COMMENTARY

Global Nutrition Crisis: What in the World Is Going On?

William F. Balistreri, MD

Disclosures

September 10, 2019

In This Article

Daunting Challenges

A look at the latest patterns in global nutrition highlights the fraught path to solving these issues.

Between 2016 and 2017, the number of individuals worldwide estimated to be "undernourished" increased from 804 million to 821 million. Ironically, this comes at the same time as rates of overweight and obesity are also increasing in most countries. In 2017, over one third of adults worldwide are now in a weight range that increases their risk for heart disease, diabetes, cancer, and noncommunicable disorders. The most rapid rise in rates of obesity were noted in Africa, in areas traditionally associated with undernutrition.[5,6]

This is a clear sign of global failure.

In a recent study, Bahadur and colleagues[7] suggested that global agricultural systems currently overproduce grains, fats, and sugars, while the production of fruits , vegetables, and protein is not enough to meet the nutritional needs of the current population. There is rising consumption of industrialized and processed food (high in sugar, salt, trans fats, and chemical additives), with limited intake of more nutritious, yet more expensive, fresh foods.[4]

Yet the relative inexpensiveness and convenience of ultra-processed foods means that more and more people rely on them.[4,8] As a new study by Hall and colleagues[8] shows, ultra-processed foods encourage excess caloric intake by increasing hunger-promoting hormones (ghrelin), which can lead to dramatic and rapid weight gain.

Mass production of processed, nutrient-poor food not only is associated with reduced nutrition but also is a major contributor to greenhouse gas emissions that propel climate change.[4] At the same time, changing weather patterns complicate food production and can lead to spikes in global conflict, which can both adversely affect food availability and accessibility.[4,5]

How Do We Stop a Vicious Cycle?

Overcoming what the Lancet Commission on Obesity describes as "inaction by policy makers, influence by profit-seeking food companies over public policy, and a lack of demand for change by the public" will require enormous efforts.[4] As a possible roadmap for dealing with the world's food manufacturing giants, they endorse the example established by the World Health Organization's Framework Convention on Tobacco Control, which explicitly excluded the tobacco industry from being involved in policy development.

To address global "malnutrition," the EAT-Lancet Commission proposed specific interventions—increased agricultural production, investment in technology to boost yields, diet education and modification, and reduction of food waste.[3]

Signs of progress in the right direction were on display at a 2018 workshop convened by the National Academies of Sciences, Engineering, and Medicine.[9] Invited presenters discussed the importance of understanding the obesity epidemic in a global context and shared perspectives on prevention and treatment efforts in the United States, with an emphasis on reducing disparities.

In addition, cities and states are raising taxes on sugary drinks and aiming to meet goals set by the Paris climate treaty. Food and beverage giants have already been shifting toward healthier products, reducing fat and sodium levels and portion sizes. Some firms have also committed to reducing plastic packaging and carbon emissions. These steps will have an impact and hopefully stimulate additional efforts.

But what can we do in our own kitchens, communities, and practices? What real-world advice can we offer? The message is clear: We should recommend a reduced intake of processed foods and animal-based foods, along with avoidance of excess sugar, refined grains, and salt. We should foster increased consumption of fresh fruits, vegetables, whole grains, legumes, nuts, and other plant-based foods, along with prudent stewardship to reduce food waste. These dietary efforts should be coupled with consistent efforts to achieve physical activity and sleep duration goals. This may sound like a daunting task, but the world is depending on us to be up to it.

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