Currently browsing posts about: Malnutrition

The Task Force on Hunger, Nutrition, and Health released its comprehensive report yesterday.

The report’s purpose is to inform the upcoming White House Conference on Hunger, Nutrition, and Health.  If so, it’s going to leave the White House in a quandary.

The report has lots of useful information, beautifully presented, and does all it should on adddressing hunger.

But as I read it, the report, titled Ambitious, Actionable Recommendations to End Hunger, Advance Nutrition, and Improve Health in the United States,” is not nearly ambitious enough when it comes to nutrition and health.

It makes far too many recommendations—30.  That’s always a bad sign (too many to do).  .

Really, only 2 recommendations are needed.  These should establish or expand federal agriculture, food, and nutrition policies to ensure:

1.  Adequate, affordable food and nutrition for everyone.
2.  Healthy diets for everyone, meaning those that follow Dietary Guidelines and are largely plant-based, balanced in calories, and low in undesirable fats, sugars, and salt (i.e., ultra-processed foods).

The hunger recommendations do the job: they call for ensuring benefits sufficient to meet households’ basic needs.

But the second?  A mess.

Here is the most obvious example [my comments follow] .

Recommendation #9: “Reduce the marketing of foods that do not align with the latest DGA and increase the marketing of foods that align with the latest DGA to children and populations with disproportionate rates of diet-related chronic conditions” [Good! But not through the recommended voluntary methods by industry.  That won’t work; it requires legislation]

But here’s Recommendation #25: “Increase the ability of food companies to communicate with consumers about the evidence for healthfulness of certain food products and nutrients.”  [Uh oh]

This comes with three action items:

1. FDA should expeditiously update its definition of the word “healthy” [good] and incentivize food companies to use the terminology and/or associated symbol in their food packaging and marketing [Yikes!] and increase the proportion of products on the market that meet the “healthy” definition [OK, as long as they are not gaming the system].
2. Congress and/or FDA should improve and streamline the process for application, review, approval, and use of health claims and qualified health claims on food packages. [No!  If it’s one thing we don’t need, it’s more misleading health claims]. 
3. Congress and/or FDA should create a new process for communicating about foods, nutrients, and other bioactive ingredients that may prevent or treat disease through label claims. [No!  We do not need more claims for the benefits of ultra-processed food products].

What’s missing from this report?

• Anything about ultra-processed foods and their effects on calorie intake and overall health.  The term is mentioned once, but only in the context of ‘more research needed’ (Recommendation #19).
• A clear statement of the benefits of soda taxes in reducing consumption of sugar-sweetened beverages.  Why isn’t there one?  A box explains: “Task Force members voiced diverse perspectives on this topic.”
• A clear statement about making SNAP align with Dietary Guidelines.  This is mentioned, but only in the context of pilot research (recommendation #2), and therefore contradicts recommendations #3 and #5.  #3:  Increase nutrition security by promoting dietary patterns that align with the latest Dietary Guidelines for Americans (DGA) through federal nutrition programs.  #5:  Leverage the federal nutrition programs’ power in economic stimulus to support food systems that promote foods that align with the latest DGA.”
• Firm calls on Congress to pass legislation to do what is needed.

What happened?  One member of the committee explained to me that its membership included everyone from anti-hunger advocates to food industry representatives, and too many vested interests were at stake.  Members could not agree on anything that would make a real difference to policy.  Anything substantive met strong resistance.

When it comes to public health policy, which this most definitely is, the food industry has no business being at the table.

This was a recommendation of the 2019 Lancet Commission on the Global Syndemic of Obesity, Undernutrition, and Climate Change.  Read that report.  It explains why including the food industry in policy recommendations that might reduce sales is not a good idea.

If I had been a member of this Task Force, I would have called for a minority report on policies for reducing consumption of sugary drinks and ultra-processed foods.  But that, of course, is why I’m no longer appointed to such committees.

• Read the Executive Summary
• Read the Full Report
• Read the Press Release
• Register here for the Webinar hosted by the co-chairs: Wednesday, Aug. 31 at 2:00 p.m. ET.

I’m getting caught up on reports this week.  Here’s one from the US Agency for International Development:  COVID-19 and Nutrition Analytical Framework

The purpose of the Framework:

• Allow policymakers and implementers to better track the interaction of the COVID-19 pandemic and nutrition
• Provide a tool for planning policies, programs, and interventions
• Help identify data gaps
• Support a systems approach to addressing problems “caused, increased, or intensified by the COVID-19 pandemic”

The Framework:

What I like about this Framework is how it so clearly identifies the upstream system levels of intervention: food, health, social, education, and infrastructure.

It’s also interactive, but for that you have to go to its source and click on each section.

The US Agency for International Development (USAID) has issued two reports arguing that reduction of the prevalence of child stunting should no longer be used as the sole measure of success of nutrition intervention programs.

Background: Stunting is defined as low height-for-age.  It has long been used as a measure of nutritional deficiency due to inadequate diet in the presence of poor sanitation and other conditions.  Interventions focused on improving dietary intake rarely prevent stunting or affect it to only a small extent.

The first report: Stunting: Considerations for Use as an Indicator in Nutrition Projects

Emerging evidence supports the need to reexamine stunting as the primary indicatorof the success or failure of nutrition interventions.  Stunting should be interpreted not as an indicator of short-term programmatic success, but rather of the overall well-being of populations.  Not all nutrition programs, projects, or activities should be expected to reduce the prevalence of stunting… Failure to reduce the prevalence of stunting should not be interpreted as the failure of a nutrition program or project.  Nutrition programs should consider—and measure—a broader range of the many benefits that programs can achieve.

The second report:  Beyond Stunting: Complementary Indicators for Monitoring and Evaluating USAID Nutrition Activities

this guide shows how accurate and meaningful results, beyond stunting, can be captured through the use of more comprehensive and responsive indicators that directly link to an activity’s logical pathway…Measuring different types of indicators across the program’s impact pathway helps to understand how well programs are implemented and how results are achieved. Most important, measures like these allow for learning about what the program has, or has not achieved,
and why.

This second report provides a useful Table listing possible non-stunting indicators such as rates of breastfeeding, nutrient supplementation, home food production, participation in food assistance programs, and the like.

These are all downstream (personal) interventions.  I’d like to see USAID fund some more upstream (policy-based) interventions and see if those might do greater good for greater numbers of people.

The Lancet has been busy.  Last week, it published a blockbuster report on the need for worldwide dietary changes to improve human health and that of the environment.  I posted about this EAT-Forum report on Friday.

Now, The Lancet releases yet another report, this one taking a unified approach to dealing with the three most important nutrition issues facing the world: Malnutrition (undernutrition), obesity, and the effects of our food production and consumption system on the environment and climate change—for which this report coins a new term: The Global Syndemic.

This report breaks new ground in identifying the food industry as one of three main barriers to ending this “Syndemic.”  I’ve added the numbers for emphasis.

• Powerful opposition by [1] commercial vested interests, [2] lack of political leadership, and [3] insufficient societal demand for change are preventing action on The Global Syndemic, with rising rates of obesity and greenhouse gas emissions, and stagnating rates of undernutrition.
• New social movement for change and radical rethink of the relationship between policymakers, business, governance and civil society is urgently needed.
• The Commission calls for a global treaty to limit the political influence of Big Food (a proposed Framework Convention on Food Systems – modelled on global conventions on tobacco and climate change); redirection of US$5 trillion in government subsidies away from harmful products and towards sustainable alternatives; and advocacy from civil society to break decades of policy inertia.

Wow.  This is telling it like it is—at long last.  From the press release:

• A key recommendation from the Commission is the call to establish a new global treaty on food systems to limit the political influence of Big Food.
• The food industry’s obstructive power is further enhanced by governance arrangements that legitimise industry participation in public policy development, and the power that big corporations have to punish or reward governments by relocating investment and jobs.
• Regulatory approaches to product reformulation (eg. salt and sugar reduction), labelling and marketing to children are needed because industry-led, voluntary approaches have not been effective.

Yes!

The documents

• The Press Release
• The Policy Brief
• The Global Syndemic of Obesity, Undernutrition, and Climate Change: The Lancet Commission report – Boyd A Swinburn et al. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32822-8/fulltext
• Obesity needs to be put into a much wider context – Sabine Kleinert, Richard Horton, The Lancet https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)33192-1/fulltext
• Rethinking systems to reverse the global syndemic – Rachel Nugent, RTI International https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)33243-4/fulltext
• Transforming food systems for better health – José Graziano da Silva, Director-General, Food and Agriculture Organization of the United Nations https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)33249-5/fulltext

The press

▪ The Guardian
▪ The Times (London)
▪ Irish Farmers Journal

Additional press, posted January 30

Newswires (syndicated in international outlets):

• ‘Radical rethink’ needed to tackle obesity, hunger, climate: report – Agence France-Presse
• To fix climate change, fix the obesity and starvation epidemics, reports say – CNN
• Obesity, bad nutrition, climate change pose triple danger, commission says – Reuters
• Also covered by Xinhua, IANS.

UK:

• Public health experts call for global food treaty – Financial Times
• Take on food industry to beat malnutrition and obesity, says report – The Guardian
• Tackling obesity ‘needs treaty like climate change’ – The Times
• Also covered by BBC Radio 4, BBC 1 Breakfast, BBC News 24, The Economist (Espresso), The Guardian (Op-ed), The Telegraph, The Independent, Daily Mail.

US:

• Report: ‘Radical Rethink’ Needed to Tackle Obesity, Hunger, Climate – Voice of America
• Big Food Blamed for Ills Far Beyond Flab in Sweeping Report – Bloomberg
• Want to fix obesity and climate change at the same time? Make Big Food companies pay. – Vox
• Also covered by Thomas Reuters Foundation, Devdiscourse.

Rest of world:

• Vested interests, misplaced economic incentive major drivers: Lancet report – Indian Express
• Obesity, malnutrition 2 sides of climate change – Hindustan Times
• Eat right to save the planet – Deccan Chronicle
• Also covered by El Pais, O Globo, The Wire, Sydney Morning Herald, The Age, Japan Times, New Zealand Herald, The Australian, El Confidential, Algemeen Dagblad, Nouvel Observateur.

If you want an overview of the current status of nutrition problems in the world, what is being done about them, and what needs to be done about them, this report is required reading (to get to the download button for the entire report, scroll to the end of the page).

The report is chock full of useful facts, figures, case studies, and recommendations.  A massive undertaking, it

was produced by the Independent Expert Group of the Global Nutrition Report, supported by the Global Nutrition Report Stakeholder Group and the Secretariat at Development Initiatives. The writing was led by the co-chairs Jessica Fanzo and Corinna Hawkes, supported by group members and supplemented by additional analysts and contributors.

For a quick overview, go right to the slide deck and then to the graphics in the executive summary.

The report deals both with problems of malnutrition (undernutrition) and obesity (overnutrition), especially in children.

It also deals with adult obesity:

It identifies measurable nutrition indicators that can be used to track progress:

It recommends actions to reduce the prevalence of malnutrition and obesity.

What stands in the way of implementing these steps?  Political will, alas.

These reports have come out annually since 2014.  Let’s hope this one gets the attention it deserves.

HLPE [High Level Panel of Experts on Food Security and Nutrition]. Nutrition and food systems. A report by the High Level Panel of Experts on Food Security and Nutrition of the Committee on World Food Security, Rome, 2017.

This report takes a food systems approach to recommendations for reducing the double burden of malnutrition—obesity in the presence of widespread hunger and its consequences.

This report aims to analyse how food systems influence diets and nutrition. It offers three significant additions to previous frameworks. First, it emphasizes the role of diets as a core link between food systems and their health and nutrition outcomes. Second, it highlights the central role of the food environment in facilitating healthy and sustainable consumer food choices. Third, it takes into account the impacts of agriculture and food systems on sustainability in its three dimensions (economic, social and environmental). 2. A food system gathers all the elements (environment, people, inputs, processes, infrastructures, institutions, etc.) and activities that relate to the production, processing, distribution, preparation and consumption of food, and the outputs of these activities, including socio-economic and environmental outcomes. This report pays specific attention to nutrition and health outcomes of food systems. It identifies three constituent elements of food systems, as entry and exit points for nutrition: food supply chains; food environments; and consumer behaviour.

The World Health Organization (WHO) has just published a series of papers on “double-duty” actions needed to end world malnutrition.  By this, it means addressing not only classic undernutrition and its consequences (stunting and wasting of children, nutrient deficiencies and starvation in adults) but also obesity and its risks for chronic disease.

In a commentary on the WHO site and in The Lancet, Fracesco Branca, Alessandro Demaio, and Corinna Hawkes say:

This is the potential of “double-duty actions”—interventions, programmes, and policies that have the ability to simultaneously reduce the risk or burden of both undernutrition and overweight, obesity, or diet-related NCDs (noncommunicable diseases). Double-duty actions offer an integrated approach to addressing malnutrition. WHO proposes three levels for increasing the efficiency of nutrition actions through a double-duty approach.

The three levels are:

1.  Ensure that current interventions, policies, and programmes designed to address one form of malnutrition do not inadvertently increase the risk of another.
2. Leverage existing actions designed to address one type of malnutrition to simultaneously reduce other types.
3. identify the shared drivers between different forms of malnutrition to proactively identify de novo actions for reducing all forms of malnutrition.

The WHO expands on these ideas in a policy brief.

They describe the interventions that can and should be taken in an action policy brief.

These are useful resources for anyone interested in and concerned about doing something about the double burden of malnutrition.

I recently coauthored an editorial on international development.  It appeared first in French, and now in English in Ideas for Development, a blog coordinated by the French Agency for Development.

Rethinking nutritional policies in developing countries taking into account the double burden of malnutrition

By Hélène Delisle, Marion Nestle, and Stéphane Besançon