Martin Bloem
Director

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GLOBALLY, WE FACE A DOUBLE BURDEN OF MALNUTRITION – some populations have high prevalences of overweight and obesity, while other populations are undernourished, and both conditions present significant health outcomes and challenges.

In the Global North, with so many high-income countries, we see a lot of activity around overnutrition and the chronic diseases that result from it. But actually, there are more people in the world burdened with undernutrition, which produces health outcomes such as stunting and wasting, which devastate nations and economies for generations to come by decreasing human capital.

To complicate matters, there’s evidence that undernutrition early in life can predispose people to overweight and other diet-related chronic diseases later in life. Some people even refer to the triple burden of malnutrition, which refers to overnutrition, undernutrition, and micronutrient deficiencies.

The challenges are diverse, but the solution is the same for all burdens, as all these conditions are rooted in poverty. By reducing poverty globally, we increase health, human capital, wellbeing and life expectancy.

Developing Sustainable Diets

Patrick Webb
Alexander MacFarlane Professor, Friedman School of Nutrition
TUFTS UNIVERSITY

Yes. National and local governments hold a special responsibility in facilitating and protecting public health. That means ensuring that public systems and institutions are not harmed or overwhelmed by health challenges. The world’s greatest single (non-infectious disease) health challenge today is poor quality diets. These are diets that do not secure minimal nutrient needs for all people around the globe; they are diets that contribute to a growing burden of diet-related chronic diseases; and they are diets underpinned by unsustainable production and processing practices that damage planetary resources as well as the climate. While the private sector is largely responsible for the current nature of food system, it is up to governments to inform, incentivize and require the system-wide changes that can support appropriate food choices in future. Healthy and sustainable dietary patterns will deliver improved nutrition, while also significantly reducing the economic and social costs associated with dysfunctional food systems. Those are costs that are borne by the public purse. That’s why governments have to take responsibility for transformative change and improve dietary habits.

Yes, they are drawing connections, but they need to work with others like the private sector, all actors in food value chains to implement policies, practices, and technologies to find solutions for both human and planetary health.

Actors in the value chains or food systems include smallholder farmers, traders, processers, retailers, wholesalers, and consumers, Woman and youth are particularly important to be empowered and reached, so they can benefit from the system.

Policy environment will also be critical. Public investment and public spending must be reprioritized for achieving both human and planetary health. Market and trade must also work to achieve both goals.

Duncan Williamson
Founder and Director
EATING BETTER

Joined up, agricultural and health policies are the cornerstone of a sustainable food system. We need to produce the right food to ensure people have access to healthy, nutritious food in a way which benefits nature, soil and livelihoods, all while we face global malnutrition and climate crises.

Our food system must be underpinned by diversity – agricultural, bio, cultural and economic – all providing us with good health. Diverse diets can reduce micronutrient deficiencies by providing a rich source of nutrients all year round and it can also result in increased income sources for farmers. Yet national food systems are supplying less diverse food. This is reflected in diets that are monotonous and based on a few staple crops, especially in low-income communities where access to nutrient-rich sources of food, such as animal source foods and fruits and vegetables is a challenge.

There is a huge disconnect between agricultural policy and our nutritional reality. Current agricultural policies are focusing on producing the wrong sort of foods, with a biased towards calorie crops. Three crops – rice, wheat and maize – provide more than 50% of the world’s plant-derived calories. At the same time, malnutrition has been rising, as agricultural policy has been focused on productivity not on nutritional outcomes, and we produce more than enough food to feed over 10 billion people, but this growth in calories has not resulted in better health for all.

One area that shows how different polices can be mutually beneficial is sustainable diets. Almost 10 years ago both WWF’s Livewell and the Barilla Foundation’s food pyramids demonstrated the linkage between nutrition and the environment and since then a growing group of leading organisations, including the Lancet and Eat Foundation, have called for joined up policy making to deliver win win outcomes.

A good, working food system should produce healthy, sustainable food that is affordable and accessible to all. Health and nutritional outcomes should underpin all agricultural and food production policies from what we grow to subsidies.

Dietary Guidelines

Isabela Sattamini
Researcher in Public Health Nutrition
UNIVERSITY OF SAO PAULO

National dietary guidelines are developed by the Ministry of Health and usually coordinated by a technical-scientific team of experts. Dietary Guidelines are evidence-based recommendations that take into account a country’s nutrition problems, diet patterns, food environments and food-systems, in addition to globally established diet-health relationships. They provide recommendations about food consumption, but can also include physical activity and sustainability aspects. In the Dietary Guidelines construction, there should be participation and consultation of social movements such as those of farmers, consumers, parents, educators, and all those who eat, and therefore, everybody in the society. There should not be a chance for financial interests to determine what the Guidelines will recommend, as these should be based on science and in the social food habits of the concerned population.

Liv Elin Torheim
Professor of Public Health Nutrition
OSLO METROPOLITAN UNIVERSITY

National dietary guidelines tell what foods to eat and what to stay away from in order to stay healthy. Dietary guidelines are usually based on research on the association between intake of foods or dietary pattern and health. Sustainability aspects of food production is increasingly included in national dietary guidelines. Dietary guidelines offer guidance to both individuals, policy makers, researchers and the food industry.

Dietary guidelines are often shaped into messages/advices/recommendations communicated to the general population to help people make the right food choices. Dietary guidelines also provide a way for monitoring the healthiness of the food intake of the population. If, for instance, the guidelines recommend eating 5 portions of fruits and vegetables per day, one can assess the proportion of the population with a lower intake and see how this vary between population groups. Over time, one can monitor how the situation changes. This information will form the basis for national food and nutrition policies. If the population’s intake deviates from the recommended intake, one can plan strategies and programs to improve the situation and target the most vulnerable groups. National dietary guidelines are also used by the food industry to guide them in making and promoting healthier food products.

Angela M. Tagtow
Founder and Chief Strategist
ÄKTA STRATEGIES, LLC

Food-based dietary guidance systems are essential for countries to set consistent guidelines for promoting and improving the nutritional health of a population. In the United States. The Dietary Guidelines for Americans are important for establishing consistent evidence-based recommendations for healthy diets for all Federal food and nutrition programs as outlined in the 1990 National Nutrition Monitoring and Related Research Act. Furthermore, they are used to inform policies and nutrition education interventions that promote health and reduce the risk of diet-related chronic diseases. Dietary patterns that are aligned with the Dietary Guidelines for Americans promote human and planetary health.

Warren T.K. Lee
Senior Nutrition and Food Systems Officer
FAO

National dietary guidelines, also called Food-based dietary guidelines (FBDGs) advise the public to consume food groups or a variety of foods on a daily basis that contribute to healthy diets and minimize the risks of malnutrition. FBDGs also suggest types of foods high in fats, sugars and/or salt foods to be consumed in small quantities in order to reduce the risks of overweight and obesity as well as diet-related non-communicable diseases. FBDGs are also used as a reference to formulate national agriculture, food and nutrition policies for producing sufficient foods to nourish people.

The success of establishing national dietary guidelines often relies on political commitment and leadership that recognizes raising people’s nutritional status is an integral part of the country’s investment. Smooth operation of FBDGs development and implementation requires adequate resources allocation; hence, securing political commitment would facilitate such a process.

FBDGs development is a science-based process that requires a team of experts with appropriate technical capacity in human nutrient requirements, food consumption survey, food composition data, food science, public health, agriculture, economy and creative designs and communications. Furthermore, the availability of national data or up-to-date national data on nutrition, diet-related health and diseases, food consumption (including food habits, culture and taboos), cost of diets and food price, incomes, food production and food supply, etc. is critically important as a base on which to develop a set of ‘fit for purpose’ FBDGs. In addition, to appoint a team leader with relevant experience in nutritional guidelines development would be conducive in coordinating the process. Otherwise, to set up an advisory committee with relevant external experts may also help steer the process of guidelines development. Upon completion of the dietary guidelines development, it would be effective to designate a responsible ministry or a public institution to promote or reinforce the use of the up-to-date FBDGs for food and nutrition policies and programming implementation, nutrition education and communication, as well as agricultural food product developments and food trade, etc. Documentation of the FBDGs implementation process and a collection of feedback from the public and stakeholders would be useful for future revision and improvement of the FBDGs when new data emerge.

Shauna Downs
Assistant Professor in the Department of Urban-Global Public Health
RUTGERS SCHOOL OF PUBLIC HEALTH

A country’s national dietary guidelines can be a powerful tool for influencing the food choices of its citizens. Although most people don’t follow nutrition guidelines closely when making their own individual food choices, these guidelines feed into national policies that have a far reach (e.g., over 30 million children participate in the United States National School Lunch Program). There has been much debate and political push back regarding the inclusion of sustainability considerations in national dietary guidelines, but these are not motivated by science nor what’s in the public’s best interest. What we eat has serious implications for our health as well as that of our planet. Food production contributes to approximately a third of greenhouse gas emissions, 70% of freshwater use and is the largest contributor to biodiversity loss globally. In order to reduce the pressure that’s being placed on the planet’s resources, we need to make changes to the foods we eat. Given the interconnectedness of food choices and sustainability, countries have an opportunity through their national dietary guidelines and associated policies to make strong dietary recommendations that align with planetary health providing their citizens with the guidance to better support a sustainable future for themselves and generations to come. A handful of countries around the world have already incorporated sustainability into their dietary guidelines and it’s time that this practice moves beyond being the exception and becomes the norm.

Food Choices

Saskia de Pee
Senior Technical Advisor Nutrition
WORLD FOOD PROGRAMME

A diet that complies with food-based dietary guidelines, in terms of including a diversity of foods from different categories, to ensure that nutrient needs (protein, healthy fats, vitamins, minerals) and health needs (low sugar, low salt, good amount of fibre etc) are met. Furthermore, the quantities of the different foods should together provide the amount of energy that an individual needs (maintain body weight, or for children grow in length and weight as per growth curve); intake of empty calorie foods (i.e. high in sugar and/or fat and not a good source of vitamins or minerals) should be low; and the main fluids consumed should be water (and unsweetened tea or coffee). The total free sugar intake should be less than 10% of energy. For example, for an adult who consumes 2400 kcal/d, that means no more than 60 g of sugar, which is equivalent to e.g. 1 can of sugar sweetened beverage or fruit juice and a sweet yoghurt or slice of cake.

Santiago Mazo Echeverri
Food Security and Nutrition Advisor
FAO

My best advice would be:

  • Choose foods items from different food groups (legumes, nuts and seeds, fruits, vegetables, whole grains cereals, tubers, dairy products (1 serving per day), meats (max 500g per week)).
  • Prefer fresh foods and not ultra processed products (high in sugar, saturated fat and salt/sodium)
  • Growth your own foods (if possible) and teach children to do the same.
  • Buy foods from local and small farmers. Don´t waste food.
  • Share frequently meals with your relatives and friends.
  • Don’t eat until you feel full.
  • Drink enough water per day and practice physical activities at least 150 min per week.

Erik Oberholtzer
Advisor
COHERE

A balanced meal usually means a combination of fresh fruits and vegetables, complex grains and some animal protein. The specific blend of balance is often debated between stakeholders causing public confusion. For me, Michael Pollan defines it best – “Eat good food, whole food, real food, mostly plants, not too much”. Eating as Pollan suggests supports more than sound nutrition. It supports ingredient diversity important to soil health and ecosystems resilience. Meals built around diverse ingredients deepen our connections to various food cultures and support micro economies around the world. Meals centered on organic heirloom varieties alleviate the pressure on the environment from industrialized food production. As a chef, meals built on fundamentals of fresh, clean, pure flavor simply taste better.

Daphene Altema-Johnson
Program Officer, Food Communities & Public Health
JOHNS HOPKINS CENTER FOR A LIVEABLE FUTURE

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References

Leading Causes of Death. CDD/National Center for Health Statistics. Accessed April 9, 2020.

Poor Nutrition. National Center for Chronic Disease Prevention and Health Promotion. Accessed April 9, 2020.

Willett WC, Koplan JP, Nugent R, et al. Prevention of Chronic Disease by Means of Diet and Lifestyle Changes. In: Jamison DT, Breman JG, Measham AR, et al., editors. Disease Control Priorities in Developing Countries. 2nd edition. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2006. Chapter 44.

Finding the right balance and making the right food choices have the potential to prevent and, in some cases, reverse the progression of diseases like type 2 diabetes, heart disease, stroke, certain cancers and obesity. Of the top ten leading causes of death in the United States, seven of them are diet related. Diets high in red and processed meats are associated with a higher risk of cardiovascular diseases, type 2 diabetes and some cancers. However, a balanced diet, with whole grains, legumes, vegetables, fruits, nuts, seeds and lower in salt is not only salient for optimal health, but necessary for the prevention of chronic illnesses and maintaining a healthy weight. Additionally, foods that are high in omega 3 fatty acids (salmon, nuts and seeds), low in saturated and trans-fat, and high in fiber (fruits and vegetables) are good choices for decreasing your risk of those chronic conditions.

Harry Aiking
Former Associate Professor in “Sustainability & Food”
VRIJE UNIVERSITEIT AMSTERDAM

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1 Aiking, H.: Protein production: Planet, profit plus people? American Journal of Clinical Nutrition 100 (Suppl.), 483S-489S (2014). DOI:10.3945/ajcn.113.071209.

2 Aiking, H., Boer, J. de: The next protein transition. Trends in Food Science & Technology (in press). DOI:10.1016/j.tifs.2018.07.008.

Many people think that sustainability is cast in stone. However, it is a highly dynamic issue, since ambient conditions determine what can be sustained for prolonged periods of time. Trends such as increasing global levels of population, income and urbanization (all leading to changing diets) are currently threatening several planetary boundaries. In fact, the rates of biodiversity loss and nitrogen cycle acceleration both exceed carbon cycle acceleration (leading to climate change). Moreover, these three boundaries are strongly interlinked1-2 by the way we produce animal protein in intensive systems (such as CAFOs).

We need protein primarily because it supplies our metabolism with nitrogen as a macronutrient. Our bodies contain 3-5% nitrogen, which is indispensable as a constituent of DNA, for example. Protein consists of 20 amino acids, some of which must be in our food as such, because our metabolism cannot synthesize them. Different foods contain varying levels of these “essential” amino acids. Therefore, strictly vegan diets require some more effort for a balanced intake than vegetarian or flexitarian diets. However, balanced diets are healthy irrespective of the proportion of plant proteins and animal proteins.

Unfortunately, few people are eating according to national dietary guidelines. This leads to unnecessary pressure on public and environmental health. Reducing our overall intake of protein, particularly from animal foods, would benefit our health as well as sustainability. The latter derives from the fact that intensive animal systems are wasting precious resources such as land, water and energy, because 6 kg of plant protein is required to yield 1 kg of animal protein, on average. Replacing feed crops with food crops can sustain about 1 billion more people. And how about wildlife? Are you aware that currently two thirds of all terrestrial invertebrates are livestock? Merely 5% are living in the wild, which may drop to 1% by 2050, if we don’t return to more plant-based diets soon. Back to the future!

Saskia de Pee
Senior Technical Advisor Nutrition
WORLD FOOD PROGRAMME

Food insecurity restricts people’s access to food, i.e. the availability of food may be limited or its affordability may be the problem. Often, people still have access to basic foods, but the availability and variety of fresh foods is more limited, and their prices are relatively high. This restricts the choice options people have. People prioritize the foods that provide them energy such as maize porridge, rice, bread or potatoes. Especially when people do not know whether they will be able to prepare a second meal that day, they will try to make the one meal as filling as possible.

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