Obesity and undernutrition ‘paradox’ fuelled by poor quality food, say experts

By Flora Southey contact

- Last updated on GMT

©GettyImages/happy_lark
©GettyImages/happy_lark

Related tags: The Lancet, WHO, Obesity, Malnutrition, undernutrition

More than one in three low- and middle-income countries are facing both extreme obesity and malnutrition, according to a new report published the The Lancet.

Nutrition development experts from the World Health Organization (WHO) and EAT Foundation are calling for renewed efforts to transform the current food system.

The push comes as a fresh report published in The Lancet​ revealed the prevalence of a ‘double burden of malnutrition’ in low- and middle-income countries (LMIC).

According to the findings, more than one in three LMICs face both extremes of malnutrition: obesity and undernutrition.

Unlike in the 1990s, where severe levels of double burden of malnutrition (DBM) were most commonly seen in wealthier LMICs, today DBM is affecting poorer LMICs.

“We are facing a new nutrition reality,” ​noted the WHO’s director of nutrition for health and development, Francesco Branca. “We can no longer characterise countries as low-income and undernourished, or high-income and only concerned with obesity.

“All forms of malnutrition have a common denominator – food systems that fail to provide all people with healthy, safe, affordable, and sustainable diets.”

The double burden of malnutrition: Fuelled by ‘poor quality’ food

The authors compared survey data from LMICs in the 1990s and 2010s to estimate which countries experienced DBM.

If a country’s population had more than 15% of people wasting, more than 30% stunted, more than 20% of women experiencing thinness, and more than 20% overweight, the country was deemed as experiencing DBM.

Components of a healthy diet include

  • A diversity and abundance of fruits and vegetables, wholegrains, fibre, nuts, and seeds;
  • Modest amounts of animal source foods;
  • Minimal amounts of processed meat, and foods high in energy, free sugar, saturated fat, trans fat, and salt.

Results revealed that more than one-third of LMIC countries had ‘overlapping’ forms of malnutrition, particularly in sub-Saharan Africa, south Asia, east Asia, and the Pacific.

The WHO’s Branca, who was the report’s lead author, told journalists during a press briefing yesterday (15 December) he was surprised DBC is now reaching low-income countries.

“Countries in sub-Saharan Africa [and] countries in south Asia which have been traditionally targeted by our efforts to reduce undernutrition now have large sectors of their populations who are affected by overweight,” ​he said.

“You have about one in three families who have a stunted child and an overweight mother. It’s a paradox.” ​The ‘common element’ between these countries is ‘clearly the poor quality of food’, he added.

GettyImages-1057556086
Malnutrition is a challenge that all countries need to address, according to report authors ©GettyImages/Stas_V

Indeed, the report associated increases in overweight with changes in the global food system that make less nutritious food cheaper and more accessible. Other contributing factors include a decrease in physical activity, which it linked to ‘major’ technological shifts in transport, at the home, and at work.

“The poor quality of food is…a big responsibility of a transformed food system, that is not addressing food security effectively,” ​Branca continued. While the energy content in foods has increased, price points have decreased, and such foods are reaching more people, the quality is poor, he suggested.

Cheap food that is high in fat, sugar and salt is ‘so common’ in a lot of areas on LMICs, he told journalists.

Sales volume data from Euromonitor International back up Branca’s argument. According to the research provider, sales of non-essential foods and beverages, as well as junk foods and sugar sweetened beverages, are on the rise in Chile, South Africa, the Philippines, and Malaysia.

The rapid growth of junk foods and sugar sweetened beverages in LMICs ‘exemplifies how aggressive this food sector is’, noted The Lancet ​report authors.

And in India and China, sugary beverages are expected to become these countries’ major markets before 2030.

Fixing the food system: ‘No country is immune’

The report recognises the need for LMICs to implement policies that improve diet quality and address both undernutrition and overnutrition across the lifecycle.

“When it comes to malnutrition, we are failing on our agreed global targets,” ​said EAT’s CEO Alessandro Demaio during the briefing.

“No country is immune, and this new nutrition reality now hits lowest-income countries also due to the global rise in overweight and obesity primarily. This sees communities and government now facing a complex web of previously distinct forms of malnutrition, simultaneously.”

GettyImages-687884048
No country is immune when it comes to this 'new nutrition reality', says EAT's Alessandro Demaio ©GettyImages/kwanchaichaiudom

Demaio stressed that addressing malnutrition need not be a ‘zero-sum game’. Dealing with obesity and undernutrition separately, in silos, risks lives, money, and progress, he told journalists.

So what can be done to prevent cheap, poor quality food being distributed, marketed and sold in at-risk LMICs? For the WHO’s Branca, public policies have a ‘major responsibility’ when it comes to addressing supply and demand of such product.

A growing number of countries are adopting economic tools to limit the amount of poor quality foods on the market, such as sugar taxes on sugar-sweetened beverages, he explained. Enforcing clear nutrition labels that indicate the fat, sugar, and salt content front-of-pack is another way governments can manage demand for ‘poor quality’ foods.

“These policies actually have an effect on the producers, who are now nudged to reformulate the products,” ​said Branca.

However, public policies can do more. Initiatives that influence the public purchase of food – whether that be for school canteens or in military barracks – can encourage healthier food environments, he argued.

“There are [more possibilities] to reshape the food system to improve the [offering] of healthier food and decrease the [offering] and the appeal of less healthy foods.”

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