems everything David Chang touches turns to gold.

• Stepanie Feldstein also wrote for Yes Magazine about the plant-based burgers and argues that while it won’t save the course we are on with climate, small individual actions do matter, and manifest in different ways.

• This Devex article asks about the relevancy of the EAT Lancet report to the global south. Good question. One expert from Liberia indicated that many in her country don’t even know about the report. That is not a surprise. That said, in the talks I have given on the report, I have emphasized what it does and does not mean for Africa and Asia (as well as what the report did and did not do), as a researcher who squarely works in both continents. Still a lot of work to do to ensure the global findings of the report translate in appropriate ways that ensure livelihoods and culture are considered right along with health and environmental challenges for particular, diverse country contexts.

• I had to laugh at the title of this Guardian article. “Most 'meat' in 2040 will not come from dead animals, says report.” Why does that sound scary when taken at face value?

Okay enough on that! The @WorldFoodPrize 2019 winner was announced this month. The prize will go to Simon Groot, a Dutch vegetable “seedsman” where he started the East-West Seed Company reaching over 20 million smallholder farmers. More about his life can be found here. Not sure how the World Food Prize calculates the reach. I recall last year they credited shared prize winners Haddad and Nabarro, with “reducing the world’s number of stunted children by 10 million between 2012 and 2017.” While these two giants definitely made contributions, how did they get to that number?

Two publications on India just came out that I highly recommend. The first is a book, published by the great Prabhu Pingali and colleagues on Transforming Food Systems for a Rising India. It is a part of a book series by Chris Barrett at Cornell, on Agricultural Economics and Food Policy. I will publish a book on food systems for nutrition in mid 2020. At the same time, the Global Food Security Journal just published an article on future diets in India. They show that by 2050, there will be projected increases in per capita consumption of vegetables, fruit and dairy products, and little projected change in cereal (rice and wheat) and pulse consumption. Meat consumption is projected to remain low. The question remains, what will that mean for their production and food supplies and their nutrition outcomes?

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Future direct consumption trends in India by Alea-Carew et al 2019 GFS Journal

Much being written about the food system front these days. To start, Nicholas Kristof, Opinion Columnist for the New York Times, in all of his eloquence highlighted the obscene inequities of our food system. He wrote:

“If some distant planet sends foreign correspondents to Earth, they will be baffled that we allow almost one child in four to be stunted, even as we indulge in gold leaf cupcakes, $1,000 sundaes and half-million-dollar bottles of wine.”

Guido Schmidt Traub and colleagues from the Food and Land Use Coalition argue that there are three ways to fix the food system in Nature. I agree with their three pillared approach (see figure below) but how? and with what investment? More details please! And if you don’t even know what I am talking about when I say “food system”, Corinna Hawkes and colleagues lay it all out in a policy brief. She also has another brief on why food systems matter for policies. I really like these - and there are more to come. Marion Nestle also lays out what it would take to change the United States food system. Marion is so practical. I would love to see her do more global work. Maybe we all need a dose of her realism.

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What it would take to change the food system. Schmidt-Traub et al 2019 nature

The SDSN Network hosted an online conference on nutrition-sensitive agriculture from 3-5 June, 2019. Nutrition-sensitive agriculture offers great potential for achieving SDG 2, as it connects agricultural development to improved nutrition outcomes. Many nutrition-sensitive agriculture interventions have been applied in recent years. This e-conference aimed to turn the evidence coming from these interventions into concrete recommendations for practitioners. Close to 1,000 people from all over the world registered for this e-conference, taking part in three live sessions and interacting via an online conference platform. We had great speakers — Matin Qiam, Harold Alderman, and Agnes Quisumbing — who highlighted the latest research. Missed it? All the powerpoints and videos can be found here.

Speaking of SDSN, they are also responsible for the SDG Index. The 2019 report just came out. Do indices really do much? Do they spur action?Guess who ranked number one in the world in moving towards achievement of the Sustainable Development Goals? Denmark followed by Sweden. What a shocker! Last? Central Africa Republic. Second worst? Chad. Triste…Looking at the OECD countries, the USA is awful. Yo Trump, I thought you were going to make America great again. Yah, right.

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OECD Progress on the SDGs (2019)

But it ain’t just America my friends, Italy is struggling on many fronts. Just coming back from Rome, I am reminded about the scale of the rubbish there. And now it seems the trash problem is becoming a public health hazard. Such a beautiful dazzling city ruined by poor management. Oh, and tourism. Mamma mia.

Speaking of indices, Bioversity just released their Agrobiodiversity Index Report which assesses dimensions of agrobiodiversity in ten countries to measure food system sustainability and resilience. Strangely, only 10 countries are shown. Not sure why there are not more. Would be interesting to know if this will be more widespread. And if you think dedicating a day to biodiversity is important, think again. @AgroBioDiverse lays out why he dislikes the International Day for Biological Diversity. I actually completely agree with him. I have very similar sentiments with the Decade of Nutrition…

Food Bytes: Weekly Nibbles from Jan 21 - 27

Food Bytes is a weekly blog post of “nibbles” of information on all things food and nutrition science, policy and culture.

Environmental effects per serving of food produced

The EAT Lancet Commission report entitled: “Food in the Anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems” came out this week. It was both praised and demonized but regardless, it made a big splash across many media outlets. I was part of the Commission and I must say, I felt pretty worn out with interviews and podcasts after the first week of its release. So what is the report? It was made up of 37 scientists that came together to do three things: The first was to quantitively describes a universal healthy reference diet that would provide major health benefits, and also increase the likelihood of attainment of the Sustainable Development Goals. The second was to define six scientific boundaries for food systems that would ensure a safe operating space within six Earth systems, towards sustaining a healthy planet. The third outlined five strategies needed for the “Great Food Transformation.” Establishing targets has its benefits but it also breeds controversy. I will write in some detail on the politics of the report at a later date, but for now, the link above has all the deets including a podcast I did with Professor Tim Lang.

On the same week as the EAT Lancet, a paper was quietly published in the New England Journal of Medicine by Andy Haines urging for a renewed focus on climate and health. The authors argue that “climate change is expected to alter…climate-sensitive health outcomes and to affect the functioning of public health and health care systems.” One could argue, we know this, but the fact that it was in a clinical medical journal shows the breadth of how climate change will impact all facets and medical professionals need to be thinking about how this will impact their patient populations, particularly the more vulnerable.

What wasn’t discussed much in the EAT Lancet were “food environments.” These are the places where consumers make a decision about what to buy, order or have delivered. Food environments are markets or cafeterias, or restaurants or food trucks. They look different everywhere. My colleague, Shauna Downs and I published an article in Public Health Nutrition looking at consumers’ perceptions of their food environments and their food consumption patterns and preferences in urban and rural Myanmar. The study shows that the availability of diverse foods had increased over time, while the quality of foods had decreased. Most consumers greatest concern about the foods available was the safety. Consumers preferred fruits, vegetables and red meat compared with highly processed snack foods/beverages. Although consumers reported low intakes of highly processed snack foods, Burmese street food was consumed in high quantities.

One food environment that could improve is the office. A study done by the CDC shows that nearly a quarter of respondents ate food obtained directly at their office. And the foods they ate were not necessarily healthy. Think the leftover pizza, the corporate snack bar, the candy in the jar, the cake for someone’s birthday. The study found that what they officemates ate during work hours was “high in empty calories, sodium, and refined grains, and low in whole grains and fruit.” Shocker? Not really but I do think work places need to stop making it so hard for their colleagues to eat healthy.

Enough with the studies! How about a podcast? A great one has just been started by our friends at NPR. It is called Life Kit and they “help you cut through all the nutrition noise” and provide guidance on how to eat healthy. And there is indeed a lot of noise out there. I listened to three of their podcasts - only about 20 minutes long - and they had some stellar nutrition experts including Dary Mozaffarrian who is the Dean of Tufts Friedman School and Doctors David Katz and David Ludwig. They are great, and I think provide sound advice on nutrition and what to eat. Listen to them on your way to work or even better, while exercising!

And speaking of eating healthy, here is an old video of Andy Warhol, eating a hamburger. Took him about 4 minutes.