TTIMES WORLD: Today's News Report

Monday, December 6, 2021
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Obesity
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Obesity

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  • by Anup Shah

Obesity is a growing global health problem. Obesity is when someone is so overweight that it is a threat to their health.

Obesity typically results from over-eating (especially an unhealthy diet) and lack of enough exercise.

In our modern world with increasingly cheap, high calorie food (example, fast food — or junk food), prepared foods that are high in things like salt, sugars or fat, combined with our increasingly sedentary lifestyles, increasing urbanization and changing modes of transportation, it is no wonder that obesity has rapidly increased in the last few decades, around the world.

    Number of People Overweight or With Obesity Rivals World’s Hungry

    In the poverty section primarily, but also in other parts of this web site, much has been written about the causes of hunger in the face of abundant food production due to things like land use, political and economic causes, etc. However, there is another side to this emerging as well: growing obesity. The World Watch Institute noted this quite a while ago and is worth quoting at length:

    For the first time in human history, the number of overweight people rivals the number of underweight people.… While the world’s underfed population has declined slightly since 1980 to 1.1 billion, the number of overweight people has surged to 1.1 billion.

    … the population of overweight people has expanded rapidly in recent decades, more than offsetting the health gains from the modest decline in hunger. In the United States, 55 percent of adults are overweight by international standards. A whopping 23 percent of American adults are considered obese. And the trend is spreading to children as well, with one in five American kids now classified as overweight.… [O]besity cost the United States 12 percent of the national health care budget in the late 1990s, $118 billion, more than double the $47 billion attributable to smoking.

    … Overweight and obesity are advancing rapidly in the developing world as well … [while] 80 percent of the world’s hungry children live in countries with food surpluses.

    … technofixes like liposuction or olestra attract more attention than the behavioral patterns like poor eating habits and sedentary lifestyles that underlie obesity. Liposuction is now the leading form of cosmetic surgery in the United States, for example, at 400,000 operations per year. While billions are spent on gimmicky diets and food advertising, far too little money is spent on nutrition education.

    Chronic Hunger and Obesity Epidemic; Eroding Global Progress, World Watch Institute, March 4, 2000(Emphasis added)

    In the above, note also how many resources are wasted or diverted to either deal with the ramifications (such as health costs), or to deal with the symptoms (via techniques such as liposuction). Of course, that is not to say that resources should not be spent on these things at all, but that it is far more cost effective and more desirable to treat the root causes, as treating symptoms only leaves underlying causes in tact.

    This is an example of hidden costs of consumption on top of the visible costs. The World Watch Institute article, quoted above, goes on to further show that comparatively less expensive measures that deal with causes have been very effective at reducing obesity problems, such as teaching nutritional literacy in schools.

    The BBC revealed that food wastage is enormous. In the United Kingdom, some astonishing 30-40% of all food is never eaten, while in the US, some 40-50% of all food ready for harvest never gets eaten. UK alone sees some £20 billion ($38 billion US dollars) worth of food thrown away each year. Furthermore, the additional rotting food creates methane, a potent greenhouse gas.

    As people eat more and more health and safety of the food production process become more important, too. Nursing Schools lists a number of concerning facts about food in the US:

    • 40-50% of all food ready for harvest never gets eaten.
    • Every year, over 25% of Americans get sick from what they eat.
    • As few as 13 major corporations control nearly all of the slaughterhouses in the U.S.
    • Americans eat 31% more packaged food than fresh food.
    • The FDA tests only about 1% of food imports. (The US imports about 15% of what they eat.)
    • A simple frozen dinner can contains ingredients from over 500 different suppliers so you have to trust all of those hundreds of companies along the way stuck to regulations about food safety.
    • 50% of tested samples of high fructose corn syrup tested for mercury.
    • Americans eat about six to nine pounds of chemical food additives per year.
    • Food intolerance is on the rise, with as many as 30 million people in the U.S. showing symptoms.
    • Fewer than 27% of Americans eat the correct ratio of meats to vegetables.
    • 80% of the food supply is the responsibility of the FDA yet the number of inspections has decreased while the number of producers has increased.
    • Keeping fields contamination-free can cost well over $250,000–a discouraging sum to smaller farmers. Obesity on the Increase

    The World Watch Institute’s statistics above are now over 8 years old but still useful for context.

    The World Health Organization (WHO) provides a number of facts on obesity, including that globally in 2005:

    • Approximately 1.6 billion adults (age 15+) were overweight
    • At least 400 million adults were obese
    • At least 20 million children under the age of 5 years are overweight globally in 2005.

    The WHO also projected that by 2015, approximately 2.3 billion adults will be overweight and more than 700 million will be obese.

    Childhood obesity is also an increasing concern for the WHO:

    The problem [of childhood obesity] is global and is steadily affecting many low- and middle-income countries, particularly in urban settings.… Globally, in 2010 the number of overweight children under the age of five, is estimated to be over 42 million. Close to 35 million of these are living in developing countries.

    Overweight and obese children are likely to stay obese into adulthood and more likely to develop noncommunicable diseases like diabetes and cardiovascular diseases at a younger age.

    Childhood overweight and obesity, WHO, last accessed August 22, 2010

    Recent years have seen a large increase in those overweight or obese.

    The WHO provides charts showing how the prevalence of those who are overweight or obese has increased between 2002 and 2010 for both males and females ovr 15:

    Male obesity 2002–2010

    Globally, male obesity has increased between 2002 and 2010
    Source: Prevalence of overweight & obesity for males over 15, 2002 - 2010, WHO International Comparisons, last accessed November 19, 2010

    The Center for Disease Control and Prevention (CDC) in the US provided a series of charts showing how obesity has dramatically increased amongst adults in the US from 1985-2008:

    Percent of Obese (BMI /> 30) in U.S. Adults in 1985Percent of Obese (BMI > 30) in U.S. Adults in 1985
    • 1 / 25
    Source: U.S. Obesity Trends 1985–2009, CDC, August, 2010

    (I have not found similar sources for other countries, yet. If you know, please let me know.)

    Also note that the WHO figures above are using a body mass index of greater than or equal to 25 as it includes both overweight and obese. The CDC numbers for US states are obese numbers only.

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    Obesity Affects Poor as well as Rich

    Obesity also affects the poor as well, due to things like marketing of unhealthy foods as the Pan American Health Organization (PAHO) highlights. Restrictions in access to food determine two simultaneous phenomena that are two sides of the same coin: poor people are malnourished because they do not have enough to feed themselves, and they are obese because they eat poorly, with an important energy imbalance… The food they can afford is often cheap, industrialized, mass produced, and inexpensive.

    The WHO that many low- and middle-income countries are now facing a double burdern of disease:

    • While they continue to deal with the problems of infectious disease and under-nutrition, at the same time they are experiencing a rapid upsurge in chronic disease risk factors such as obesity and overweight, particularly in urban settings.
    • It is not uncommon to find under-nutrition and obesity existing side-by-side within the same country, the same community and even within the same household.
    • This double burden is caused by inadequate pre-natal, infant and young child nutrition followed by exposure to high-fat, energy-dense, micronutrient-poor foods and lack of physical activity.

    Award-winning journalist Michael Pollan, commenting in an interview on the problem for America’s poor, notes that basic crops such as corn and soybeans are used to such an extent that many unhealthy and processed foods are created from them, at a subsidized rate, thus contributing to the problem:

    Because we subsidize those calories, we end up with a supermarket in which the least healthy calories are the cheapest. And the most healthy calories are the most expensive. That, in the simplest terms, is the root of the obesity epidemic for the poor—because the obesity epidemic is really a class-based problem. It’s not an epidemic, really. The biggest prediction of obesity is income.

    Blair Golson, America’s Eating Disorder, Alternet.org, April 19, 2006

    Pollan and bestseller Eric Schlosser also released a documentary film, Food Inc, that looks into the effects of subsidizing unhealthy practices, further. Schlosser’s bestselling book, Fast Food Nation is also discussed on this site’s section on beef.

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    Health impacts

    With obesity comes increasing risks of

    • Cardiovascular disease (mainly heart disease and stroke) — already the world’s number one cause of death, killing 17 million people each year.
    • Diabetes (type 2) — which has rapidly become a global epidemic.
    • Musculoskeletal disorders — especially osteoarthritis.
    • Some cancers (endometrial, breast, and colon).

    In addition, childhood obesity is associated with a higher chance of premature death and disability in adulthood.

    The WHO adds, What is not widely known is that the risk of health problems starts when someone is only very slightly overweight, and that the likelihood of problems increases as someone becomes more and more overweight. Many of these conditions cause long-term suffering for individuals and families. In addition, the costs for the health care system can be extremely high.

    In Europe, for example, the WHO’s European regional body says that obesity is already responsible for 2-8% of health costs and 10-13% of deaths in different parts of the Region.

    (See the obesity and overweight facts and What are the health consequences of being overweight?, both by the WHO, for more details.)

    In Britain for example, a Centre for Food Policy and Thames Valley University report, titled Why health is the key for the future of farming and food (January 2002) says that despite food scandals getting headlines, far more people are affected by diet-related diseases such as cardiovascular disease, cancer, diabetes and nutritional deficiencies than diarrhoeal diseases (salmonella, campylobacter, etc) — some 35% compared to 0.2%.

    As the report says bluntly, food safety may scandalise the country and attract political attention, but it is the routine premature death by degenerative disease that extracts the greater ill-health toll (p.15).

    This phenomena is seen in many rich nations, though Britain comes out worse than most on many such indicators (p.16).

    The report further highlights that the costs of coronary heart disease alone are around £10 billion a year (approximately 14 billion in U.S. dollars). These costs are made up of

    • £1.6 billion in direct costs (primarily to the tax payer through the costs of treatment by the British National Health Service) and
    • £8.4 billion in indirect costs (to industry and to society as a whole, though loss of productivity due to death and disability). (p. 38)

    Other issues and problems they point out include:

    • Encouraging/advertising unhealthy diets and foods (especially to children);
    • Generally putting low priority on health;
    • Industry-dominated food policy at the expense of local grocery stores;
    • Deteriorating health of children in poverty;
    • and so on.

    The report however, does not include costs from the effects of wider industrial agricultural policies that have given rise to BSE, Foot and Mouth disease, or the cost to the environment, etc.

    New York Times food writer Mark Bittman summarizes how this is a global issue because over-consumption and over-industrialized-production of unhealthy foods is also putting the entire planet at risk:

    Experts believe that obesity is responsible for more ill health even than smoking, the BBC has noted, which ties in with the World Watch quotation above about health costs for obesity in the U.S. exceeding those associated with smoking.

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    Various causes of obesity

    Taking a more global view, the prestigious British Medical Journal (BMJ) looks at various attempts to tackle obesity and notes that obesity is caused by a complex and multitude of inter-related causesfuelled by economic and psychosocial factors as well as increased availability of energy dense food and reduced physical activity.

    The authors broke down the causes into the following areas:

    Food systems causes of obesity

    The main problem has been the increased availability of high energy food, because of:

    • Liberalized international food markets
    • Food subsidies that have arguably distorted the food supply in favour of less healthy foodstuffs
    • Transnational food companies [that] have flooded the global market with cheap to produce, energy dense, nutrient empty foods
    • Supermarkets and food service chains [that are] encouraging bulk purchases, convenience foods, and supersized portions
    • Healthy eating often being more expensive than less healthy options, (despite global food prices having dropped on average).
    • Marketing, especially food advertising through television [which] aims to persuade individuals—particularly children—that they desire foods high in saturated fats, sugars, and salt.
    The local environment and obesity

    How people live, what factors make them active or sedentary are also a factor. For exapmle,

    • Research, mainly in high income countries, indicates that local urban planning and design can influence weight in several ways.
    • For example, levels of physical activity are affected by
      • Connected streets and the ability to walk from place to place
      • Provision of and access to local public facilities and spaces for recreation and play
    • The increasing reliance on cars leads to physical inactivity, and while a long-time problem in rich countries, is a growing problem in developing countries.
    Social conditions and obesity

    Examples of issues the BMJ noted here include

    • Working and living conditions, such as having enough money for a healthy standard of living, underpin compliance with national health guidelines
    • Increasingly less job control, security, flexibility of working hours, and access to paid family leave … undermining the material and psychosocial resources necessary for empowering individuals and communities to make healthy living choices.
    • Inequality, which can lead to different groups being disadvantaged and having less access to needed resources and healthier foods

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    Addressing Obesity Globally, Nationally, Locally, Individually

    British celebrity-chef-turned-food-activist, Jamie Oliver, recently won the prestigious TED Prize for his campaigning in the UK to fight obesity. His wish that the TED Prize speech asks him to share was to help to create a strong, sustainable movement to educate every child about food, inspire families to cook again and empower people everywhere to fight obesity. He explained this in his video:

    Given the complex, inter-related causes of obesity, addressing it also requires a multi-pronged approach:

    Dealing with inequalities in obesity requires a different policy agenda from the one currently being promoted. Action is needed that is grounded in principles of health equity.

    Missing in most obesity prevention strategies is the recognition that obesity—and its unequal distribution—is the consequence of a complex system that is shaped by how society organises its affairs. Action must tackle the inequities in this system, aiming to ensure an equitable distribution of ample and nutritious global and national food supplies; built environments that lend themselves to easy access and uptake of healthier options by all; and living and working conditions that produce more equal material and psychosocial resources between and within social groups. This will require action at global, national, and local levels.

    Sharon Friel, Mickey Chopra, David Satcher, Unequal weight: equity oriented policy responses to the global obesity epidemic, British Medical Journal, Volume 335, December 15, 2007, pp. 1241-1243

    The BMJ criticizes traditional methods to address obesity as typically trying to change individual’s behavior. While important, on its own, they feel it is not sufficient; there is limited evidence for sustainability [of this direct approach] and transferability to other settings, for example.

    Furthermore, the recent UK Foresight Report makes clear the complexity of drivers that produce obesity; it highlights that most are societal issues and therefore require societal responses.

    The BMJ therefore describes some examples of initiatives at these various levels:

    Addressing obesity at the global level

    This involves international institutions, agreements, trade and other policies. For example,

    • The World Health Organization (WHO) is a key institution at this level. It’s global strategy in this area focuses on developing food and agricultural policies that are aligned to promoting public health and multisectorial policies that promote physical activity, as well as generally being an information provider.
    • A joint program of the United Nations Food and Agriculture Organization and the World Health Organization, the experience of the Codex Alimentarius Commission highlights the challenges at international level. The Commission was set up to help governments protect the health of consumers and ensure fair trade practices in the food trade.
    • But challenges and obstacles persist. For example, industry representatives hugely outnumber representatives from public interest groups, resulting in an imbalance between the goals of trade and consumer protection.

    In addition,

    • Ensuring that global food marketing does not target vulnerable societies the BMJ feels there needs to be binding international codes of practice related to production and marketing of healthy food, supported at the national level by policy and regulation.
    • This is preferred over voluntary guidelines, typical of the industry’s response to threats of regulation, because such responses may result in differential uptake by better-off individuals or institutions and provides little opportunity for public and private sector accountability. (Emphasis added)
    • For example, regulating television advertising of foods high in fat or sugar to children is a highly cost effective upstream intervention. (This is also discussed in more detail on this site’s section on Children as Consumers.)
    Addressing obesity at the national level

    National policies typically aimed at healthier food production include targeted and appropriate domestic subsidies. For example,

    • Norway successfully reversed the population shift towards high fat, energy dense diets by using a combination of food subsidies, price manipulation, retail regulations, clear nutrition labelling, and public education focused on individuals.
    • Mauritius relatively successful program includes price policy, agricultural policy, and widespread educational activity in various settings.

    Ireland is an example of the also-needed multi-agency approach with their Healthy Food for All initiative seeking to promote access, availability, and affordability of healthy food for low income groups.

    Addressing obesity at the local level

    Examples of local level action the BMJ mentioned include

    • The success of the Brazilian population-wide Agita Sao Paulo physical activity program which successfully reduced the level of physical inactivity in the general population by using a multi-strategy approach of building pathways; widening paths and removing obstacles; building walking or running tracks with shadow and hydration points; maintaining green areas and leisure spaces; having bicycle storage close to public transport stations and at entrances of schools and workplaces; and implementing private and public incentive policies for mass active transport.
    • The London Development Agency plans to establish a sustainable food distribution hub to supply independent food retailers and restaurants.

    However, a key challenge they note is the lack of systematic evaluation of initiatives, particularly with an equity focus, [which] makes it difficult to generalize policy solutions in this field.

    So while there are many measures possible at many levels, a cultural shift in attitude is needed.

    The benefits of a healthier diet is obvious. Yet, as Dr. Dean Ornish, a clinical professor and founder of the Preventive Medicine Research Institute, explains, the large number of cardiovascular diseases that kill so many around the world is not only preventable, but reversible, often by simply changing our diets and lifestyle:

    Dean Ornish on the world’s killer diet, TED Talks, December 2006

    Another BMJ article notes in a prognosis in obesity that we need to move a little more and eat a little less:

    New economic analyses help dispel the myth of people getting fatter but eating less. The first 20 years of our adult obesity epidemic, from the 1970s to 1990s, was explained mainly by declining physical activity: Americans believe they have less time to do things but in reality are spending more time watching television and being inactive. Subsequently, the obesity epidemic appears to have been fuelled by largely increased food consumption. A paradoxical increase and deregulation of appetite during inactivity has been matched by an increasing supply of food at lower real cost. Consumption of supersize food portions will accelerate this process, reflecting a failure of the free market that demands government intervention.

    Professor M E J Lean, Prognosis in obesity; we all need to move a little more, eat a little less, British Medical Journal, Volume 330, 11 June 2005, p.1339

    Award-winning journalist Michael Pollan argues in an interview that not only is what you eat important, but how you eat, as well:

    At the end of the industrial food chain, you need an industrial eater. What you eat, and how you eat are equally important issues. There is a lot of talk and interesting comparisons drawn between us and the French on the subject of food. We’re kind of mystified that they can eat such seemingly toxic substances—triple crème cheeses and foie gras, and they're actually healthier than we are.

    They live a little bit longer, they have less obesity, less heart disease. What gives? Well, according to the people who study this: It’s not what they eat, it’s how they eat it. They eat smaller portions; they do not snack as a rule; they do not eat alone. When you eat alone, you tend to eat more. When you’re eating with someone there’s a conversation going on, there’s a sense of propriety; you don’t pig out when you’re eating at a table with other people.

    So the French show you can eat just about whatever you want, as long as you do it in moderation. That strikes me as a liberating message. But it’s not the way we do things here. We have a food system here that is all about quantity, rather than quality. So how you eat is very, very important, and to solve the obesity and the diabetes issue in this country, we’re going to have change the way we eat, as well as what we eat.

    Blair Golson, America’s Eating Disorder, Alternet.org, April 19, 2006

    Perhaps a more bizarre suggestion in UK has been by a doctor (or scientist — I heard this on the radio and did not have time to get the exact details) who suggested that McDonald’s should narrow their doors so that fat people cannot get in. Maybe this hints at how extreme the problem might be for a medical doctor to be so extreme in a possible solution, as there are problems with this type of suggestion. For example,

    • This sounds like an extremist and reactionary measure to deal with the issue, and raises concerns about rights of individuals to make their own choices.
    • Furthermore, it could lead to a form of prejudice and hostility towards certain types of people.
    • More effective could be to address the deeper issues discussed further above and below.
      • For example, the fast food industry is not effectively charged for their contribution to environmental destruction around the world, or even their indirect contribution to world hunger by making poor people grow food for export rather than to feed themselves. (See this site’s section on beef, and hunger for more on these aspects.)
      • These examples just touch the surface, but these all add up to hidden costs for society but savings for the fast food companies.
      • Pricing beef, for example, based on true cost of production would make these inefficient and unhealthy foods more expensive, and a deterrent for the majority of people, who might turn to healthier options (though this itself isn’t an automatic given).

    But the underlying concern of the doctor is still important. At the end of April 2004, the British government urged the public to exercise five times a week. Levels of physical activity among the general population have fallen significantly over the past 25 years the government had also noted. Compelling scientific evidence shows that more active people are less likely to become obese and develop heart disease.

    Another major determinant in people’s preferences and habits, especially in a consumer society, is marketing.

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    Healthy versus Unhealthy Food Marketing; Who Usually Wins?

    Of course, obesity is not an easy challenge to overcome, as today’s commercial markets include a very wide variety of foods that are unhealthy, but attractively marketed to kids, as also mentioned in the children section. And many resources are deployed to support that industry. This is another example of hidden waste.

    Soaring diabetes rates are inextricably tied to the global obesity epidemic, as Inter Press Service (IPS) notes. Yet, the political will to be able to change certain cultural habits and to take on powerful industries promoting such habits that lead to these problems, is where the challenge lies.

    In theory were it not for these political and cultural challenges, the cost of addressing the problem could be quite low (regular exercise, sensible eating habits, for example). But, There is not enough resolve to take on these monster industries and to force changes that will make our environment promote healthy rather than unhealthy choices when it comes to food and physical activity says Dr. David Schlundt, a psychology professor at the Diabetes Center of Vanderbilt University in Tennessee state, in that IPS article.

    The WHO [World Health Organisation] is basically powerless to do anything about the problem other than draw attention to it and perhaps develop some recommendations that will be very difficult for governments to implement Schlundt also notes.

    Talk of banning ads to kids met with resistance from industry

    As a small example, in November 2003, another UK government member of Parliament had suggested a bill to ban TV ads promoting food and drink high in fat, salt and sugar aimed at young children. This received a lot of support as well, as groups and other members of Parliament felt that self-governing by the industry was not working. However, the bill didn’t get anywhere due to lack of time although it is repeatedly being called for.

    The BBC noted in March 2004 that over 100 of the UK’s leading health and consumer groups have urged the government to ban junk food ads, saying they are fueling rising rates of obesity. Some of these groups are leading medical and related organizations in Britain.

    However, as the BBC also noted, a UK government minister said she was skeptical about the merits of banning junk food ads and, in concert with what the food and drink industry said, sound science was needed to ensure that this was indeed a major cause of health problems. Encouraging healthier living and eating would be better it was noted.

    Ironically, it is the food and drink industry that has the advertising muscle and clout, and, as a campaigner from one of the groups commented, Huge profits are at stake, so we don’t believe that they will voluntarily stop promoting junk foods to kids. For the sake of children’s health, statutory controls are urgently required.

    As also mentioned on this site’s section on Children as Consumers, industry raises fears that ad bans will result in job losses, but also a loss in quality programming for children, because those ads fund programs.

    Industry attempts at self-regulation not working, sometimes reversing

    Many groups have long been raising urgent concerns because a conservative estimate from experts suggests that over 40% of the UK population could become obese within a generationThe food and drink industry are on the defensive because of the potential loss in sales. As a result, they tend to suggest blaming the individual; it is the individual’s choice at the end of the day. However, while true, advertising is so much part of culture that it would be overly simplistic to say ads do not have an effect and that it is only through exercise and personal discipline that these issues can be overcome. Furthermore, if it is individual choice, then food companies would not need to market and create perceived food needs; the necessity to eat would be enough to drive the market.

    The above example about pressure to ban advertising and the associated skepticism on its merits comes from the UK. In the US, industry has offered to self regulate. However, it looks as though pledges to reduce junk food advertising have not been met:

    As detailed further on this site’s section on children and consumption, a number of food companies in the US said they would volunteer to cut ads directed towards children, as reported by the International Herald Tribune (December 11, 2007). The companies, Coca-Cola, Groupe Danone, Burger King, General Mills, Kellogg, Kraft Foods, Mars, Nestlé, PepsiCo, Ferrero and Unilever, agreed not to advertise food and beverages on television programs, Web sites or in print media where children under age 12 could be considered a target audience, except for products that met specific nutrition criteria.

    However, 3 years on from the above announcement, The Food Advertising to Children and Teens Score (FACTS) — an organization developed by Yale University’s Rudd Center for Food Policy and Obesity to scientifically measure food marketing to youth — found that some of the pledges to reduce marketing had actually reversed.

    It found that the fast food industry continues to relentlessly market to youth. For example,

    • The average preschooler (2-5) sees almost three ads per day for fast food; children (6-11) see three-and-a-half; and teens see almost five.
    • Children’s exposure to fast food TV ads is increasing, even for ads from companies who have pledged to reduce unhealthy marketing to children.
    • Children see more than just ads intended for kids. More than 60% of fast food ads viewed by children (2-11) were for foods other than kids’ meals.

    Some $4.2 billion was spent in 2009, a fifth of which was by McDonald’s alone. TV accounted for the bulk of the advertising (86%) though Internet marketing was increasing. (See p.51 of their main report, Evaluating Fast Food Nutrition and Marketing to Youth  (November 2010), for the details)

    The organization suggested changing the industry-defined definition of television programs that require restrictions on the type of advertising aimed at children. Rather than restrictions only applying when the program is created solely for children, it wants a broader standard, such as the total number of children that watch a program. That would extend the reach of child friendly advertising guidelines to such broadly popular shows as American Idol and Glee. (See p.14 of the report)

    Taxing junk food; a popular idea, but realistic?

    If media regulation is proving challenging, then other ideas may too, such as some notion of tax on junk foods. The industry will of course be against such measures, instead preferring things like exercise and individual responsibility instead (though an individual — often poor on time — versus professional marketing usually suggests an imbalance in available information and decision-making).

    Some studies suggest that economic instruments (such as price rises or taxation) of unhealthy foods might have an effect, but it is not guaranteed. For example,

    This review found no direct scientific evidence of a causal relationship between policy-related economic instruments and food consumption, including foods high in saturated fats. Indirect evidence suggests that such a causal relationship is plausible, though it remains to be demonstrated by rigorous studies in community settings.

    C. Goodman, A. Anise, What is known about the effectiveness of economic instruments to reduce consumption of foods high in saturated fats and other energy-dense foods for preventing and treating obesity?, Health Evidence Network, World Health Organisation, July 2006

    In mid-November, 2010, the BBC’s Panorama explored this notion of taxing the fat, saying that Britain is the fattest nation in Europe, and wondered whether it was time to consider such a tax as it may help the National Health Service afford the various costs associated with this problem.

    The documentary also went to Denmark — the first country in the world to implement such a tax — to see how it was working there, and to the US, where it explained how a proposal to tax sugary drinks like Coca Cola has met with fierce opposition.

    It found that there were signs of young people losing weight in the already heavily taxed Denmark, although older adults were still gaining weight.

    One potential use of the tax would be to subsidize healthier foods such as fruits and vegetables. But, a potential problem with taxing junk food is that many fruits and other healthy ingredients are often used in unhealthy foods such as sweets and sugary drinks, and even cosmetics and other products such as shampoos. So how can you ensure the tax proceeds are used appropriately?)

    The documentary also implied that the current UK Health Secretary wasn’t keen on the idea and that his view was in line with the fast food industry, as targets and other measures may be lowered, as well as funding for current health campaigns for more active lives.

    Exercise and individual responsibility has been the food industry’s preferred alternative to regulation (it avoids extra costs on the industry, which industry representatives claim would cost jobs and competitiveness, and while it transfers extra burden and cost onto consumers, they are often ready to sell more in relation to that as described further below).

    However, the documentary also noted that more and more studies are showing that while both diet and exercise are crucial to healthy lives, the balance isn’t necessarily 50-50. Instead, diet appears to have a much larger bearing on people’s health and obesity. In addition, the numerous amounts of calories now available in fast foods are so high that the levels of exercise needed to burn the excess off is immense. Many people wouldn’t have that time.

    And possibly as an example of a more bizarre sounding use of resources to get children to become more active, in Britain, a chocolate company was promoting sports equipment in return for vouchers and coupons from chocolate bars. The more you ate, the more sports equipment you would get, presumably to burn off the excesses eaten! The UK’s Food Commission called this absurd and contradictory and pointed out that if children consumed all the promotional chocolate bars they would eat nearly two million kilos of fat and more than 36 billion calories.

    The BBC, reporting on this (April 29, 2003), commented the following, amongst other things:

    • One set of posts and nets for volleyball would require tokens from 5,440 bars of chocolate
    • This would require spending £2,000 (about $3,500) on chocolate and wolfing their way through 1.25 million calories, some 2 million kilos of fat.
    • A basketball would be 170 bars of chocolate, which, if it were to be burned off, a 10-year-old child would need to play for 90 hours.

    While the confectionary companies suggested that children were going to eat these anyway, others raised concerns that this is promoting more unhealthy eating. The chairman of the UK government’s obesity task force, Professor Phil James, said: This is a classic example of how the food and soft drink industry are failing to take on board that they are major contributors to obesity problems throughout the world. They always try to divert attention to physical activity.

    What is more, as most British media outlets also highlighted, then Minister for Sport, Richard Caborn, endorsed it.

    But this is not the only example. For years, other companies have linked their foods to such schemes for educational or sports equipment for schools. What they get for selling this is branding and future consumers.

    This has also been an example of controversial school commercialization which was unanimously condemned at a large teachers union conference in England around the same time.

    This site’s section on Children as Consumers also notes that towards the end of 2007, additional efforts started in the UK to understand the effect of advertising on children. It also has more details on efforts to address issues related to obesity and the challenge parents (often the ones who are blamed) when going up against marketers. This is another example of how this can have all sorts of knock-on effects to society and to resource requirements to deal with these issues. And that results in further expenditure and use of resources which, from this perspective, can be seen as costly and wasteful.

    Deforestation, Bananas and International Economic Trade
    Banana

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    Bananas

    Author and Page information

    • by Anup Shah

    Some of the previous pages in this section such as those on sugar and beef highlighted a number of concerns. These concerns included the burdens on the environment, on people’s healths, on nations’ ability to cope, and other issues. Such examples begin to only hint at the deeper waste of capital, resources and even labor.

    Bananas: common fruit, complex issues. (Source: Wikipedia)

    This page looks at some of the issues around the banana industries, and as well as showing similar issues as the previous sections, highlights some concerns about the fragility of entire economic regions that have become so dependent on just a few areas, such as banana exports.

    As mentioned in an earlier page on this section, numerous issues combine, contributing to further deforestation, environmental degradation, poverty, hunger and so on. As a reminder of what was said on the Effects of Consumerism page it is mentioned here again:

    When looking at the destruction of rain forests in Central America, a similar pattern to what is mentioned above, was observed by John Vandermeer and Ivette Perfecto, in their book Breakfast of Biodiversity: The Truth About Rain Forest Destruction, (Food First, 1995), and also highlighted by editor Douglas H. Boucher, The Paradox of Plenty; Hunger in a Bountiful World, (Food First, 1999), pp. 86—87. Summarizing that here:

    The patterns of inter-related issues that would affect forest destruction could be seen in many different reasons, such as banana production, citrus and other fruits, rubber tree plantations, and other commodities. Yet, these were similar politically if quite distinct biologically, and would typically include the following stages:

    1. Visionary capitalists identify an economic opportunity for the market expansion of an agricultural product
    2. They purchase (or steal, or bribe into a government concession) some land, including land that may contain rain forest, which is promptly cut down.
    3. They import workers to produce products
    4. After a period of boom the product goes bust on the world market which leads to cut backs, layoffs, etc.
    5. Those laid off must seek other means to survive, and in poor countries and rural areas that may mean growing subsistence crops on marginal lands
    6. The only place the now unemployed workers can find land no one will kick them off of is in the forest, which means yet more forest is converted to agriculture

    They continue to point out the flaws in the accepted Malthusian theories of population growth placing demands on natural resources.

    Image: Women in Belize sorting bananas and slicing them from bunches. (Source: Wikipedia)

    Vandermeer and Perfecto use the example of banana production in Central America and the Caribbean to show an example of such a pattern of inter-related issues that affect forest destruction.

    They also point out that most other commodities follow these patterns (and further examples are also discussed on this web site’s section on the causes of hunger).

    Bananas grow on large plants not trees. (Source: Wikipedia)

    The further expansion of the banana industry in the late 1980s and early 1990s they hinted to, was part of the first step described above. That is, to produce for the emerging larger European market with the potential unification and large free trade zone.

    This led to things like clearing rainforest for banana plantation, mass migration to work the plantations and so on.

    A period of boom was followed by a bust, so more people were left unemployed, settling on marginal land or clearing small areas of rainforest to grow subsistence crops just to survive and so on.

    They wrote this in 1995 and a few years later we saw the banana trade war between Europe and USA.

    • The United State at the request of American corporations in Central and South America were trying to destroy the Caribbean markets via complaints to the World Trade Organization of being restricted access to the European market.
      • The Caribbean markets were getting preferential access to European markets.
      • But because of the potential of a larger market there, the Caribbean region which is heavily dependent on the Banana industry and the European market to export most of its bananas, also suffered potential economic threat.
    • The additional banana growth in Latin America has been accompanied with social and environmental problems, as described above by Vandermeer and Perfecto and as they also update in an epilogue to their book.

    Underlying all this though, is how both the resources in Central American and the Caribbean have been largely diverted away from local needs, to exporting a few commodities in order to meet wealthier consumption needs. (For more on the banana trade disputes, see this site’s section on bananas. It talks in more detail about the trade dispute, the corporate influence and effects on the poor.)

    The banana example, therefore, touches many different issues, including labor exploitation (as Chiquita, one of the main corporations involved have been even accused of killing workers), environmental degradation, poverty, economic issues, development and so on.

    • We are seeing, also with coffee especially, the emergence of fair trade products, like fair trade coffee, where producers and workers are paid fairer prices for their products.
    • While that is extremely important, the other issue for certain commodities such as bananas, coffee, tea and so on, is the mass production of it in many countries mainly for export, while resources for local development and building the economy are neglected.
    • Structural Adjustment, free trade agreements, such as the Free Trade of the Americas, and other international agreements (as discussed elsewhere on this web site) are heavily geared against such self-sufficiency based development. (And often the term free trade is in name only, as detailed on the free trade section of this web site.)
    • This ensures the poor are adjusted to become continually dependent on external factors, such as commodity prices (which get cheaper and cheaper with more production), and tastes.
    • Such agreements also prevent local economies from developing by preventing the multiplier effect of money as it would circulate through an economy. Instead, money comes in and goes out at just the production level.
    • Hence, local purchasing power is not developed, so the real market is in exports. This continues to create more inequality and contributes to other problems such as crime and corruption.

    That is not to say that bananas should not be eaten at all in protest, or production stopped.

    • But this does begin to highlight the injustices that go with the current political and economic ideas behind the way such commodities are produced.
    • People will likely want to continue to eat bananas, but the overproduction means there is much wastage.
    • Additionally, nations should be able to have more freedom in determining what to produce.
    • Instead, international institutions such as the IMF and World Bank, have a lot of influence on the third world and how third world countries should adjust their economies. (See this site’s section on structural adjustment for more details on that angle.)
    • At the same time, actual production methods etc by the large multinationals need to be addressed for their labor practices and environmental degradation.

    Of course, these options are all fraught with political obstacles, such as geopolitics, power play, influence from wealthier nations, and so on. Else, these situations likely would not have arisen or become so problematic in the first place! (For a far more thorough discussion on ways forward, on the banana and rain forest destruction issue in particular, but also touching all major issues as they are all inter-related, see Vandermeer and Perfecto’s work, mentioned above. In addition, many areas across this web site discuss these issues in more detail with additional examples. Links to those pages are also given towards the end of this site’s section on consumption.)

    As with the preceding examples then, there is much wastage. That is, there is a lot of waste due to things like all the resources used to pay for the buildings, office materials, infrastructure support and all the other cascading resource expenditures used to maintain these inequalities, and to maintain unequal competition/monopolization. There is also a lot of waste in the sense of accompanying poverty, dependency and social destruction. Human potential and capabilities are destroyed and wasted because of the trade disputes and agreements. This wasted wealth is, more generally, due to wasted capital, wasted labor and wasted resources.

    GAIN Working Paper Series 21 - Bringing business thinking to worker nutrition programs
    Ghana

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    GAIN Working Paper Series 21 - Bringing business thinking to worker nutrition programmes

    GAIN Working Paper Series 21 - Bringing business thinking to worker nutrition programs

    This study aimed to do something that had not been done before: apply business case thinking to worker nutrition programs in supply chains, using a structured and systematic approach. The study extended the definition of "business case" beyond financial returns on investment to cover a broad range of possible motivations for companies and sectors to invest in nutrition in their supply chains.

    The cocoa nutrition innovation programme in Ghana - Harvesting the benefits of nutrition for farmers, families and workforce

    The cocoa nutrition innovation program in Ghana - Harvesting the benefits of nutrition for farmers, families, and workforce

    There are many complex and political challenges faced by companies working with large and diverse supply chains. For the cocoa sector, child labor, attaining a living income, and deforestation are often seen as the most urgent. However, one area that affects productivity, profitability, and reputation but is relatively easy to solve is workers’ nutrition.

    Bite the Talk podcast

    Episode 08

    Raising the alarm on COVID-19 and malnutrition

    Focus Ethnographic Study (FES) in Ghana

    Focus Ethnographic Study (FES) in Ghana

    This Focused Ethnographic Study (FES) used research modules derived from a cultural-ecological framework to examine the infant and young child feeding practices, behaviors, and beliefs from a household perspective.

    Balancing health, cost and convenience in feeding infants and young children in Accra

    Balancing health, cost, and convenience in feeding infants and young children in Accra

    The purpose of this study was to examine the potential of Maisoyforte 6-24, a new fortified, non-instant cereal for infants and young children (IYC), which was proposed by a local Ghanaian company to the Global Alliance for Improved Nutrition (GAIN) for start-up support.

    Development of food-based recommendations using Optifood-Ghana

    Development of food-based recommendations using Optifood-Ghana

    A Focused Ethnographic Study and dietary analysis using the Optifood system were carried out in two farming districts in Ghana. The main aim of the overall study was to identify strategies, based on locally available foods, to improve the nutritional quality of the diet of infants and young children in selected regions in Ghana.

    Findings of an analysis of infant and young child feeding in Ghana using Optifood and focused ethnographic studies

    Findings of an analysis of infant and young child feeding in Ghana using Optifood and focused ethnographic studies

    The aim of the study was to identify a set of evidence-based, population-specific, food-based recommendations that can be promoted to improve the nutritional status of infants and young children in farming communities of Ghana.

    Technological and market interventions for aflatoxin control in Ghana

    Technological and market interventions for aflatoxin control in Ghana

    This report describes a randomized controlled trial among groundnut farmers in northern Ghana designed to test the impact of two approaches to encouraging the adoption of post-harvest practices for the reduction of aflatoxins. Results indicate that simply training farmers and making tools for aflatoxin prevention available has a significant impact on post-harvest practices. 

    Focused ethnographic study–Gomoa East district, Ghana

    Focused ethnographic study–Gomoa East district, Ghana

    This report presents the findings and discussion of a Focused Ethnographic Study in Gomoa East District, Central Region. The study yielded important insights about current infant and young child feeding behaviors and practices and enabled the identification of appropriate interventions to address infant and young child diet inadequacies and malnutrition. 

    Focused ethnographic study–Karaga district, Ghana

    Focused ethnographic study–Karaga District, Ghana

    This report presents the findings and discussion of a Focused Ethnographic Study in Karaga District, Northern Region. This study yields important insights about current infant and young child feeding behaviors and practices and enabled the identification of appropriate interventions to address infant and young child diet inadequacies and malnutrition.

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    Nutrition Tanzania made significant progress in improving nutrition among children under 5 years of age
    Tanzania

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    Challenge

    During the period 1992– 2015, there was a tangible reduction in the number of underweight children and in those suffering from chronic malnourishment. However, despite these gains, concerns persist regarding the high rates of stunting among children and the stark disparities in nutritional status. Progress on various indicators has been either stagnant or has slipped.

    In 2015, more than 2.7 million Tanzanian children under 5 years of age were estimated to be stunted and more than 600,000 were suffering from acute malnutrition, of which 100,000 were severe cases.

    There are huge variations in the nutritional status of children under 5 years of age. Ten regions account for 58 per cent of all stunted children and five regions account for half of the children suffering from severe acute malnutrition in Tanzania. All three forms of undernutrition are higher among children from the poorest quintile than the richest quintile and higher among boys than girls.

    Given the importance of nutrition in the overall physical and cognitive development of children, there is a need to focus on the first 1,000 days of a child’s life to prevent the negative effects of malnutrition from becoming irreversible. This requires a multi-pronged approach to address risk factors ranging from inadequate food and illness to poor access to safe drinking water, sanitation and hygiene.

    High rates of anaemia and low body mass index among adolescent girls and pregnant women are also causes of concern. Investing in nutrition is essential for Tanzania to progress. It is estimated that the country will lose US$20 billion by 2025 if the nutrition situation does not improve. In contrast, by investing in nutrition and improving the population's nutritional status, the country could gain up to US$4.7 billion by 2025.

     

    Solution

    What is UNICEF doing?

    UNICEF works with government and other partners to elevate nutrition within Tanzania’s national plans and priorities. UNICEF also supports districts to implement the National Food and Nutrition Policy. In terms of the United Nations Development Assistance Plan (2016– 2021), UNICEF has a lead role in focusing on equity to improve the nutritional status of children and women in Tanzania.

    UNICEF is working with the government and other partners to implement a multi-sectoral nutrition response; scale-up high-impact nutrition interventions and services; and respond to the nutritional needs of refugees and other children affected by emergencies. UNICEF supports the inclusion of chronically poor pregnant women and young children as beneficiaries of regular cash transfers, to protect food supply and consumption and to help vulnerable families invest in the nutrition, health and education of their children during times of stress and hardship.

    Working through local partners, UNICEF also ensures that the poorest and most marginalized households in Mbeya, Iringa, Njombe, Songwe and Zanzibar are targeted with messages and promotion of infant and young child feeding and care practices.

      

    What we want to achieve by 2021

    • Improved maternal, infant, and young child nutrition services

    • Improved micronutrient supplementation and fortification services

    • Improved available integrated management of severe acute malnutrition services

    • Improved capacity of relevant ministry departments and select local government authorities to implement a multi-sectoral nutrition response at national, regional and district level

    • Operationalized multi-sectoral nutrition information and surveillance systems

    Less inflammation with a traditional Tanzanian diet than with a Western diet
    Tanzania

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    Urban Tanzanians have a more activated immune system compared to their rural counterparts. The difference in diet appears to explain this difference: in the cities, people eat a more western style diet, while in rural areas a traditional diet is more common. A team of researchers believe that this increased activity of the immune system contributes to the rapid increase in non-communicable diseases in urban areas in Africa.


    Urban Tanzanians have a more activated immune system compared to their rural counterparts. The difference in diet appears to explain this difference: in the cities, people eat a more western style diet, while in rural areas a traditional diet is more common. A team of researchers from Radboud university medical center in the Netherlands, the LIMES Institute at the University of Bonn in Germany and the Kilimanjaro Clinic Research Center in Tanzania believe that this increased activity of the immune system contributes to the rapid increase in non-communicable diseases in urban areas in Africa.

    The survey was conducted among more than 300 Tanzanians, some of whom live in the city of Moshi and some in the countryside. The team found that immune cells from participants from Moshi produced more inflammatory proteins. The people surveyed had no health problems and were not ill, but an activated immune system may increase the risk for lifestyle diseases, such as cardiovascular disease.

    The researchers used new techniques to investigate the function of the immune system and the factors that influence its activity. Quirijn de Mast, internist-infectious diseases specialist at Radboud university medical center explains: "We looked at active RNA molecules in the blood -- known as the transcriptome -- and the composition of metabolic products in the blood."

    Major differences in diet

    These analyses showed that metabolites derived from food had an effect on the immune system. Participants from rural areas had higher levels of flavonoids and other anti-inflammatory substances in their blood. The traditional rural Tanzanian diet, which is rich in whole grains, fibre, fruits and vegetables, contains high amounts of these substances. In people with an urban diet, which contains more saturated fats and processed foods, increased levels of metabolites that are involved in cholesterol metabolism were found. The team also found a seasonal change in the activity of the immune system. In the dry season, which is the time of harvest in the study area, the urban people had a less activated immune system.

    Migration to the cities of Africa

    It has been known for some time that a Western lifestyle and eating habits lead to chronic diseases. According to de Mast, two important findings have emerged from this study. "First of all, we showed that a traditional Tanzanian diet has a beneficial effect on inflammation and the functioning of the immune system. This is important because rapid urbanization is ongoing, not only in Tanzania, but also in other parts of Africa. The migration from the countryside to the city is leading to dietary changes and is accompanied by a rapid increase in the number of lifestyle diseases, which puts a heavy burden on the local healthcare systems. That is why prevention is essential, and diet can be very important for this."

    Western countries can learn from the results Second, these findings from Africa are also relevant for Western countries. Urbanization took place a long time ago in most western countries. By studying populations at different stages of urbanization, researchers therefore have unique opportunities to improve their understanding of how diet and lifestyle affect the human immune system.

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