The lost art of reading a book

I recently did an interview for the Reading List with Phil Treagus. I am a big book fan (my better half is a book publisher and archiver) but especially books on food (go figure). I also have two books coming out this year that I am pretty excited about. The first is through Johns Hopkins University Press titled “Can Fixing Dinner Fix the Planet?” The book is my own take on improving food systems and brings in a lot of my own experiences working on food issues in different places in the world. It comes out May 2021. The second book is a textbook published by Palgrave titled “Global Food Systems, Diets and Nutrition: Linking Science, Economics and Policy.” My colleague Claire Davis and I are excited to see this book out in June 2021.

This is what I had to say about books and you can also go to the original interview here.

How do you describe your occupation?

Educator and researcher of food systems.

Talk us through a typical day for you…

My day starts with a series of very early morning (begins around 5 am) zoom meetings with other researchers and organizations (UN, NGOs, etc.) working in Europe, Africa, and Asia on projects, publications, or initiatives. If I am not teaching a course that semester, I usually have one guest lecture to do and am usually on one or two public panels/webinars/keynote talks throughout the day. I try to block some time to read, write and do data analysis and, of course, to exercise (one hour a day)—usually mid-morning or late afternoon. Sometimes, I have 10-15 meetings throughout the day, so having concentrated focus time is challenging. Dinner is always the highlight of the day. We eat early, like 5:30, and my husband whips up gourmet meals. We usually watch something on Netflix or Criterion for about an hour or so. Then back at it to do a bit of writing in the early evening. I am in bed (and asleep) by 10 pm.

What are you reading at the moment, and what made you want to read it?

Science Fictions: How Fraud, Bias, Negligence, and Hype Undermine the Search for Truth by Stuart Ritchie. With so much dis- and misinformation on facts, data, and evidence, and the significant conflicts of interest in the food world, I was very keen to look inward into the science community that generates information. Where have we failed? Where are our faults? What could we do better? This book highlights the pitfalls of how we develop, communicate and vet science (with nutrition examples throughout the book) and turns the mirror on the science world. It is fantastic!

Can you remember the first book you read by yourself?

It is a toss-up. The two that stand out to me and are forever imprinted on my brain is Mrs. Frisby and the Rats of Nimh by Robert O’Brien and James and the Giant Peach by Roald Dahl. Strangely, and I haven’t thought about this until just now, both involve the food world. Mrs Frisby (a mouse) needs to move her home, which is endangered from the fields’ annual spring plowing. She asks a sophisticated bunch of rats for help. The story of James centers on a boy who enters a peach, and his world changes. Both stories highlight the magic and mysticism of ecosystems and experiences with that magic.

Are you a page folder or a bookmarker?

Page folder. But I go one step further. I fold the top of the current page I am reading so I know where I am the next time I pick up the book. I fold the page’s bottom if there is something on that page I want to go back to or research later.

Can you tell us a little more about the Global Food Security Journal?

The Journal strives to publish evidence-informed strategic views of experts from a wide range of disciplinary perspectives on prospects for ensuring food security, nutrition, and health across food system issues. We wish to publish reviews, perspectives articles, and debates that synthesize, critique and extend findings from the rapidly growing body of original publications on global food security, nutrition, food systems, and related areas; and special issues on critical topics across food security, food systems, and nutrition including how these are impacted by climate and environmental dynamics.

If you could gift yourself books at age 16 and age 25 – what would they be and why?

The Omnivore’s Dilemma: A Natural History of Four Meals by Michael Pollan and The End of Food by Paul Roberts. Pollan has mastered the craft of telling compelling food stories that have political, social and environmental repercussions in such an approachable way. While the book focuses mainly on the United States, it does raise questions as to the sustainability and ethics of how we grow our food and the individual dietary choices we make every day. Pollan has his fair share of critics, but I have yet to see an academic write such a compelling narrative on the fractured global food system. Paul Roberts’s book had an even deeper impact on me. It was hard to eat after reading his book because essentially, you feel the world is doomed! As Jim Morrison of The Doors sang, “the future is certain and the end is always near.” The End of Food, as the title suggests, brings those lyrics to life…

If you could invite 5 authors (dead or alive) to a dinner party – who would they be and why?

Amartya Sen (for his incredible influence on how we view poverty, famine, and human development and his many authored books including Poverty and Famine). Mark Kurlansky (for his incredible journalistic deep dives into things like Salt, Cod and Paper). Leah Penniman (author of Farming While Back and co-owner of Soul Fire Farm. A walking the talk author and entrepreneur!). Rachel Carson (for her landmark book Silent Spring that influenced the entire environmental movement). Joseph Campbell (his vast knowledge on the human experience and author of A Hero with a Thousand Faces). I highly recommend the interviews he had done towards the end of his life with Bill Moyer. After watching that, I wanted to be better at my craft.

What was the last book you purchased, and why did you buy it?

New Climate War by Michael Mann. Michael is a climatologist at Penn State. He is a clear communicator and fantastic science whose work has helped build the evidence on global warming. His new book is all about the politics of inaction on climate. In the food world, and very much tied to climate, we face similar issues of political inertia, interference and power imbalance of powerful industry players and complex scientific messages. Hopefully, I can learn something from Mann’s experience in battling the “merchants of doubt” and how he and others have fought to keep the evidence of climate change on the top of the global agenda.

What is your favourite thing about reading?

The quiet time and the ability to reflect on other’s views, worlds, and perspectives. I also find that I like the feel, experience, and act of reading an actual book as opposed to an e-book or an audiobook.

What’s the best book you’ve read in the last 6 months?

The Fire Next Time by James Baldwin. Written in 1962 but felt like it was written in 2020.

In your Twitter bio you describe yourself as a ‘goat lover’, I have to ask you to elaborate on this…

Goats are just so cool. Resilient, smart, and independent. And did you know they can surf? My husband and I even keep a blog, named “Goat Rodeo.” Speaking of books, there is a great book about goats entitled Goat Song by Brad Kessler who leaves New York City with this partner to go raise Nubian goats in Vermont.

If you could insert yourself into any book, which would you pick and why?

This is a tough one! Maybe Rats: Observations on the History and Habitat of the City’s Most Unwanted Inhabitants by Robert Sullivan. Robert would roam the city streets of New York in the silence and darkness of night observing what rats would feast on, and how they lived their lives. I am disgusted by but fascinated with these resilient little creatures and it would have been fun to spend a year doing this sort of rodential research. Turns out their diets are a lot like humans…they like junk food.

What is the book that you feel has had the single biggest impact on your life? What impact did it have?

This is really a tough one. I want to say Ulysses by James Joyce but that is a total lie. Perhaps Silent Spring by Rachel Carson. As a trained molecular nutritionist, it upended the way I think about food, human health and environmental sustainability. I pulled my head out of the petri dish and have focused much more on their connections and the macro- long view of food systems and how and where they fit into sustainable development.

If you could only own three cookbooks, which would you pick and why?

Anything by Alice Waters but especially The Art of Simple Cooking. She lays out the necessities of cookware, ingredients and basic recipes you need to at least feel like you are cooking organic, wholesome food straight out of the 1970s Berkeley. She also just propels food and cooking to an art form. Bibi’s Kitchen because it highlights the diversity of Africa’s cuisine told through and shared by grandmothers. Salt, Fat, Acid, Heat: Mastering the Elements of Good Cooking by Samin Nosrat. She makes cooking so approachable.

Are there any books you haven’t mentioned that you feel would make your reading list?

I’d also include:

Chronicles by Bob Dylan,
Just Kids by Patti Smith (I am a big fan of music books),
Salt Sugar Fat by Michael Moss,
Blood, Bones and Butter: The Inadvertent Education of a Reluctant Chef by Gabrielle Hamilton,
Food Politics and Soda Politics by Marion Nestle (see our interview with Marion Nestle),
Mass Starvation by Alex De Waal,
One Day I will Write About this Place by Binyavanga Wainaina,
Four Fish by Paul Greenberg,
Sweetness and Power by Sidney Mintz,
The Wizard and the Prophet by Charles Mann,
and The Way we Eat Now by Bee Wilson.

Which book sat on your shelf are you most excited about reading next and why?

The Secret Life of Groceries by Benjamin Lorr. I love the premise of this book. The author takes the reader through the inner workings of the nebulous supermarket that has become the powerhouse influencer on our diets. I am sort of scared though. I have a feeling I am going to never want to set foot in a supermarket again after reading this. Much like how I felt after reading Fast Food Nation by Eric Schlosser. I have yet to eat at McDonald’s (not that I really want to) since reading that book…

In Africa, Covid-19 Threatens to Worsen Hunger

This is a cross-posted blog and originally on Bloomberg Opinion. The original can be read here.

The continent has some unique strengths, but food insecurity is a special vulnerability. 

“It is easy to see the beginnings of things and harder to see the ends,” Joan Didion wrote in “Goodbye to All That.” Her words resonate in the midst of the Covid-19 pandemic, when no one has a clue whether we’re at the beginning, in the middle or near the end. In sub-Saharan Africa, not knowing is especially worrisome because it’s difficult to tell whether the continent’s fragile food supply systems will weather the strain.

 While the continent has made great strides toward economic security over the past several decades, Covid-19 could stymie that progress. Conditions vary greatly from country to country, but many struggles to ensure that their citizens have access to basic essentials: soap to clean hands, potable water and nutritious food to keep immune systems strong. Hunger and food insecurity have not gone away. Twenty-three percent of people in sub-Saharan Africa are undernourished. Because of the global economic fallout from Covid-19, the number of people worldwide facing acute food insecurity could nearly double this year to 265 million, the United Nations World Food Programme estimates, and much of that impact will be felt in Africa.

 At the same time, obesity and noncommunicable diseases (heart disease and diabetes for example) are rising in many low-income countries, Africa included, and both are proving to be serious complications for people infected with Covid-19. Much of the continent is also still dealing with other complex infectious diseases – HIV/AIDS, tuberculosis, malaria, and other neglected tropical illnesses – that will make it more difficult to treat Covid-19 infections.

 As it expands on the continent, Covid-19 will put further stress on already strained health systems – with limited numbers of ventilators and proper beds, minimal personal protective equipment, and, in some places, too few health care workers.

At the same time, food supply chains are starting to falter. Lockdowns in 30 African countries have made it very challenging for farmers to sell their goods in markets or for workers to get to fields. Food assistance is not always making it to those most in need. Many informal markets – the infamous wet or open-air markets, where most Africans shop for food – are closed, further imperiling food insecurity and threatening malnutrition. Reports from the Global Alliance for Improved Nutrition’s offices in Nigeria and Mozambique noted that prices of food, particularly the fruits and vegetables, have increased significantly.

In many African cities, social distancing and self-isolation are a recipe for disaster. Slums and informal settlements are overcrowded and lack basic services such as running water, cooking facilities, and electricity. And even if people infected with the coronavirus had safe places to isolate, some feel they must work to keep their families fed. Commutes to work often involve overfilled buses and long traffic jams – which increase the spread of disease.

With global unemployment rising, remittances worldwide are also are expected to fall – by 20%, or nearly $110 billion, according to the World Bank. In sub-Saharan Africa, they may drop by 23%. This will push more people to go to work, increasing their exposure.

To be sure, African countries have a few things working in their favor. For one, they have experience with massive infectious diseases – HIV/AIDS, Ebola, and polio, to name a few – and public health systems have been strengthened over the last decade. The Democratic Republic of the Congo has been hard hit by Ebola, but there are signs of progress with a declining case load in early 2020.

 In the current crisis, African governments can take some early lessons from the rest of the world that has been grappling with the pandemic a month or two longer, and work to keep the food supply moving. The continent is still 60% rural, and many urban Africans have close ties to the countryside, owning land or family plots. With luck, lower population density in rural areas may slow the spread of Covid-19, allowing farmers to continue to grow food, that is if they can get access to seeds and the technologies needed to plant and harvest. Support to food producers is an absolute necessity to keep the continent food sufficient.

 Sub-Saharan Africa is also fortunate to have a relatively young population, which may make it better able to weather outbreaks of Covid-19 with less hospitalization and death.

 Still, it remains hard to see the end. Some people hypothesize, with little evidence, that Africa may not be hit as hard as other places because of its warm climate. Perhaps, they say, the spread will be slower in Africa, and that will buy extra time. Given how easily Covid-19 has spread in other warm places such as Singapore and Thailand, that’s not something to count on.

 To ensure that Africa doesn’t starve and that it can weather the Covid-19 storm, it is essential to make sure people are guaranteed access to food, water, soap, masks, and cash transfers to support their families. The poorest and most vulnerable should be the priority. World governments with their donor partners, including the World Bank and the World Food Programme, will be counted on for support over the next four months. Businesses who make food products need support as well. We must all help make sure they come through.

The silent companion: Food Bytes Edition April 2020

Silence. We sit in our houses, in silence, watching the world from afar with only COVID-19 as our silent companion. But this silence isn’t really calming. The silence has an urgency to it. It is loud. And there is only so much silence one can take.

We are seeing the restlessness. We are seeing signs of noise. The world wants to open up and get things moving again. But that is risky. And our companion is keen to stay with us, just sitting in the quiet.

But some things have to move. Like our food system. As precocious Lawrence Haddad wrote:

“Keep the supply of nutritious food moving—and expand the flow. Unlike the 2008-2009 food price crisis, this coming crisis is not one of drought, oil prices, and biofuels. This is a car crash of supply chain logistics.”

Yes, cars crashing. Noisy.

There is also information noise. Some good, and some bad. As science and data emerge, the noise will get filtered out. Until then, we have to adapt to the loud stream of information to find the gems. Here are a few:

• The Nutrition Connect has been diligently publishing blogs on food, nutrition, and COVID on a weekly basis. We are up to 21! There have been a few really good papers on the implications of COVID on the food system.

• Maximo Torero of FAO published a Nature commentary on food supply chains. He argues that while stocks of food are sufficient, that is quickly changing with food price spikes, food sitting at ports, exports being banned, and dumping of commodities.

• Chris Barrett at Cornell University also published an important piece on food shocks. He argues that food supply disruptions must be met with safety nets to ensure that the world avoids catastrophic hunger.

• The Economist published an excellent overview of export trade, supply, and demand changes in the food system and what can be done to avert hunger. They argue that trade must stay open and keep food flowing.

• Jennifer Clapp points out the inefficiencies and weaknesses of the food system in this short op-ed in the New York Times. She argues, instead, to support local value chains and supply.

• The NYT has a well-rounded piece on meatpacking processing facilities and the fall-out of potential large-scale declines in meat production and processing, along with potential positives on the climate.

• Yours truly published a piece at Bloomberg Opinion on the challenges and maybe gleams of hope that the continent of Africa has to avoid catastrophic food insecurity.

And then there is the future of restaurants, the places where many of us go to socialize, try new cuisines, and enjoy the fruits of our food system in all its finest glory. A few very thoughtful articles have been published on the future of restaurants and what they will look like (NOT THE SAME, NOT AS MANY, AND NOT AT THE SAME PRICE STRUCTURE…). Some will close their doors, forever. There is that silence again. Here are a few good reads:

• The New Order, by Tom Sietsema: “Restaurants can’t possibly return to their old selves, at least not immediately. I imagine fewer tables, longer lines outside restrooms, hand sanitizer where flowers used to be, and shorter menus with fewer contributors.”

• As Restaurants Remain Shuttered, American Cities Fear the Future, by Jennifer Steinhauer and Pete Wells: “The danger facing restaurants, which thrive on crowded rooms and get by on razor-thin margins, poses a special threat to small cities and large towns where a robust food culture plays an outsize role in the economy. In places that had been hollowed out by poverty and suburban flight, like parts of Indianapolis, Cleveland, and Detroit, they are engines of growth.”

• My Restaurant Was My Life for 20 Years. Does the World Need It Anymore? by Gabrielle Hamilton: “And yet even with the gate indefinitely shut against the coronavirus, I’ve been dreaming again, but this time I’m not at home fantasizing about a restaurant I don’t even yet have the keys to. This time I’ve been sitting still and silent, inside the shuttered restaurant I already own, that has another 10 years on the lease.”

While sitting still and silent may no longer be an option for the global economy (it is imploding on a profound level), nor the food system, if we are to remain viable, we need to support our food system workers, producers, and entrepreneurs. They need personal protection, living wages, and decent work. These buffers will keep economies chugging along, and potentially stave off widespread hunger and malnutrition. Until then, turn it up and bring the noise.

Food bytes: March 21st edition

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

As much as we want to pretend all is normal, it is clearly not. We are in the middle of a global pandemic, with a massive amount of uncertainty, fear, and in some places, complacency. We will be posting another blog entry on the COVID crisis but for now, we will highlight, just a few emerging articles on the growing concern of food insecurity and the food supply, along with our regular updates on all things happening in the food space.

On COVID, we have never been in a situation like this before with talk of it reshaping the global order or social collapse or cohesion. So to predict how markets will continue to react to the future and the health of the global food supply is uncertain. Anyone who postulates how it will go is misleading us. Yes, of course, we can look in real-time on how households and communities are handling the crisis, and we can look to the past, on how other pandemics like the Spanish Flu, impacted food security and supplies. However, times are different. Food supplies are globalized. The population in 1918 was 1.6 billion. We are now at 7.5 billion.

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Locusts in east africa (copyright: BBC News)

Rob Vos at IFPRI argues there is no major concern for food insecurity, yet. They came to this conclusion by looking at food prices of staple crops. Huh. As the Brookings Institution rightly pointed out, low-income seniors are already feeling the impacts. In the U.S., with roughly 15% of households being food insecure, some are concerned about their ability to feed themselves in the coming months. A WaPo article quoted: “If coronavirus doesn’t get us, starvation will.” Then there is Africa. Food insecurity and stark hunger could worsen in an already fragile context. East Africa is also reeling from an invasion of locusts which don’t help the already burgeoning food insecurity in the region. This video is pretty insane if you want to see the locust infestation.

The EAT-Lancet Commission report follow ons just keep coming. Did you know that the report has already been cited 790 times since its publication in January 2019? Insane! A few interesting articles are emerging that again test the validity of the Commission’s findings.

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The water footprint (blue and green water) of different nut types (shelled) as well as some other food products for comparison, in litre/kg and litre per g of protein. (Vanham et al 2020)

• One article published by the LIvestock Innovation Lab at the University of Florida shows the importance of animal source foods and explains that raising livestock and eating animal source foods can be compatible with sustainable development.

• Another article questioned the recommendation in the report to increase nut consumption. The article dissects the water intensity issues in producing trees and ground nuts especially in India, China, Pakistan, the Middle East, Mediterranean, and the U.S. Check out cashews in the figure!!

• A publication in the Journal of Nutrition argued that the mortality reduction effect of the EAT-Lancet proposed diet in the USA is no greater than the impact of energy consumption changes that would prevent under-weight, over-weight, and obesity alone, calling into question its findings. Authors are funded by the National Cattlemen's Beef Association…

• Pedro Sanchez, one of the world’s experts on tropical soils and a World Food Prize winner wrote a piece about the land needed to grow the Lancet-EAT diet was oversimplified. He provided some alternative calculations. He argues that current total world food production is estimated at 9.30 billion metric tons of crops and animal-sourced foods, with crops grown in 1.27 billion hectares of land. Implementation of the EAT-Lancet diet for 10 billion people by 2050 would require a lot less, 5.39 billion metric tons of food in 1.10 billion hectares of cropland, assuming no increase in crop yields.

Pedro’s paper was part of a special issue in Food Policy in the Food Policy journal initiated by Editor in Chief Chris Barrett. The issue is about the evolution of the Consultative Group on International Agricultural Research (CGIAR), and the international agricultural research centers (IARCs) that comprise the CGIAR System. Over the past two decades, the CGIAR has undergone a series of reforms with the latest reform being termed “One CGIAR”.  Maybe they should take a lesson from the UN and find out how the One UN worked out…The special issue is out and is meant to “help inform a research strategy for the new One CGIAR.”

Robotics, AI, nano. Will these technologies transform the food system, and eliminate the “human” element from agriculture work? Yet to be seen. This article in the Economist discusses agricultural robots. And they have names: Tom, Dick, and Harry.

In the world of nutrition, meat will remain a controversial topic that is heating up. Nutrition is always accused of having serious conflicts of interest - who pays for the research? Who is biased? Who is paid off? JAMA and Scientific American highlights the controversy with meat-funded research and plant-funded research - and the “bullying” by both sides. Katz responds here. The livestock industry responds here. This debate has left consumers confused, and lacking any trust in science. A few other tidbits on meat. This NYT opinion piece by Alicia Wittmeyer argues that to stop eating meat, can alienate us from our traditions. Meanwhile, the EU is considering a tax on meat.

Speaking of diets, with 2.1 billion overweight and obese adults, and half of the U.S. facing obesity, we need some new strategies. Intermittent fasting seems to be all the rage these days as the best way to lose weight and keep it off. A review in JAMA highlights the evidence, and NYT provided some guidance. We tried it. It is not so hard. Just eat between the hours of noon and 8 pm. Thereafter, no calories should be consumed in solid or liquid forms.

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Changes in purchases of high-in beverages, by education level of household head (Tallie Smith et al 2020)

Diet quality matters too. Bee Wilson, an amazing writer of food and its history, wrote a long piece in the Guardian on the contributions of ultra-processed foods on the global obesity crisis. These foods are cheap, attractive and convenient, and we eat them every day. But they are also riddled with sugar, salt, and unhealthy fats. This article is worth the read. Some countries are worried. Take Chile. They instituted a Food Labelling and Advertising which put warning labels on the front of food packages if the food was high in sugar, high in salt or high in fat. Sugary drinks, unhealthy snacks, and packaged foods must carry the front-of-pack labels. These foods are also regulated. These foods cannot be marketed or sold in schools or on TV. Has it worked? Yup. Sales of these foods are down 23%. In college-educated consumers, as you can see in the figure, purchases were done 29%!

Food Bytes: February 10th Edition

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

2020 is off and running and the world finds ways to fill in the gaps it makes.

There is lots of interesting stuff being published or planned for publishing in the food systems space.

There are new journals out there. Nature Food released its inaugural issue called “silos and systems” (with a corn silo on the cover) and it is really great so far. Highly recommend reading it - all open access articles to boot! While it has been around about two years, Nature Sustainability is high-quality and publishes a lot on food systems. Colleagues at Cornell are working with the Journal to come up with evidence-based innovations across food supply chains ready for scale-up. More on this project can be found here. The prestigious Cell Journal now has a sister journal called “One Earth.” While it focuses on climate and earth sciences, there are lots of food gems in each issue thus far.

I am also serving as the Editor in Chief of the Global Food Security Journal. We publish:

1. Strategic views of experts from a wide range of disciplinary perspectives on prospects for ensuring food security, food systems, and nutrition, based on the best available science, in a clear and readable form for a wide audience, bridging the gap between biological, social and environmental sciences.

2. Reviews, opinions, and debates that synthesize, extend and critique research approaches and findings from the rapidly growing body of original publications on global food security and food systems.

I am also serving as an Associate Editor of Food Systems and the Environment for the American Journal of Clinical Nutrition. We published our 10-year vision. In that, we highlight that the Journal will be soliciting cutting-edge papers that disentangle research that spans food system activities and actors, environmental change, and health and nutrition outcomes, taking into account the rapid socioeconomic, political, and societal transitions in the 21st century. The research space is complex and requires a convergence of new disciplines to understand the benefits and trade-offs of evidence so vital to improving diets and nutrition. We are looking for agriculture, food value chains, climate, environment, and diet themes to come together to answer the many evidence gaps that impact nutrition and human health.

The Lancet series on the double burden came out in late 2019 basically showing that there is a significant increase in low- and middle-income countries struggling with both undernutrition and overweight and obesity. The second and third papers on the etiology and actions to address the double burden stand out.

There is some controversy brewing in the nutrition world. But what else is new? JAMA published a pretty scathing article about conflicts of interest stemming from the series of articles that meat is actually not detrimental, or at least, neutral for health. JAMA argues that another group of scientists basically bullied the journal into retracting the articles, which did not happen. The JAMA called it “information terrorism.” What a mess.

A few of us from GAIN and Johns Hopkins University presented the Global Food Systems Dashboard at IFPRI last week. Check out the video and highlights here. The Dashboard brings together extant data from public and private sources to help decision-makers diagnose their food systems and identify all their levers of change and the ones that need to be pulled first.  Follow updates and announcements of the official launch on Twitter.

2019: The year of food and nutrition reports!

2019 was an interesting year in the food and nutrition space.

The Lancet had food on its mind this year with THREE Commissions/Series:

• Food in the Anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems

• The Global Syndemic of Obesity, Undernutrition, and Climate Change: The Lancet Commission report

• The Double Burden of Malnutrition

The EAT-Lancet Commission made the biggest “footprint” and spurred much debate and controversy, and pissed some people off. Good. That is exactly what it was meant to do. This along with the Syndemic made the Altmetrics top 100 papers of 2019. Cool.

The Global Burden of Disease finally published a solo paper on diets as a risk factor. That too made the Altmetrics top 100 list.

A slew of other reports on food, planet, and people came out this year. See the image below which doesn’t capture everything. They all pretty much say the same thing: We need to transform our food system if we want to save ourselves and the planet that we live on. We cannot disentangle the two. We depend on each other. It won’t be easy. The stakes are high and so are the challenges (like urban and population pressure). It will take significant, synergistic political will and investment. We are running out of time. That is the gist.

The Global Nutrition Report and Scaling Up Nutrition (SUN) movement churned on to keep the momentum, largely in the undernutrition space, moving.

We saw some neglected areas get more attention this year. Fish, plant-based burgers, older children and adolescents. The Nobel Prize went to two stellar development economists whose research has informed our thinking on poverty, and how we can reduce it. But of course, with a dose of caution.

The Committee on Food Security is in the process of crafting the Voluntary Guidelines on Food Systems and Nutrition. Regional consultations took place all year, and a draft is now out for review. If you are interested in providing written feedback on Draft One, you can do so by sending comments to cfs@fao.org by February 5, 2020. You can find all the info here.

This was the year of reports. Let’s make 2020 the year of action. We have a lot of evidence of what to do and how to do it. Many of us have written about it in ways in an attempt to get the attention of politicians. Now, we need to take what is written on paper and translate that into changes that matter for people. We need to vote for policymakers that care about these issues at the local level. Let’s push to make food, climate, and health a part of their campaigns, and give them the opportunity to take ownership of the issues.

We also need to think about politics outside our hometowns. We have seen some major shifts in the global political machinery of how we relate to each other and our willingness to participate as global citizens. Some of the heavy hitters, such as the U.S., will continue on its downward spiral into irrelevance, with the UK following close behind. But until they completely make themselves obsolete, their decisions, unfortunately, matter for the world, as we witnessed with the shoulder-shrugging at the COP 25 negotiations in Spain. Another year, lost.

But I am a cautious optimist. Well…let’s not push our luck here. Maybe more of a realist. We have the Tokyo 2020 moment to increase investments for nutrition (which are currently dismal). We will be half-way through the UN Decade of Action on Nutrition and 1/3 through the Sustainable Development Goals (not sure what this means, but hey). Derek Byerlee and I wrote about how far we have come and what achieving SDG2 means for the world. We have the Committee on Food Security hopefully approving the Voluntary Guidelines mentioned above. And we always have COP 26, to stir up a miracle to save the planet. These global moments are important, but not enough.

This is what I plan to do in 2020:

1. I am going to take a look in my own backyard to make changes (and maybe stop flying around the world, thinking I am saving it).

2. I will vote with my fork and the dire importance of the 2020 election in the U.S. cannot be understated.

3. I will work more with people and less with paper – i.e. stop being involved in all these goddamn reports (that few read…).

Food Bytes: Aug 26 - Aug 31

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

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Have you ever wondered which cuisine the world craves? Turns out, Italy. Yeah, no shit Sherlock. Italy is the largest exporter of their cuisine followed by Japan, Turkey and Mexico — Órale! Who is the largest importer, meaning, their food just sucks? You guessed it Sherlock. America. F!@#%* yah! China and Brazil don’t seem so keen on their local cuisine either. They follow the U.S. on importing other country cuisines. Funny. Brazil’s food based dietary guideline boasts harnessing its local cuisine. We guess people just don’t read those pesky guidelines…

Dari Mozaffarian and Dan Glickman wrote a timely op-ed piece in the New York Times that diets are now the number one risk factor killing Americans, costing the U.S. health care system billions each year. They provide a range of solutions and signify that governments and food and beverage industries need to be held accountable. While unhealthy diets continue to kill so many, politicians completely ignore the issue. As America moves towards what will be a contentious, decisive election year, they suggest that “every candidate should have a food platform, and every [presidential] debate should explore these positions.” Not sure this rhetoric will be high on the Trump “make American great again, for real this time” re-election campaign because the “Potus” just ain’t really that into food. Unless you consider consuming fast food a gourmand type diet.

Another op-ed piece in the New York Times by Catherine Kling urges that producers who cause “nutrient pollution,” in the form of nitrogen and phosphorus coming from agriculture fertilizer and manure run-off, should be required to pay for the cleanup. She suggests that state government regulations should be enforced to ensure that farmers reduce nutrient pollution. Wonder how livestock ranchers feel about that? Gee, take a guess.

IFAD and Bioversity just put out a great guideline on supporting nutrition-sensitive neglected and underutilized species (NUS) and wild edibles (check out Figure 2 particularly). The guideline is led by the great Stefano Padulosi at Bioversity who has some deep experience working on NUS value chains in many parts of the world. He is also the “Rocket Man.” What are NUS you ask? Here is how they define it in the guideline:

Many are the synonyms which have been used since the mid-1980s to refer to NUS, including minor, under-used, under-exploited, under-developed, orphan, promising, lost, alternative, traditional, niche crops, crops of the future, future smart food. In reality, all these terms are often context-specific and loaded with heavy cultural meanings and not easily understood in the same way by everybody. The term “Neglected and Underutilized Species” might not be the ideal expression and may not be appealing to people.

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There is so much focus these days on diet and the food system footprints on climate change. It is seriously having its moment. But in the back of our mind’s eye, we hark back to an article published in 2017 in Environmental Research Letters, that indicated that largest impact an individual can make to reduce their greenhouse gas footprint is to have one less child. Check out this graphic to the right. Powerful. This action is followed by living car free. Diet is further down the list of impacts. Food for thought…

Interestingly, they didn’t model reducing food waste by individuals. The World Resources Institute (WRI) has just released a global action agenda on reducing food loss and waste by 2030. It is a really practical guide to setting targets, honing in on who should take action and what scalable interventions are available. Everything WRI puts out is pretty stellar and this is another data rich, practical guide to tackle one of the most important issues of the food system.

What if all Americans ate less meat? Not necessarily eliminating meat completely, but just much less? By the way, American are already slowly and steadily decreasing their beef consumption since the 1980s. In the Nature journal Scientific Reports, scientists tested this idea. By replacing 25% meat with plant alternatives dominated (strangely) by soy, green pepper, squash, buckwheat, and asparagus, Americans can eliminate pastureland use while saving 35–50% of their diet related needs for cropland and 330 million metric tons of greenhouse gas emissions each year, but increase their diet related irrigation needs by 15%.

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These advertisements on the left for PETA Vegan guides are all over DC (note the elephant in the background just to remind you that yes, DC is the capitol of the U.S. and the district lives and breathes politics. You can’t get away from it. It will smother, suffocate and slowly destroy you). Where were we? Oh yeah. We picked up the guide and thumbed through it. Some of the recipes didn’t look so tantalizing, and much of what was recommended wasn’t all that healthy. There were lots of photos of faux meat mimicking fried chicken fingers, hotdogs, and meatballs doused in sticky sauce, as well as lots of cakes. Is it possible to promote sustainable, healthy, and animal cruelty free vegan diets for those who choose to go that route PETA? That can’t be too hard can it? While it was an A for effort, maybe version 2 of the guide will feature more healthy foods and less overly processed, junk food.

In other news, with Uber Eats and other gig economy food deliveries on the rise, so is the toll on the drivers delivering food. They are risking their lives in places like South Africa. Tragic. And just to deliver the ultimate convenience to our dinner table.

Venezuela. Talk about a free fall into despair and chaos. Because of the turmoil, food security and the deeper issues of consistent insecurity have taken a big hit. Venezuelans lost an average of twenty-four pounds in body weight. Nine out of ten live in poverty. Roughly one in ten have left the country.

A paper just published in the Lancet hits right at the heart of the trade war between the U.S. and China. The authors feel that it is time to reshape trade policies towards those that favor sustainable food and nutrition systems. They argue there are three starting points for public health actors to take up this agenda.

1. Recognize the fundamental and front-line nature of trade policy as both a barrier and potential catalyst for health.

2. Engage more effectively and with the right stakeholders to push for policy space within trade and investment agreements.

3. Reach beyond trade to promote a development discourse that makes explicit the nutrition imperative — nutrition is crucial to achieving most of the Sustainable Development Goals.

The Food Archive holds a special place in its heart for special focus issues that scientific journals put out. That is, when journals hone in on a hot topic and publish a complementary set of articles on the topic to show different facets and perspectives on the topic.

Here are some recent highlights:

• Tomorrow’s Earth by Science Magazine

• Climate Crisis and Health by New England Journal of Medicine

• Food Security and Violent Conflict by World Development

• Health in Humanitarian Crises by Lancet

• Food for Thought by British Medical Journal

In the last food bytes post, the hard to watch unfold Brazilian Amazon fires were highlighted. This piece highlights that forest fires are happening all over the world, many in biodiverse hotspots, making climate change all that much worse. Very sad not only for forests but for those who live among and depend on them. The map on the right shows fires over the last year. Look at southwest Africa and Southern Africa. Look at Madagascar (think lemurs…) and Southeast Asia. Wah!!

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One place prone to massive forest fires (the 2018 fires were the most devastating in the state’s history) is California but every day it finds a way to rub its beauty in our face. Geez, okay Cali, you win.

Speaking of California, and to keep the whole Woodstock vibe going, let’s just end with a little Joni Mitchell, because she sings about omelets and stews and well, because this has to be one of the best albums ever recorded. Click below to hear her beautiful song, California.

California, Joni.

Oh the rogue, the red red rogue
He cooked good omelets and stews
And I might have stayed on with him there
But my heart cried out for you, California
Oh California, I'm coming home
Oh make me feel good rock'n roll band
I'm your biggest fan
California, I'm coming home

— Joni Mitchell

Food Bytes: July 21 - Aug 25

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

Took a bit longer to get up the next Food Bytes entry due to summer holidays. So here it goes.

Summer is going out with a roar. The Inter-Panel on Climate Change (IPCC) produced their outstanding report on climate change, desertification, land degradation, sustainable land management, food security, and greenhouse gas fluxes in terrestrial ecosystems. Lots of media coverage followed. Diet recommendations were made (reducing beef, taking on a more flexitarian diet etc). If we want to live in this changed climate, we need to adapt. The saber-toothed tiger had a less flexitarian diet and we know what happened to them…

Speaking of adapting, scientists found a “stature gene” among Central African hunter gatherers, also known as pygmies. This short gene gave them an advantage in Africa’s hot, humid rainforests. I was really hoping this gene hopped across the Atlantic to Italians, or even more so, short Italian American women living in DC to help explain my enduring squat-ness, but alas, no such luck. While on the topic of luck, according to the Union of Concerned Scientists, you should also stay away from cereal that has corn as the main ingredient if you want to have an environmentally friendly diet. So better forget about your Froot Loops and Trix and reach instead for your Lucky Charms.

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Farmgate value of global vegetable production by income groups of countries, average 2012–2013, current US dollars (Source: Schreinemachers et al 2019 GFS Journal)

Let’s continue with the climate onslaught shall we? This article talks about the beginning of the end of the livestock industry. But is that really so? Don’t underestimate the chicken man. And do you know how much of a carbon footprint you consume with your diet? BBC provides a calculator - do the math and you will quickly be blanketed in a quilt of guilt. It ain’t just beef that you gotta worry about…

Sam Myers of Harvard published a great piece in the WaPo on how increased CO2 in the atmosphere will “zap” nutrients from key crops. He argues that 175 million people could become zinc-deficient, 122 million would not be able to get protein, and 0.5 billion would have iron-deficiency-related disease. So now we need to worry not only about getting enough food to feed 10 billion, but the quality of those foods in fulfilling our nutrient needs. And the declines in nutritional quality are happening in real time. A study examining 43 “garden” crops in the U.S. found declines of 6 nutrients - protein, calcium, iron, phosphorous, riboflavin and vitamin C - since 1950. The food supply already can’t keep up. Mario Herrero and colleagues found that our current food supply does not produce enough fruits and vegetables, and in the course of the next 30 years, that supply will worsen. If everyone were to follow the WHO recommendation of 400 g/person/day of fruits and vegetables, 1.9 billion people would not have the access to these foods – the food supply just cannot keep up.

But a recent article in the Global Food Security Journal argues that vegetables hold a lot of economic power. Yeah sure. That is, if we can produce them. And then people want to eat them. They suggest that governments will need to increase their investment in farm productivity including improved varieties, alternatives to chemical pesticides, and the use of protected cultivation. There is also a need for better post-harvest storage of veggies, food safety and market opportunities. To tap the nutritional power of vegetables, consumers need to know how vegetables contribute to health, be able to afford them, or be able to grow them themselves. God speed to those New Yorkers living in 300 square feet of space with no windows and definitely, no outdoor space.

The recent paper by Eker and colleagues, published in Nature Sustainability, adds to the sustainable diet literature and evidence base, examining how consumer diet shifts can contribute to mitigation of climate change. Utilizing scenario assessments, the authors model the impacts of different compositional and behavioral dietary shifts among the global population on environmental footprints. Compositional dietary shifts included average meat consumption, flexitarian (more plant-based), vegetarian, and vegan dietary patterns. As other studies have shown, changes in diet composition towards more plant-based diets, have implications on the environment. However, more significant shifts, by a large swatch of the world’s population, towards vegetarianism would need to occur to see impacts on greenhouse gases and other environmental measures (such as land use). The paper is unique in that it models the behavioral dietary shifts among consumers and their impacts. The authors found that younger populations (ages 15-45) respond to social norm behaviors, that is, as the world moves towards more vegetarian type diets, the change towards those diets is more rapid.

They argue that the values a society holds among peer groups can outweigh the influence of scientific facts. This was evident in that behavior shifts in response to health or climate risks were not as significant as motivators of behavior change. Secondary education attainment (a predominant proportion of the world’s population) and self efficacy and identity among women were also important motivators of dietary behavioral change. This study argues that for us, as individuals to make an impact on the environment through our diets, significant shifts need to be made by a large segment of the world’s population. These shifts require a movement towards a vegetarian type diet to reap both environmental and health benefits. Much of this change would happen through peer influence (think social media), through women’s agency, and through those with a secondary school education. The change, would need to happen on a grand, transformative level as called for by the EAT-Lancet Commission report in early January 2019.

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Fires in the Brazilian Amazon. Source: NYTIMES

Foreign Policy well articulates the findings from the EAT Lancet and the IPCC report here and argue that the global food crisis is here. Now. Live. I also was on the Bloomberg Daybreak America’s show to discuss the impacts of the food system and diets on climate change. Check out the show here (segment starts at 1:22:50). Scientists have been forecasting their warnings for 40 years - they were right and no one listened. Maybe people (and governments) will start paying more attention and take some serious action. The NOAA show that July 2019 was the hottest month on record since they started recording temperatures. Speaking of heat, the Brazilian amazon fires are getting lots of attention right now. The NY Times shows a time scale of problem. It should be noted that these human induced fires are mainly done to prepare agriculture lands. And they occur every year, around the same time in the Amazon. The article makes three points on why these fires are different. (1) There were 35 percent more fires so far this year than in the average of the last eight years. (2) There has been a rise in deforestation in recent years, after a long period of decline. (3) While a large majority of the fires were on land that had already been cleared of forests many others are burning with particular intensity that are “deforestation fires.”

While we are discussing trees, it seems a banana fungus, known as “Fusarium wilt tropical race 4 (TR4)” has been devastating plantations in Asia and now the Americas. It is supposedly impossible to eradicate and can live in soil for 30 years. The economic upheaval cannot be overstated. Speaking of loss, a study out of Santa Clara University found that one-third of edible produce (like tomatoes, sweet corn, artichokes, watermelon, cabbage, strawberries and kale) remains unharvested in the fields. Reasons? Field/harvest stability, weather, pests and plant diseases, labor availability, market prices, and buyer specifications for how produce should look and feel like.

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By the time we got to Woodstock…

I just can’t keep up with all the latest food trends. Did you know McDonalds has jumped on the podcast bandwagon? Yeehaw. Virtual restaurants are on the rise, meaning that they are digital-only establishments that don’t need a dining room or waiters. They rely on people ordering their food from apps. But kickin it back to ol’ school, this article gives ode to the Waffle House, started in 1955 in Avondale Estates Georgia. You just can’t replicate that with an app. Oh, how I reminisce of those bygone days. Can you believe Woodstock happened 50 years ago? I just bought this book: Hippie Food: How Back-to-the-Landers, Longhairs, and Revolutionaries Changed the Way We Eat by Jonathan Kauffman. Bring on the tempeh. Seems all things hippie are back in style. Keep an eye out for a blog dedicated to 1968-1969 and how it influenced our food ways.

Delving further back into history, the New York Times has an excellent piece on the “barbaric history of sugar” that fueled slavery in the United States. By the mid-19th century, the U.S. had 125,000 slaves working on sugar plantations! Fast forward to today, we are now trying to figure out how to reduce, remove or tax this “white gold” in the food supply. Forty countries and 7 cities have a sugar tax. The Economist highlights a study showing how to optimize sugar taxes without regressive effects. They suggest that: “In the real world, if taxes in one place get too high shoppers will arbitrage the rules by traveling to buy soft drinks elsewhere. Taking this into account they reckon that the optimal rate for cities is 0.5 cents, although a more efficient system would be a state or national tax to control America’s sugar rush.”

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Impact of climate change on crops, water and income in Timor-Leste. Source: Bonis-Profumo et al 2019.

Here is just a few cool papers, reports and books that came out in the last few weeks:

• Association Between Plant-Based Dietary Patterns and Risk of Type 2 Diabetes: A Systematic Review and Meta-analysis. There is a strong inverse dose response association between plant-based diets and risk of type 2 diabetes This association was strengthened when healthy plant-based foods, such as fruits, vegetables, whole grains, legumes, and nuts.

• Soft condensed matter physics of foods and macronutrients. This article discusses the importance of physics in understanding the texture, taste, and composition of foods. It is an atom-colliding article of food science and matter physics. Get your genius on.

• Ravaged landscapes and climate vulnerability: The challenge in achieving food security and nutrition in post-conflict Timor-Leste. This article focuses on the fascinating Timor-Leste - an agrarian society that won independence in 2002 and is struggling to achieve food security and reduce undernutrition as the country modernizes. The economy depends on fossil fuel revenues and oil reserves are dwindling. A review of climate, agricultural, and nutrition data reveals high weather vulnerability, low agricultural productivity, and slow dietary and nutritional progress. But solutions exist. Agricultural sector actions can make important contributions to poverty reduction, food security, dietary diversity, micronutrient sufficiency, and overall nutrition. Agriculture can be made to be more nutrition- and gender-sensitive with a focus on mixed farming systems, biodiversity, climate-smart practices, and access to inputs, training, and technologies for farmers to enable sustainable and healthy rural livelihoods. Ultimately, productivity levels must improve to support the availability of sufficient and nutritious foods.

• Gene-environment interplay: what do our genes say about dietary choices? Those of us who work in public health often forget about epigenetics and the way our genes play out in our diets and health status. The authors say: “Diet is not just dictated by guidelines and individual choices, but also by availability and accessibility. Therefore, future studies that investigate the relationship of gene expression and a healthy diet in individuals exposed to a similar environmental milieu—for example, in accessibility, inducements, and the socioeconomic construct—are needed to understand the gene–environment interplay at the community level. These results can leverage genetic expression analyses to provide early biological footprints of an unhealthy diet environment, in order to facilitate the investigation of social factors that influence prevalences and outcomes of disease processes, such as food deserts and food swamps.”

• Trends and Correlates of Overweight among Pre-School Age Children, Adolescent Girls, and Adult Women in South Asia: An Analysis of Data from Twelve National Surveys in Six Countries over Twenty Years. The researchers found that overweight children had significantly higher odds of having an overweight mother and were more likely to come from wealthier households, live in urban areas, and have more education.

• Modernization of African Food Retailing and (Un)healthy Food Consumption. In Zambia, two-thirds of the households use modern and traditional retailers simultaneously, but richer households are more likely than poorer ones to use supermarkets and hypermarkets. Use of modern retailers is positively associated with higher consumption of ultra-processed foods, after also controlling for income and other socioeconomic factors. However, the use of traditional stores and kiosks is also positively associated with the consumption of ultra-processed foods, suggesting that modern retailers are not the only drivers of dietary transitions. Interesting!

• The SDG of zero hunger 75 years on: Turning full circle on agriculture and nutrition. In this paper, Derek Byerlee and I look back to the pioneering 1943 UN Conference on Food and Agriculture in Hot Springs, Virginia where the first international commitment to ending hunger was made. Despite these good intentions, however, the agricultural and nutrition communities largely went their separate ways for the next 50 years. Following through on the conference’s balanced approach of “more and better food” would have resulted in better nutrition for all. Today, the SDGs have once again put nutrition and agriculture together at center stage. Despite some important gaps in knowledge, financing, and implementation capacity, we are finally in a better position to shape food systems in a way that ends hunger and all forms of malnutrition.

• Technical Brief: Economic Evaluations of Multi-sectoral Actions for Health and Nutrition. This is a fantastic brief by the AHN Academy. This is a fantastic brief by the AHN Academy to “created to advance knowledge and scientific understanding among the global research community of economic evaluation methods and metrics related to costs and benefits of agriculture, food and livelihood strategies for nutrition and health.” They examine different types of economic evaluations and move towards standardizing a set of metrics to economically assess nutrition.

• The Political Economy of Food. Jody Harris and colleagues at IDS just published this IDS Bulletin that examines the issues of power across food systems. It looks at the various active players, relationships, activities, and institutions that play a major role in shaping food systems and power inequities. This was a much needed publication and I plan to use it in my class on food policy.

How much does it cost to eat a decent meal?

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The incredible Alex Honnold, also a vegan… Copyright: The great Jimmy Chin for National Geographic

The answer to that question turns out to be a lot for some people. There are have been some recent projects and papers as a result aimed at trying to understand whether or not people can afford the kind of diets recommended in national food-based dietary guidelines, the EAT Lancet, and other publications. Many have pontificated that these healthy, higher quality diets — promoted in such guidelines and Commissions made up elitist scientists — are unaffordable for most of the world. Some argue the recommendations are just downright dangerous (beef industry responding to the EAT Lancet) or unfair. GAIN argued that meat is important for child growth, and athletes. I don’t think they meant it is an absolute essential for athletes, as Alex Honnold is a vegan and that dude climbed El Capitan with nothing but sheer muscle strength, stamina and maybe an insanely lack of feeling of fear. If you have not seen the documentary Free Solo, I highly recommend it. What a human feat, and with no meat! Yes, I wax poetic.

This debate is not new, and there has been a lot of science articulated the cost. And there are more papers to come. But a few new papers are looking beyond just a specific country, a specific national dietary database or a specific population, and looking at the costs of foods and diets around the world from low- to high-income countries, whether they fulfill nutritional needs, and if not, what disease outcomes are they associated with.

IFPRI’s Derek Headey and Harold Alderman, two pretty stellar researchers in nutrition, published a fantastic piece in the Journal of Nutrition. They tested relative caloric prices (RCPs) for different food categories across 176 countries. One will have to read the methods in some detail to understand how they come up with this calculation but one key piece is how they calculate the RCP. They measure the ratio of the price of 1 calorie of a given food (the edible portion) to the price of 1 calorie of a representative basket of starchy staple food in each country. As the authors articulated: an RCP of 5 for eggs implies that it is 5 times as expensive to obtain a calorie from eggs as it is to obtain a calorie from starchy staples. Easy yes?

While the authors find that there is a lot of variety in the food prices nationally, in high-income countries, most non-cereal foods were relatively cheap, including sugar- and fat-rich foods. In contrast, in low-income countries, healthy foods were expensive, especially most animal-sourced foods and fortified infant cereals. Oils/fats were notably very cheap in all regions as were unprocessed red meat, which was moderately cheap in all regions. As the authors wrote in a recent blog:

“As countries develop, their food systems get better at providing healthier foods cheaply, but they also get better at providing unhealthier foods cheaply. Hence the problem in less developed countries is that poor people also live in poor food systems: Nutrient-dense foods like eggs, milk, fruits and vegetables can be very expensive in these countries, making it much harder to diversify away from nutrient-sparse staple foods like rice, corn and bread. The problem in more developed countries is rather different: Unhealthy calories have simply become a very affordable option. In the U.S., for example, calories from soft drinks are just 1.9 times as expensive as staple food calories and require no preparation time.”

The authors then looked at the association of these prices with nutrition outcomes, controlling for confounders like education, urbanization and income. Higher milk and fortified infant product prices were positively associated with childhood stunting. They also found that little children consume less of these important foods when expensive. An increase in soft drink prices was associated with a reduction on overweight prevalence.

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Headey and Alderman show the association of milk prices with childhood stunting. Copyright: IFPRI

A few years ago Adam Drewnowski and Nicole Darmon published a study, using very different methodology and from French databases, showing that foods of lower nutritional value and lower-quality diets generally cost less per calorie and tended to be selected by groups of lower socioeconomic status. A number of nutrient-dense foods were available at low cost but were not always palatable or culturally acceptable to the low-income consumer. Acceptable healthier diets were uniformly associated with higher costs. They argue three things:

1. Energy-dense foods composed of refined grains, added sugars, or fats are cheaper per calorie than are the recommended nutrient-dense foods.

2. Lower-quality diets, with a higher content of added sugars and fats, were generally less expensive on a per-calorie basis.

3. Cheaper and more energy-dense diets, often devoid of vegetables and fruit, tend to be selected across different countries by lower-income groups.

Another paper coming out in the Lancet by IFPRI (including Headey) and Tufts colleagues including the great Will Masters, examined retail prices of foods and identified the most affordable foods to meet EAT-Lancet targets. They compared the total cost per day of these foods to each country's gross national income to see if the MOST affordable EAT-Lancet diet exceeded household incomes.

Here is what they found: Examining 744 items across 159 countries, revealing that the most affordable EAT-Lancet diets cost a global average of $2.89 per day ($2.44 per day for low-income countries and $2.77 for high-income countries). The largest share was the diet cost was fruits and vegetables (31.2%), followed by legumes and nuts (18.7%), meat, eggs and fish (15.2%) and dairy (13.2%). While this is a pretty cheap diet in high-income countries, it is not affordable for 1.56 billion of the poorest households in the world where this diet would cost households 70% of their daily income (national averages)! Where is this diet unaffordable? Mostly in sub-Saharan Africa and South Asia.

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On the left side is the cost of the EAT-Lancet diet by country income levels and major regions. On the right side, is the cost of the EAT-Lancet diet as a percentage of Gross National Income per capita. Copyright: Lancet.

They also concluded that the EAT-Lancet diet would cost 64% more than achieving minimally adequate levels of essential nutrients and is currently unaffordable in low-income countries, because “it requires larger quantities of higher-cost food groups such as dairy, eggs, meat, fish, fruits and vegetables than the near-subsistence diets that are currently consumed by very low-income people.” The authors argue that:

“Our findings indicate that a widespread global shift to the EAT-Lancet diet recommendation is feasible only through some combination of higher earnings, more favorable market prices and nutrition assistance for low-income people, in addition to changes in local and global food systems that drive food choice among more affluent populations. Meeting EAT-Lancet targets in low-income areas will require higher farm productivity and improved access to markets, plus greater non-farm earnings and social safety nets, allowing people to shift consumption away from starchy staples and increase their intake of more nutritious but currently unaffordable animal-sourced and vegetal foods.”

Sam Bloch tested out the EAT-Lancet diet in early 2019 and wrote up a great piece in the New Food Economy (love this site). He found it hard to follow and it was more expensive. And he is probably a high-income consumer (living in New York City) and his wife is a chef!

A group at World Food Programme is doing a “Fill the Nutrient Gap” (FNG), which aims to “support identification of strategies to increase availability, access, and choice of nutritious foods, to ultimately improve nutrient intake.” This approach looks at the nutrient intake of different target groups, and then uses linear programming to look at the barriers to nutrient intake including the availability, cost and affordability of nutritious diets for households and target groups with higher nutritional needs. They then model potential interventions to improve them. I have heard they have done at least 25 countries. So they are taking it further as compared to these other studies. They are not only looking at the cost of diets, but why they are expensive and what households can do about it.

In last year’s Global Nutrition Report, we showed some preliminary data on the range of non-affordability of a nutritious diet across areas in different countries. The data shows a range of non-affordability depending on the region in each country – for example, across different regions of El Salvador, 9% to 44% of households cannot afford a nutritious diet, whereas the range is much greater in Lao People’s Democratic Republic (17% to 95%).

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The range of “non-affordability” of the typical diet in select countries. Copyright: GNR 2018

There are others working on the cost of a diet. Marco Springmann will also test out the cost of the EAT-Lancet diet, as an EAT-Lancet Commissioner. I think his study will look more at the cost of dietary patterns - vegetarian, pescetarian, omnivorous etc. So keep your eye out on that publication!

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.