Food Bytes: July 1 - July 7

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

Ever wonder why the nutrition community doesn’t play nice with each other? I do. Phil Baker at Deakin University just published an interesting, but heady, paper trying to understand nutrition action networks and what it would take to make them more effective in garnering political commitment towards ending malnutrition. Just take a look at the figure below looking at the context in which nutrition sits. Talk about complex! They argue for four things to improve political commitment to nutrition:

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Complex contexts for the nutrition world

1. Coordinating bodies that are better at advocating resources can of course, get more money and strengthen the networks in which they work.

2. Coordinating and governance bodies need to be more inclusive and transparent in their decision making.

3. Civil society should work to influence decision makers. Helps when transparency is in place.

4. Finances matter and create powerful incentives for us to play in the sandbox together.

I may have gotten all this wrong, but like I said, the paper is intense, but super important to better understand why nutrition hasn’t seen massive progress like other sectors. I really do think that the grand nutrition architecture has some serious issues around coordination, cooperation, and reality checks it needs to come to grips with. Not Phil’s words, but mine…For another blog post!

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Of course, the nutrition community doesn’t just struggle with political commitment. It also struggles with delivering key interventions to those populations most in need. A recent study by Stuart Gillespie and colleagues looked at 24 different nutrition interventions to see if their coverage is measured and tracked in major health surveys done at the national level. These interventions are things like vitamin A and iron supplementation, growth monitoring, and infant feeding counseling. Basically the answer is no. The coverage of these interventions are not collected and not in any standard way across countries. The paper presented a few case studies including India. The figure on the right shows the scatter of data collection of key nutrition actions (counseling, growth monitoring and food supplements) typically not included in the core national health surveys. The bars show the national coverage of data and the dots are the states of India. Another paper published in PLoS medicine looked not only at whether or not a health intervention coverage was captured in surveys, but looked at need, use, and quality of those interventions. It would be great to see these authors do a follow up looking at those three measures to assess effective coverage of nutrition indicators.

And while we are ripping on the functionality of nutritionists and their work, let’s discuss the indecisiveness of the science they dabble in. The Atlantic published a piece on why nutritional sciences is so confusing for consumers. There have been a lot of articles on this recently, and I think it started with Michael Pollan’s book In Defense of Food a decade ago. The Atlantic argue that doing the science is very hard - figuring out what people eat and the consequences of those eating patterns - is not so straight forward and as the article highlighted “inexact.” But the evidence over decades has accumulated and most nutritionists agree largely on what is considered a healthy diet and the healthful habits that people should take on. But that is sort of boring isn’t it. The article also highlights the emerging role of the microbiome. But more on that later.

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There have been a few recent papers looking at the impact of interventions to improve food environments. One was a systematic review and meta-analysis on sugar‐sweetened beverage - SSB - taxes and their impact on beverage purchases and dietary intake. A suite of different taxes were examined mainly in Europe and US cities. What the researchers found was that a 10% SSB tax was associated with an average decline in beverage purchases and dietary intake of 10% in 6 jurisdictions. This tax was associated with a 2% increase in total untaxed beverage consumption (e.g. water) but this was not significant. Another study looked at the anticipated impacts of implementing a 2016 Chilean Law of Food Labeling and Advertising mandating front‐of‐package (FOP) warning label for products high in sodium, total sugars, saturated fats, and/or total energy. Researchers photographed packaged food and beverage products from six different supermarkets in Santiago, Chile before the law went into effect. They found that basically very little reformulation by industry occurred before the law went into action and <2% of products would have avoided at least one warning label with reformulation. A similar study looked at the food supply ahead of the law implementation and found similar issues.

While we are on the topic of FOPs, a really interesting study looked at how realistic would it be to mandate these types of labels in the U.S. The study found that: “Certain interpretive FOP labels which provide factual information with colors or designs to assist consumers interpret the information could similarly withstand First Amendment scrutiny, but questions remain regarding whether certain colors or shapes would qualify as controversial and not constitutional. Labels that provide no nutrient information and only an image or icon to characterize the entire product would not likely withstand First Amendment scrutiny.” Wow. Interesting. Gotta love the ol’ US of A’s constitution.

The U.S. is not always the asshole in the room. Well, maybe we are. Let’s talk USAID. For those of you who are not familiar with them, they are the United States Agency for International Development and self describe as “the world's premier international development agency and a catalytic actor driving development results.” Okay…they are also the agency driving around in white trucks all over Africa and Asia with the cringe-worthy signage “From the American People.” Awkward. USAID has done some not so good things in international development but it has done some good things too, dammit. They have been committed to nutrition. The Official Development Assistance (ODA) numbers that are reported in the Global Nutrition Report each year demonstrate their financial commitment. They have supported many programs at a significant scale in low- and middle-income countries. Some impactful, some, not so much. I am really screwing myself over here to ensure I never get USAID money aren’t I. Anyways, they just published the history of USAID in nutrition. It is a nice story. Check it out.

Speaking of food environments and obesity, with the Chicago Council on Global Affairs, I did a one-minute video on why is obesity such an issue globally and the importance of food systems in solving, not just contributing to the issue. If your attention span lasts the whole one minute, you can find out my favorite food. It involves a food rich in zinc!

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It’s not just food systems that need to improve if we want to make a dent in the obesity pandemic, it is what is inside our bodies as well. The microbiome is the next frontier for science and its role and relationship with obesity is a complex Game of Thrones TV series - it is going to take some time to dig into the history, to understand the future and who really rules us. Some researchers argue that our microbiota is associated with the propensity of being overweight. Others argue that diet is a big driver of the biome composition and species richness, maybe more so than the biological state of nutritional status - i.e. overweight and underweight. But unraveling this game requires us to be brave, yonder north of the wall, and live in peace with the Wildlings. And John Snow. Rrrrrrr.

And as always, I throw in something just to scare the hell out of any of you who are still living in la la land thinking the world is just bliss. Check out this paper. The title reads: "Global warming has increased global economic inequality.” Boom. Do I need to say more? Now you can go back to your mind-numbing regular programming.

Just so you don’t think I am a vindictive person, I leave you with Google’s Stories of Yoga. For any of you yogi gurus out there, this is everything you want and need to know about yoga, its history, its practice and its inspiration. See? I can be nice. NAMASTE!

Food Bytes: May 26 - June 2

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

Loved this NYT article about Africa’s millennials who are making their way back to farming. “We are making farming sexy.” Hallelujah. Welcome you “agripreneurs.” Make Africa the world’s breadbasket.

Speaking of leading newspapers, if you live in L.A., the city of angels, you will like the new Food section of the LA Times. It is more about where to eat and cook and less about politics and there is a paywall. While LA is having a renaissance on all things food creation, Gotham city is shutting many of its old school diner doors. “A luxury rental tower called the Frontier stands on the site of the old Frontier Diner in Murray Hill.” The New York we all loved died long ago…

Addicted to the joe? Here is everything you ever wanted to know about coffee and its expansion from Africa to the Americas.

Policy does matter. Did you doubt that? Bloomberg Philanthropy highlights the new Task Force on Fiscal Policy for Health – co-chaired by Mike Bloomberg and economist Larry Summers – to address the growing health and economic burden of noncommunicable diseases with fiscal policy tools that are currently underutilized by governments and their leaders. Lots o’ case studies including good stuff on sugar tax.

We know America is struggling. The Brookings Institution has published an interactive exploration of how she is doing. The Hamilton Project’s Vitality Index is a measure of a place’s economic and social wellbeing. It combines a county’s median household income, poverty rate, unemployment rate, prime-age employment rate, life expectancy, and housing vacancy rate. What does this have to do with food? Well, everything. Check it out.

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Vitality Index of America. The bluer, the better.

The last food bytes posting highlighted the research on processed foods, and impacts on weight gain. This thoughtful NPR piece talks about how hard it is to move away from processed foods, even when Americans are cooking more. Sarah Bowen and colleagues discuss the barriers: cost, time, and culinary resources. It just ain’t that easy to cook wholesome, from scratch meals day after day. You just can’t beat convenience sometimes. As the authors say: “… inequality is baked into our food system.” And ain’t that the truth.

Our favorite Tamar Haspel over at the WashPo is keeping it real. Now she is delving deep on the plant based burgers which seem to be all the rave. There are two - The Beyond Burger (peas) and Impossible Burger (soy). She takes both to task on environmental impacts, nutrition impacts and cost. And then there is steak. Will we ever replace it or our craving for it?

CSIS’s Take As Directed has a great podcast with Chris Murray at IHME on global diets and risk of disease. He discussed this paper that was highlighted previously on Food Bytes. “Diets account for more deaths [cardiovascular and cancers] than any other risk factor.” He argues the medical community is surprised and skeptical of this message. Interesting!

The Economist breaks down taxes on sugary drinks. Mexico was the trendsetter and now, 40 countries and seven American cities have started to tax sugary drinks. They argue that those that are not in favor of the tax argue that taxes are a “fun-killer, souring people’s pleasure” and can be regressive, because poorer people spend a bigger share of their incomes on soft drinks. But if demand is sensitive to increased prices, then a tax will change behavior, in a positive direction. Let’s see how it all plays out. The bigger question is, will taxes make a dent in the obesity pandemic. Hard to tell.

For any of you who collect and analyze child growth data (also known as anthropometry) in the field, the WHO has finally released a technical report that defines basic criteria and standards for sampling, training and standardization of anthropometrists, data collection, supervision, for data management including quality assessment and analysis, interpretation and reporting of anthropometric data. FINALLY. This is LONG overdue. Well done WHO. 

And last but not least, GAIN has started a new site called Nutrition Connect. Its purpose is to mobilize knowledge, share experiences, and stimulate dialogue on public private engagements (PPE - not be confused with PPP!) for nutrition. Links can also be found in the Food Archive’s Resources page.

Why Hunger Amidst Plenty?

I had the pleasure of doing a keynote talk at the “Ending Global Hunger Conference” at the Center for Global Food Security of Purdue University . My talk was entitled “Why Hunger Amidst Plenty?” My slides are here.

The punchline of the talk was this: We are living in a complex world made up of multiple burdens of malnutrition. While the obstacles to address the burden are daunting for citizens, there are tools to solve it. We just need political will, global cooperation, and immediate action.

The malnutrition burden is massive. But the story is mixed - there is the good, the bad, and the ugly. Let’s start with the good. Stunting is coming down - in some places quite fast - like Ethiopia, Bangladesh and Nepal. Also, the risk of dying from a famine has become much, much smaller than at any time in history. Then there is the bad. For the third year in a row, there has been a rise in world hunger. The absolute number of undernourished people has increased to nearly 821 million in 2017, from around 804 million in 2016. These are levels from almost a decade ago. Further, “hidden” hunger remains significant but is shrouded in mystery. We don’t know the state of micronutrient deficiencies, particularly among the nutritionally vulnerable populations, such as children under five years of age, women and adolescent girls. And now the ugly. Overweight and obesity is rising everywhere and among every stage of life. No country has stopped the trends we are witnessing.

The question remains why?

• Why do we still have hunger & undernutrition?

• Why are we not seeing improvements? And in some cases reversals of progress?

• How did we get to this place of paradox: hunger & obesity?

• What can we do about it?

I argue that hunger is still rampant because of poverty, conflict change, conflict, poor infrastructure, unstable markets, food loss and waste, and periods of seasonal hunger in rural places.

But how did we get to this place of paradox? That is complex but in a nutshell, our lives and lifestyles are transforming as are our diets and food systems. Many in the world are now consuming sub-optimal diets, exercising less and hence are more sedentary, and these contribute to the risk of disease and death. At the same time, healthy diets are not accessible to all.

As a result, many people are now affected by both food insecurity and obesity at the same time.  Food-insecure populations, really no matter where they live, are subject to the same, but unique influences in trying to consume a healthful diet:

• Limited resources and lack of access to healthy, affordable foods

• Cycles of food deprivation and overeating

• High levels of stress, anxiety and depression

• Limited access to health care

• Fewer opportunities for physical activity

• Greater exposure to marketing of obesity-promoting products

The question remains, what to do? There is no one simple measure that can successfully shift the burden at the national or global scale. Rather, a constellation of different approaches and strategies, operating across scales and supply chains, and targeted at different people and organizations will be required. I argue for 10 actions:

1. Care. We need governments, industry and citizens to care about their diets and their nutrition, climate change and food systems.

2. Push for countries to develop a food systems policy. No country has implemented a full range of updated, comprehensive, and evidence informed strategies to encourage a healthier and more equitable food system.

3. Consider the situation a “Syndemic” and take on triple duty actions.

4. Consider options for keeping the food system within environmental limits. Dietary, technological change on farms, and reductions in food loss and waste are critical to reduce environmental impacts of our food system on the planet.

5. Don’t forget about who will continue to feed the world. As Ruth DeFries eloquently wrote: “Now we are transforming from farmers to urbanites. Our newest experiment-to feed massive numbers of people from the work of a few-is just beginning. The outcome is yet to be seen.” Who will feed us when the average age of the world’s farmer is 60?

6. Invest in small and medium holder farmers. Smallholder farmers have more diversified landscapes, making important contributions to the overall dietary diversity for the world’s population. 53-81% of micronutrients in the food supply are produced by small and medium farms. These farms make up 84% of all farms and 33% of the land areas globally and are more predominant in Asia and sub-Saharan Africa.

7. Maximize net increases of nutrition along value chains. Identify points in the chain that can be “leveraged for change.” Leverage points can cause nutrients to be lost or exit the value chain as well as enhance the nutritional value of select nutrient-rich foods.

8. Engage and empower women in on- and off-farm opportunities. Women need social capital including information and access to new technologies and farming practices and tapping into social networks that may assist in times of hardship. Women need access to credit with greater ability to invest in infrastructure and to smooth consumption or production shocks. And last, we need to improve their human human capital and agency - give them opportunities for education, and increase their ability to get health and nutrition services.

9. Help consumers navigate this complex web. Give them the information and knowledge the make healthy choices. Make them affordable, accessible and culturally appropriate. But consumers are super, duper confused…

10. Dig deeper. We must address the underlying social determinants that impact malnutrition. Every country is impacted by poverty but its determinants may be different, or the same…

Food Bytes: Weekly Nibbles from Jan 21 - 27

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

Environmental effects per serving of food produced

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

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

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

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

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

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