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.

The co-existence of obesity and hunger in America

This is a re-posting from The Bloomberg Opinion.

The U.S. is notorious for its weight problem. With just 5% of the world’s population, it’s home to 13% of the world’s overweight and obese people. Roughly two-thirds of adults in the U.S. are overweight or obese and, even more alarming, 38% of boys and girls ages 10 to 14 are.

On first glance, these numbers seem to reflect overabundance — Americans have more food than is good for them. But the problem is more complicated than that, and worse: Many of the same people who struggle with extra weight also regularly go to bed hungry. That may sound like an impossible contradiction, but dig deeper, and it quickly becomes clear how hunger and obesity are related. Both are often rooted in poverty.

Percentage of obese adults in the U.S. (obesity = body mass index of more than 30). Source: The State of Obesity

Nearly 12% of American households are, by Agriculture Department standards, “food insecure” — meaning they have difficulty buying enough safe and nutritious food to meet their household needs. That amounts to roughly 40 million people, including some 540,000 children who experience very low food security. Food insecurity tends to be highest among Hispanic and black non-Hispanic families, and of course among unemployed and poor households.

Food insecure adults in the U.S. are 32% more likely than others to be obese — especially if they are women, one study found. Another revealed that children living in food insecure households have a greater-than-average tendency to be overweight or obese, and have poor eating habits. Other studies suggest that food insecure children also tend to display significant behavioral problems, disrupted social interactions, poor cognitive development and marginal school performance. These challenges, in turn, increase their risk of becoming obese adults.

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.

Food-insecure and low-income families face unique challenges that impair their ability to consume a healthful diet and maintain an ideal body weight. Their lifestyles tend to be sedentary because of their built environments, and their food tends to be served in large portions. The relatively inexpensive, calorie-dense food at their immediate disposal often lacks the nutrients needed for optimal health. As a result, though they may follow a nutritious diet for short periods, these are punctuated by cycles of financial and personal stress that lead to food deprivation, overeating, limited access to health care, reduced opportunities for physical activity and greater exposure to unhealthy food environments.

How can such cycles be minimized? It will take a concerted effort from many actors. The U.S. Congress, for one, should increase funding for the Supplemental Nutrition Assistance Program — food stamps — on which 50 million American families depend. And it should shift agriculture subsidies away from their heavy focus on corn, soybeans and other Big Ag crops and toward the farming of fruits, vegetables, nuts and legumes.

Local food banks, an important resource for food insecure households, deserve the support of citizens and communities, and should be encouraged to provide more fresh foods and fewer processed foods high in salt, sugar and unhealthy fats.

Employers can help, too, by providing mental and physical wellness programs, as well as discounts and subsidies for physical activity programs. These investments are inherently worthwhile, because employees who exercise tend to have better concentration and work output.

Finally, hospitals and health clinics can help working households provide healthy meals by creating what are called prescription food programs: Hospitals provide a set amount of money for each patient household, or a prescription that can be redeemed for nutrient-rich foods, including fruits and vegetables, in participating nearby markets or grocery stores.

The goal for governments, health-care providers and community groups should not be limited to building more markets in neighborhoods that now lack for healthy groceries. It’s also essential to encourage more community gardens and farmers markets, subsidize healthy foods, promote nutritious food choices, and ban  junk food advertisements to children. Fighting against obesity and hunger is a matter of fighting for basic food security — even here in the U.S.

Food Bytes: October 6th edition

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

Fall has arrived and with it, some interesting controversies in the food space.

Let’s start with sustainable diets. The New Yorker has a great read about the Impossible burger saving climate change. But according to the International Livestock Research Institute, “alt proteins” are not an answer for poorer countries. As Romeo Void sang, “never, say never.” Jonathan Safran Foer was a meat eater and went cold vegan. And he has another book about it.

Who is not going to save us all from climate change? Brazil. There is a lot of attention to the Brazilian Amazon forest fires. Here is a really good video summarizing the current situation of the Brazilian Amazon forest fires, much of it due to beef. Speaking of beef, there was a lot of controversy over a recent publication that it is okay for people to not limit their red meat consumption, following a slew of reports on its harmful impacts on health and the environment. NYT has been covering the controversy and now most recently, backlash with conflicts of interest. It turns out some were funded by the beef cattlemen association and ILSI, quoting NY Times here a “shadowy industry shaping food policy around the world.”

Paul Ferraro of Johns Hopkins has an article about how climate change solutions remain so elusive, particularly on the way we disseminate evidence. He argues: “We've always assumed the evidence must matter, but in reality we have almost a complete absence of evidence about the value of evidence…But then when it comes to building capacity, disseminating that information, we don't apply a scientific lens anymore. We just do it. We have no idea how to effectively use the science and the evidence we generate to move human behavior.” Tru dat.

Maybe fish will save us all. A fantastic article in Nature on the importance of global fisheries in solving micronutrients. My favorite? Shellfish, particularly, clams. Did you know spaghetti vongole was from Naples? Certo!

The World Bank has summarized the current controversy of childhood stunting being equated to a measure of cognitive development. And on the other end of the spectrum of child growth, a new report estimates that the number of obese children globally is predicted to reach 250 million by 2030, up from 150 million now. Wow. Scary stuff. We often things of these child outcomes — stunting, wasting and overweight — as separate, but we should really stop doing that. This article calls for a unified approach. While I agree, it seems these days we are on a divided battlefield in nutrition and food, with no agreement on much of anything in sight. But, I am a pessimist!

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.

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.

Food Bytes: May 6 - May 25

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

The Annual Reviews have just released a special issue on the Future of Food. Presents 20 articles on "Research & efforts to ensure a safe, nutritious, & affordable global food supply, while preserving biodiversity & minimizing environmental damage." Keen to read these by some stellar scientists!

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Processed food is having its moment. New research shows that those who eat ultra-processed foods gain more weight than those who ate whole or minimally processed foods. Researchers at the National Institutes of Health, tested this using the randomized, controlled trial approach. Study participants on the ultra-processed diet ate an average of 508 calories more per day and ended up gaining an average of 2 pounds over a two-week period. People on the unprocessed diet ended up losing about 2 pounds on average over a two-week period. Fantastic food writer Bee Wilson has a new book entitled: The Way We Eat Now: How the Food Revolution Has Transformed Our Lives, Our Bodies, and Our World. She writes about how these processed foods, ala junk food, has taken over traditional diets everywhere in the world, and is having impacts on health, at a very alarming pace.

Another study highlighted the impacts of poor diets on health. An estimated 80,110 new cancer cases among adults 20 and older in the United States in 2015 were attributable to eating a poor diet. Other research supports this claim. The study found that decreasing dietary fat and eating more fruits and vegetables may lower a woman’s risk of dying of breast cancer. They tracked 48,835 women ages 50 to 79 without breast cancer since the 1990s.

The way we eat is changing. There is a fantastic piece by the Guardian looking at how more and more people are eating alone, and it has quite dramatic changes on the way we eat, what we eat and why we eat. Netflix is involved in this equation…

Let’s discuss individual foods. Are you obsessed with vanilla? Check this out. Like citrus? You may be disappointed after reading this. With 70% of America consuming bananas, they can’t be that bad right? Think again. Do you dig on swine? This may scare you.

Some places, as we know still are food insecure in the world. The UN FAO reports 815 million people go to bed hungry. Venezuela, sadly is not immune, and is really in a free fall. NYT is reporting that “Butchers have stopped selling meat cuts in favor of offal, fat shavings and cow hooves, the only animal protein many of their customers can afford.” Terrible times for the country. Let’s hope things turn around soon.

On the polar opposite, but strangely, very much on the same side of the coin, it always thought that urbanization is driving the obesity pandemic. A very impactful Nature study has shown that 55% of the global rise in mean body mass index since the mid-1980s—and more than 80% in low- and middle-income regions—was due to increases in body mass index in rural areas. The team of scientists argue that: “There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.”

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The difference between rural and urban mean body mass index in women. Figure A is 1985. Figure B is 2017.

Nature is on a role. They also just published a really important paper nothing related to food, but on HIV. The researchers used a high spatial resolution across the continent to look at HIV prevalence sub-nationally. They already published a similar study examining undernutrition. They show that the epidemic is very unevenly spread. Of the 25 million HIV-positive people in sub-Saharan Africa, one third live in very small, highly concentrated pockets. The remaining two-thirds are spread out more broadly. This work will help hone in on the hotspots and where attention should be drawn to continue progress on halting the spread of HIV.

As for furthering education and building capacity, the London School of Hygiene and Tropical Medicine is starting a new Center on Climate Change & Planetary Health and the University of Washington has a new degree program on Food Systems, Nutrition and Health. Google them if you are interested in these new academic programs!

The Sustainable Development Solutions Network is hosting a 3-day webinar on Nutrition-sensitive agriculture. Sign up! We have three stellar speakers who will be talking about:

• Smallholder production and Dietary Diversity

• Market Challenges and Solutions to Nutritious Food Access

• Women’s Empowerment for Better Nutrition

And on a personal note, I was sad to hear about the passing of Kenyan writer Binyavanga Wainaina. He has some famous stories, including How to Write About Africa. But his most defining moment has been his coming out as a gay man, in a letter to his mum, raising awareness and rights of LGBTQIA throughout the continent.

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…