Sweetener consumption rising everywhereNo country consumes recommended F&V“Globalization” of diets through food retailing and packaged food expansionBUT, substantial variation in trends suggests not all factors universal
The food environment and diet transition oct 19 static map
The Food Environment: How Does It Influence the Dietary Transition? Laurian Unnevehr Senior Research Fellow, IFPRI Presentation to the OECD Food Chain Network October 26, 2012
Rising U.S. Childhood Obesity% of children 25 20 15 1980 2000 10 2008 5 0 All 2-5 yrs 6-11 yrs 12-19 yrs
Global Burden• 1.5 billion people overweight or obese• WHO estimates deaths from overnutrition exceed those from undernutrition• Diet related disease has a global cost estimated at $1.4 billion Source: WHO, World Economic Forum and Harvard School of Public Health, 2011
The Dietary Transition• Agriculture-based economy – Starchy staples based diets – Undernutrition, esp women and children• Transforming economy – Diet diversification improves diet quality – Emergence of double burden• Urbanized economy – Diet includes too many calories, fats, sugars – Non-communicable disease burden
Bangladesh: Food Group Shares of Total Food Supply (kcal/capita/day) 24 52 53 130 Grains, Roots, and Tubers 5 38 85 Legumes and Nuts 87 Dairy Products Flesh Foods Eggs Fruits and Vegetables Sugars 2005 Oils and Fats MiscellaneousData Source: FAO Food Balance Sheets, 2009 Tanzania: Food Group Shares of Total Food Supply (kcal/capita/day) Grains, Roots, and Tubers 63 168 Legumes and Nuts 93 Dairy Products 2 151 Flesh Foods 65 Eggs 69 1257 Fruits and Vegetables 268 Sugars Oils and Fats Miscellaneous
China: Food Group Shares of Total Food Supply (kcal/capita/day) 90 468 Grains, Roots, and Tubers 63 Legumes and Nuts Dairy Products 285 1596 Flesh Foods Eggs 75 Fruits and Vegetables Sugars 515 Oils and Fats Miscellaneous 56 100Data Source: FAO Food Balance Sheets, 2009
United States: Food Group Shares of Total Food Supply (kcal/capita/day)TWICE the recommended amount Caloric Meat, Eggs, and Sweeteners Nuts Dairy Added Fats and Oils and Dairy Fats Fruit Vegetables Flour and Cereal Products Less than HALF the recommended amount Source: USDA/ERS
% Overweight Adults Follows Caloric Intake Per Capita Across Countries 4000 Countries at the same level of income 3500 have different outcomesCaloric Intake (Kcal/Person/Day) Egypt 3000 Indonesia 2500 Nicaragua 2000 High Income Zambia Middle Income 1500 Low Income 0 10 20 30 40 50 60 70 80 % Adults Overweight (BMI ≥ 25) Sources: FAO; WHO
Why are Consumer Choices Constrained?• Affordability – Prices – Income• Knowledge – Habits – Limited information• Access – Nutrient dense foods – Modernization of food system
Do we have an “Obeso-genic” Food Environment? Illustration by Meredith Nelson
What are the Proposed Policies?Major Reports Common Recommendations• National Academies 2012 • Nutrition labels• World Bank 2011 • Advertising controls• OECD 2010 • Public information• World Economic Forum • Regulation of school / 2011 workplace meals • Tax unhealthy/ subsidize healthy foods Recent EATWELL review found most of these polices are in widespread use in high income countries.
What Do We Know about the Factors that Shape the Food Environment?• Prices• Information• AccessHow do these factors play out differently acrossdifferent kinds of food economies?
Prices Have Modest Impacts On Diets Fruits and Vegetables Soda10% price 16% less drop 5% more 20% tax consumed consumed Very modest effects on calories or weight. Sources: Dong and Lin (2009); Andreyeva et al. (2010); Dharmasena and Capps (2012)
But They Do Shape Consumption• Prices shape long run consumption habits, preferences, health outcomes – Higher prices for vegetables associated with more diabetes in U.S. (Meyerhoefer and Leibtag, 2011) – Lower food prices associated with higher rates of obesity in OECD countries over the past 20 years (Huffman et al., 2010)
Prices in Transforming Economies• Greater response to price changes expected in low income countries – 2008 price increases reduced nutrient density of diets (Ianotti et al. 2011)• Emphasis on keeping staple prices low may discourage diet diversification – Pulses prices relatively high in India (Kadiyala 2011)
Information• Nutrition education has resulted in greater awareness, but little change in diets• Behavioral approaches to “nudge” consumers towards better food choices• Product and menu labeling have brought changes mainly through product reformulation
Information Influences Supply• Mandatory labeling motivates food producers to change product formulation• Benefits all consumers whether they read the label or not• Trans fat label in 2006 led to rapid substitutions in major brands• CDC reports reduction in trans fat in blood in 2009 Sources: Golan and Unnevehr 2009; CDC 2012.
Information in Transforming Economies• Behavior change communication is key element of many nutrition interventions• When combined with value chain interventions, can address constraints to change – Orange-flesh Sweet Potatoes in Mozambique• Efforts to monitor, certify packaged food attributes – GAIN’s Access to Nutrition Index
OFSP in Mozambique and Uganda (HarvestPlus) Intervention: • Production: (dissemination of vines and farmers’ training) • Demand creation (nutrition education) • Marketing and Reached: product development 14,000 hh (Mozambique) 10,000 hh (Uganda) Doubled Vit A intake Source: DeBrauw, Gilligan, et al. 2012
Access• Socio-economically disadvantaged areas have fewer food retail options for healthy food• Access to unhealthy options leads to poor diet and health outcomes for low income women, teens in US (Currie 2010)• Increased supermarket access in low income countries associated with greater diet diversity, both healthy and unhealthy (Toiba et al. 2012)
Is a Healthy Dietary Transition Possible?• Dynamics of food system in transforming economies provides scope for changing path• Promising food environment policies: • Targeted productivity and value chain development for nutrient dense foods • Market institutions that incentivize nutritional quality and safety • Monitor food access for vulnerable consumers as system modernizes • Learn from the many policy experiments underway in OECD countries