by Marion Nestle

Currently browsing posts about: Food-systems

Oct 24 2016

Rethinking nutrition policy in developing countries

I recently coauthored an editorial on international development.  It appeared first in French, and now in English in Ideas for Development, a blog coordinated by the French Agency for Development.

Rethinking nutritional policies in developing countries taking into account the double burden of malnutrition

By , Marion Nestle, and

The world now experiences two forms of malnutrition which may seem contradictory: “undernutrition” (which includes micronutrient deficiencies) and “overnutrition” (obesity and its health consequences).The problem of malnutrition in developing countries is approached by most aid bodies (donors, international organisations and NGOs) and governments solely from the angle of undernutrition. And yet in these countries, the complex and multi-faceted challenge which malnutrition now presents can justifiably be called the double burden of malnutrition. In addition to the continuing problem of undernutrition there are now major issues linked to overnutrition and its associated illnesses.

Rapid nutrition transition

The stereotyped image of skeletal young children with protruding bellies saved by souls of goodwill in sub-Saharan Africa is still too widespread. Severe acute malnutrition still persists of course, especially among the victims of extreme poverty, natural catastrophes and wars. Naturally, this deadly disease must continue to be addressed and treated, as numerous NGOs are doing.

The treatment of malnutrition should focus not only on severe malnutrition in children. Less severe malnutrition, going back to life in the foetus and resulting from malnutrition in women even prior to their pregnancy, continues to contribute to stunting, which affects 23.8% of all children under the age of 5 throughout the world.

In parallel with acute and chronic undernutrition, the “nutrition transition” in low-income countries, driven by globalisation, urbanisation and technological progress and linked to “overnutrition,” leads to a swift increase in obesity and other chronic diseases – mainly diabetes and cardiovascular diseases. Nutrition transition is the term used to describe the progressive Westernisation of eating patterns, typified by a sharp increase in the consumption of animal fats and processed foods all over the world, combined with an increasingly sedentary lifestyle. It is easy to see how this transition encourages the increase in overweight and obesity.

Today, undernutrition alone is not the major issue; the greatest problem is the double burden of undernutrition and overnutrition. According to estimates from 129 countries with available data, 57 experience serious problems of both undernutrition in children and overweight in adults[i]. And Africa is not exempt from this double burden where undernutrition and overweight are undeniably linked. In West Africa, 50% of women of child-bearing age are anemic while at the same time 38% are overweight and 15% are obese. For the whole of sub-Saharan Africa, 40% of children have stunted growth characteristic of chronic undernutrition, while 7.5% of adults suffer from obesity. Malnutrition early in life increases the subsequent risk of chronic diseases in places where obesity is encouraged by the environment. Obesity is now on the increase among children in all developing countries. The World Health Organization (WHO) reports that between 1990 and 2015 the number of overweight or obese African children doubled from 5 to 10 million. 

The responsibilities of the industrial food system

It is often said that communication aimed at changing food habits is the best way to prevent obesity, a problem reserved for rich people in low-income countries. This cliché contains three errors:

  • The first is the claim that preventing nutrition-related chronic relies entirely on the capacity of individuals to make appropriate choices regarding food, physical activity or lifestyle. This claim ignores the well-documented effects of the food system and the socio-cultural factors which play a determining role and which influence the choice of individuals.
  • The second error is to believe that significant changes cannot be made to the eating practices of limited-income groups in the absence of an increase in resources. Yet several studies show the opposite, whether they are about exclusive breastfeeding for the first six months of life and improved complementary feeding, or else hygiene measures and supplies of drinking water.
  • The third error is to consider that obesity continues to be only a problem of the rich in low-income countries. Obesity is escalating and affecting growing numbers of not so well-off people, particularly in cities.

When analysing the impact of the food system, it is necessary to account for the agri-food industry (Big Food). On a world-wide scale Big Food is primarily responsible for the nutrition transition” towards processed food. “Globalised” industrial food is gradually replacing traditional cooking and locally produced foods, with ultra-processed foods’ (food-like substances as Michael Pollan calls some of them) undeniable appeal for city-dwellers and young people as these products are strongly associated with Western-style fast food and heavily promoted by the media. This appeal is reflected in profound changes in consumption trends in developing countries. Global sales of highly processed foods increased by 44% from 2000 to 2013, but only by 2% in North America as opposed to 48% in Latin America and 71% in Africa and the Middle East.

So what is the problem? Industrial food products (and drinks) are often a nutritional disaster: rich in calories, sugar, fat and salt, but low in essential nutrients and fiber. Even more, these products are relatively inexpensive, often less expensive than more nourishing local food products.

Changing the food environment

What is the explanation for the popularity of these “globalized” food products? Part of the answer lies in extremely effective advertising. Anyone travelling in Africa, for example, will see campaigns to promote salty stock cubes to replace traditional spices and vegetables. “Social marketing” efforts to change eating behaviour must be as forceful as these adverts, with commensurate budgets.

One idea is to impose a tax on soft drinks or other highly processed foods and use the revenues to finance cutting-edge nutrition education campaigns. This is what the United Kingdom has recently decided to do by taxing soft drinks.

It is especially important to rethink the nutrition programs created by NGOs and financed by international aid. Correcting the nutrition of malnourished mothers or children is only part of the problem.

A wider vision is needed to recognize the threat to world health posed by nutrition-related chronic diseases.

To cope with this new challenge, it will be important to address many determinants of health – education, social disparities, housing, and culture – as well as the food environment. The latest report on global nutrition1 points out the excellent return on investment of nutrition interventions (16 for 1), and challenges governments and decision-makers to identify and implement strategies that target the double burden of malnutrition. If this is not done, it will be difficult to reach the nutrition objectives set by the WHO for 2025 (see below). Solutions do exist, however, as can be seen from places such as Ghana, Brazil, or the state of Maharashtra in India, which have had encouraging results in fighting malnutrition in all its forms.

Global nutrition targets for 2025

  • Reduce the number of children with stunted growth by 40%
  • Reduce and keep the prevalence of acute malnutrition in under-five children (low weight) under 5%
  • Avoid any increase of overweight in children
  • Reduce the prevalence of anemia in women of child-bearing age by 50%
  • Increase exclusive breastfeeding for babies less than 6 months old by 50%
  • Reduce low birth weights by 30%
  • Avoid any increase in the prevalence of overweight, obesity and diabetes in adults.

The opinions expressed on this blog are those of the authors and do not necessarily reflect the official position of their institutions or of AFD.

[i] Global Nutrition Report 2016
Jul 29 2016

Brazil’s food revolution is working!

Bridget Huber of The Food and Environment Reporting Network (FERN) has produced a don’t-miss” article in The Nation: “Welcome to Brazil, where a food revolution Is changing the way people eat: How the country challenged the junk-food industry and became a global leader in the battle against obesity.”

As she explains, Latin America is leading worldwide opposition to food industry marketing, and much is happening in Brazil.

She writes about the advocacy work of Carlos Monteiro, Professor of Nutrition in the School of Public Health, University of Sao Paolo, who says:

The local food system is being replaced by a food system that is controlled by transnational corporations…this dietary deterioration doesn’t just harm bodily health but also the environment, local economies, and Brazil’s rich food traditions. We are seeing a battle for the consumer.

She further explains:

Over the last 30 years, big transnational food companies have aggressively expanded into Latin America. Taking advantage of economic reforms that opened markets, they’ve courted a consumer class that has grown in size due to generally increasing prosperity and to antipoverty efforts like minimum-wage increases and cash transfers for poor families. And as sales of highly processed foods and drinks have plateaued (and even fallen, in the case of soda) in the United States and other rich countries, Latin America has become a key market…In recent years, Brazil has inscribed the right to food in its Constitution and reformed its federal school-lunch program to broaden its reach while bolstering local farms.

And in 2014, the Ministry of Health released new dietary guidelines that made healthy-food advocates across the world swoon [I did a post on them when they were released].  Monteiro helped lead the team that wrote them; the guidelines transcend a traditional nutrition-science frame to consider the social, cultural, and ecological dimensions of what people eat. They also focus on the pleasure that comes from cooking and sharing meals and frankly address the connections between what we eat and the environment.

Huber’s investigative report is long and detailed, and well worth the read.

And it comes with a great graphic comparing the situation in Brazil with that of the U.S. (this is just an excerpt):

Those of us advocating for food systems that are healthier for people and the planet have much to learn from our colleagues in the South.

Feb 6 2015

Weekend reading: The U.S. Food System

Roni Neff, editor.  Introduction to the U.S. Food System: Public Health, Environment, and Equity.  Johns Hopkins Center for a Livable Future, Jossey-Bass, 2015. 

New Picture (1)

This is an undergraduate textbook for students in courses dealing with almost anything having to do with food as it relates to larger societal issues of economics, policy, marketing, culture, security, health, and the environment.  It is large (542 pages, 8.5 x 11), easy to read, and well illustrated.  It ought to be terrific in stimulating thinking about these issues, particularly because it covers everything you can think of that’s important in this area, from farm subsidies to school lunches.  The only thing missing is international dimensions, but that would take another book of this size.

Also focused on the U.S. food system is the Institute of Medicine’s report I wrote about a couple of weeks ago: A Framework for Assessing Effects of the Food System.


Between the two, you have a full course on food systems, especially because the IOM report comes with:

Jan 14 2015

Institute of Medicine releases report: Framework for Assessing Food System Effects

The Institute of Medicine has just released A Framework for Assessing Effects of the Food System.

The report is enormous (my paper copy weighs more than 5 pounds) and it is about as wonky as these things get.

It’s underlying purpose is buried in the Preface.

The U.S. food system provides a remarkably varied food supply to the U.S. consumer at lower cost than nearly anywhere else in the world. Many are concerned, however, that the cost of food in the marketplace may not reflect its true cost. Some of the costs of food production and distribution are not reflected in the marketplace price of food but are “externalized,” borne by other aspects of the health, environmental, and social domains of our society.

This report is about how to establish a basis for calculating the true cost of industrial food production.

The committee did not actually calculate such costs.  The report just says what researchers need to consider when making such calculations.

Even without having done that work, the report is a fabulous resource for understanding the the effects of the US food system on health, economics, the environment, and society.

It establishes the framework and explains how to use it:

  • Recognize effects across the entire food system
  • Consider all effects
  • Account for complexities
  • Choose appropriate methods

Reading through this takes some doing.  Here, for example, is what it says about using the framework:

The framework provides a set of design considerations for planning an assessment of the food system across the domains of health, environmental, social, and economic effects. It invites the user to think explicitly about system boundaries, dynamics, heterogeneity across space and populations, and the range of driving forces that shape food system outcomes…What this framework suggests is that all else does not remain equal and that any meaningful assessment must consider the likely and unintended consequences of proposed change for the status quo when its performance is in question.

The report gives specific examples of how the framework works for examining the effects of advice about eating fish or fruits and vegetables or changing the way hens are caged.

An Epilogue has some concluding thoughts.  Some selected examples:

  • Comprehensive studies of food systems that use all principles of the committee’s framework are rare in published literature.
  • Policies or actions that aim for an outcome in one domain of the food system (e.g., health) can have consequences not only in the same domain, but also in other ones (e.g., environmental, social, and economic domains.
  • Even though major improvements in the U.S. food system have resulted in the past from the introduction of new technologies, needed future improvements in the system may not be achievable solely through technological innovation and may require more comprehensive approaches that incorporate non-technological factors to reach long-term solutions.

The report ends with some recommendations, among them:

  • The committee recommends that Congress and federal agencies continue funding and supporting the collection (and improvement) of federally supported datasets that can be used for food system assessment studies along with consideration to creating new data collection programs as priorities arise.
  • The committee also notes the need to build human capacity in the field of systems science research.
  • The committee intends the report to stimulate broad thinking about the consequences of food system policies and actions beyond a single dimension.

OK food system analysts: get to work.  Find out what industrial food production really costs—economically, socially, and environmentally.

Here are the documents:

Jul 2 2014

University of California’s new Global Food Initiative

I was fascinated to read yesterday that the President of the University of California (my alma mater), Janet Napolitano,  presented plans for a new 10-campus food initiative  to the California State Board of Food and Agriculture.  I loved it that she made the announcement with Alice Waters at Berkeley’s Edible Schoolyard.

The UC Global Food Initiative, Napolitano said:

is a commitment to work collectively to put a greater emphasis on what UC can do as a public research university, in one of the most robust agricultural regions in the world, to take on one of the world’s most pressing issues.  The food initiative will build on UC’s tradition of innovative agricultural research to support farmers and ranchers. Future efforts will build on work already begun by UC’s 10 campuses and its Division of Agriculture and Natural Resources.

Here’s what she says the UC Global Food Initiative will do:

  • Use collective purchasing power and dining practices to encourage sustainable farming practices, healthy eating, and zero food waste.
  • Put food pantries and farmers markets on all 10 campuses.
  • Partner with K-12 school districts to enhance leveraging procurement.
  • Integrate food issues into more undergraduate and graduate courses.
  • Develop catalogues of food-related courses.
  • Put demonstration gardens on each campus for experiential learning.
  • Mine data on California agriculture and response to climate change.
  • Allow small growers to serve as suppliers for UC campuses.

What fun!  Can’t wait to see how it works.

Good work Alice Waters!

I hope other universities—including mine—start copying.

Here’s the info:

Go Bears!

Mar 7 2012

U.N. Special Rapporteur: Five Ways to Fix Unhealthy Diets

Olivier de Schutter, the United Nations Special Rapporteur on the Right to Food, has issued five recommendations for fixing diets and food systems:

  • Tax unhealthy products.
  • Regulate foods high in saturated fats, salt and sugar.
  • Crack down on junk food advertising.
  • Overhaul misguided agricultural subsidies that make certain ingredients cheaper than others.
  • Support local food production so that consumers have access to healthy, fresh and nutritious foods.

De Schutter explains:

One in seven people globally are undernourished, and many more suffer from the ‘hidden hunger’ of micronutrient deficiency, while 1.3 billion are overweight or obese.

Faced with this public health crisis, we continue to prescribe medical remedies: nutrition pills and early-life nutrition strategies for those lacking in calories; slimming pills, lifestyle advice and calorie counting for the overweight.

But we must tackle the systemic problems that generate poor nutrition in all its forms.

Governments, he said:

have often been indifferent to what kind of calories are on offer, at what price, to whom they are accessible, and how they are marketed…We have deferred to food companies the responsibility for ensuring that a good nutritional balance emerges.

…Heavy processing thrives in our global food system, and is a win-win for multinational agri-food companies…But for the people, it is a lose-lose…In better-off countries, the poorest population groups are most affected because foods high in fats, sugar and salt are often cheaper than healthy diets as a result of misguided subsidies whose health impacts have been wholly ignored.

Much to ponder here.  Let’s hope government health agencies listen hard and get to work.

For further information, the press release adds these links:

Oct 17 2011

Five new books about global food systems

It’s the fall book season and the food books are pouring in.  Here are five good ones, so recent that some have 2012 publication dates.

Michael Carolan, The Real Cost of Cheap Food, Earthscan 2011: The chapter titles, all of which start with Cheap Food, tell the story:  Globalization and Development, Conflict, Hunger and Obesity, Meat, The Environment, But at What Price, Community and Culture, and Who Wins.  The conclusion is Making Food Affordable.  How?  Eat less meat, don’t grow food for fuel, support urban agriculture, and other such excellent ideas.

Colin Sage, Environment and Food, Routledge, 2012: A beautifully designed and well written examination of every possible way in which food interacts with the environment.  It focuses on global food systems and their challenges and what we need to do to make the systems more sustainable.

Per Pinstrup-Anderson P and Derrill D. Watson II, Food Policy for Development Countries: The Role of Government in Global, National, and Local Food Systems, Cornell University Press, 2011: A serious look at how global food policies affect nutrition and health, poverty and food insecurity, and domestic markets, and the effects of all this on managing natural resources and climate change.  The book ends with a chapter on ethical aspects of food systems: “Investments in national and international public goods, particularly infrastructure and agricultural research developed for smallholders, are critical elements in supporting pro-poor economic growth and achieving their human rights.”

Madeleine Pullman and Zhaohui Wu, Food Supply Chain Management: Economic, Social and Environmental Perspectives, Routledge, 2012: A textbook for an undergraduate course but well worth a look for its analyses of how commodity food chains work, trends toward vertical integration, and the way supply chains are or are not regulated: “Many agree that the current system and trends have created a formidable force against the emergence of alternative food systems—particularly one that considers economic, environmental and social attributes simultaneously.”  Desirable foods supply chains would do better for consumers, farm workers, and the environment, and would be a whole lot more sustainable.

Alan Bjerga, Endless Appetities: How the Commodities Casino Creates Hunger and Unrest, Bloomberg Press, 2011:  Food prices are rising to the point of international crisis.  Based on the author’s personal visits to farmers around the world, Bjerga explains how the crisis happened (short answer: greed), its tragic effects, and what now has to be done to reverse them.


Jul 6 2011

How to pay for a better food system?

At TPMDC, Brian Beutler explains why the U.S. does not have enough money to pay for food assistance programs, safety regulation, better school food, or support for sustainable agriculture.


Page 1 of 3123