Su-su-summertime sadness

Summer is coming to an end and Lana Del Ray’s song, su-su-summertime, summertime sadness keeps running through my head. Not sure if I am sad it is coming to an end, or sad that it wasn’t the summer I dreamed it would be. But is it ever? Summer always starts with such high hopes. The stretched-out days, sun-drenched bronzed skin, quality time with nature whether it be in water or atop mountains, relaxing nights in the backyard, vacations, beaches. A time when the livin’ is easy. When “laziness finds respectability.” As Charles Bowden said, “summertime is always the best of what might be.”

Summer conjures up inspiration. Just think of the vast number of songs that have eloquently articulated that summertime feeling. Sly and the Family Stone, War, Bananarama, the Isley Brothers, Childish Gambino, the Motels, Seals and Crofts, Don Henley, Death Cab for Cutie, Lana Del Ray, The Lovin’ Spoonful, to name a few.

The posted playlist is just a sampling of “summer” songs. I purposely chose songs that had “summer” in the title, but clearly there are so many songs about summer, the anticipation of it, or the experience of it. Think Alice Cooper’s “Schools out for Summer”, The Go Gos “Vacation”, The Ramones “Rockaway Beach”, and anything by the Beach Boys…

Remember when square Sandy and T-bird Danny reminisce about their summer affair “summer lovin’ had me a blast, summer lovin’ happened so fast” in Grease? Oh the fleeting moments of young, summer romance…We’ve all been there.

But my favorite summer (sad) song has to be from Jonathan Richman of the Modern Lovers.

That summer feeling
When there's things to do not because you gotta
When you run for love not because you oughtta
When you trust your friends with no reason not ta (nada)
The joy I name shall not be tamed
And that summer feeling is gonna haunt you
One day in your life.

My summers always haunt me. The could’ves, the should’ves, the would’ves. I could have done more with my summer, or I could have done less. I should have done what the Italians do and take a whole month off to celebrate Ferragosto. I would have gone to the beach this summer and worked on my tan but alas, I don’t want to look like Keith Richards, an old leather shoe with lips.

So what the hell does this post have to do with food you may be asking yourself? Indulge me for just a few minutes more.

When I got to thinking about writing a post about summer and what it means for all things food, it got me thinking about seasons. The beginning of one season, ends another season. I feel that years go by faster when a place experiences four seasons - winter, spring, summer and fall. It can be refreshing - shedding skin, birth and death, light and dark. Winter is often associated with death, old age, pain, loneliness, despair or an end. Yikes. Spring is almost always associated with rebirth, renewal, hope. Summer, well, we have already expunged that season enough, but it does symbolize fullness, joy, and dare I say, freedom. August, often means bounty, change, maturity and maybe some anticipation of decay...

Lynch’s annoying twitter feed

When you live in a place like Arizona or California in the US, or in the southern tropics, you have sort of two seasons - hot and less hot, wet and dry. Back in 2009, David Lynch would annoyingly remind us on a daily basis of the wonderful, consistent, balmy weather in Los Angeles. And he wasn’t fibbing. Way to rub salt in the wounds of us New Yorkers struggling to stay alive amidst the bleak snow-covered streets and dead plantation.

The Earth’s tilt toward the sun and its trips around the sun dictates the cycle of seasons. The longest and shortest day of the year occur when Earth's axis is either closest or farthest from the sun also known as the summer and winter solstices.

Equinoxes are another significant day during Earth's journey around the Sun. On these days, the planet's axis is pointed parallel to the Sun, rather than toward or away from it. The spring, or vernal, equinox for the northern hemisphere takes place on the same day as the south's autumnal equinox and vice versa.

Seasons are so critical for food. Seasons bring different harvests of food that contribute to the diversity and quality of our diets. There are many studies out here looking at the seasonal affects associated with access to and availability of foods. Studies in Ghana, Bangladesh, and Malawi show that seasonality is a key element to food availability in many low-income countries, what is often called “local seasonality.” Seasonality impacts food access often through food prices of even the most basic staple foods. In many high-income countries, people don’t even think about seasons. You can get anything you want, any time of the year, what is called “global seasonality.” Blackberries in January, apples in June, corn in April. All completely off-season from when they could actually be harvested in the United States. Thank you global trade (take note Potus). We have become completely disconnected from the agrarian calendar. But more on that in a minute.

Jenny MacDiarmid, a fantastic researcher in Scotland, asked whether eating seasonal foods contributes to a more sustainable diet. One could argue that demanding global seasonality in a diet would provide nutritional benefits by increasing diversity of the diets, particularly perishable foods, but it could have high environmental costs. MacDiarmid argues that greenhouse gas emissions (GHGE) of globally seasonal food are not necessarily higher than food produced locally as it depends more on the production system used than transportation. She wrote: “Adopting a global seasonality approach to food supplies may not have major consequences for GHGE but to meet demands it could create greater water stress in already water scarce countries. A similar argument could be made against increasing the global supply of fresh food year-round because of the increased land it will require, which will have knock-on effects for loss of environmental biodiversity.”

Nigerian crop calendar

The agrarian or farm calendar is essentially the same as the crop calendar which is a time tool on when to plant, sow, and harvest local crops based in specific agro-ecological zones or landscapes. FAO has a bunch of examples based on crop or country. Here is an example of Nigeria. Yams looks like a solid bet for year-round food. This calendar shows maize across a few countries. It shows how diverse the planting and harvesting seasons are across the world, with some places getting in two harvests of corn per year.

Harvest calendar of the United States

It was always thought that the United States school year calendar was based on the agrarian calendar. The idea is to keep kids at home during the summer months (June through August), the most active time to plant and harvest. I even thought that was true. Turns out, it is not. Rural and urban schools had different calendars but summer was just a logical time for teachers and students to take breaks. According to this Washington Post article, “In the early 1800s, agrarian communities generally operated public schools for a winter and a summer term of two to three months each. The spring and fall, labor-intensive times for farming, featured no school. During the summer — no less important an agricultural season — older children were typically absent from school, since families counted on their labor.” Interesting. The myth of the United States education system still rooted in ancient agrarian times is a myth after all.

And if one were to look at the seasonal calendar of the United States, it would be near impossible to line that up with the current school year calendar of the country. The sheer diversity in temperatures, what is grown, where, and when, would put a child in each region of the country in a different academic calendar year, were it to be dependent on our farm systems. The harvest calendar of the United States based on temperature is shown on the right.

Seasonality also brings challenges associated with malnutrition. Due to seasonal variability of food production, dietary intake, food security and morbidity in the developing world, many children suffer from impaired growth or acute malnutrition issues. Seasonal malnutrition is often tied to disease burden brought on by seasons - rainy seasons bring about diarrhea incidence as one example. Stephen Devereux and colleagues published a PLoS paper about seasonal hunger and showed the patterns linking severe acute malnutrition and malaria during the rainy season in Niger.

Vaitla B, Devereux S, Swan SH (2009) Seasonal Hunger: A Neglected Problem with Proven Solutions. PLoS Med 6(6): e1000101. https://doi.org/10.1371/journal.pmed.1000101

Interestingly, when one searches for reviews in PubMed on seasonality and stunting (54 articles) or wasting (4) or undernutrition (220), very little emerges with most articles involving Vitamin D specifically. It shows how little the nutrition community pays to seasonality - which impacts interpretations of research findings of timed surveys and interactions with disease burden, programming and policy interventions. Andy Prentice has been studying seasonality for a good long time in The Gambia, and he wrote a paper back in 1994 on the topic. Crazy. Action Against Hunger wrote about it as a “missing link” a few years ago, arguing that seasonality rarely get attention by governments.

But how are seasons changing with climate change and what will this mean for malnutrition and our food security? A lot. We wrote about the seasonal affects on malnutrition in the context of near-term weather events, like El Nino and La Nina in the Global Nutrition Report in 2015 with Madeleine Thomson of Wellcome Trust. The report (check out chapter 6), articulates that for the poorest groups, the seasonal cycles of food availability, infection, and time use remain a significant challenge to nutrition security and provide a stark indicator of the vulnerability of populations to climate risk. The figure below shows how stunting varies by month of birth for Indian children under the age of three.

Stunting variation in India based on season (Global Nutrition Report 2015)

We also wrote about the impacts of seasonality in the context of climate change on the entirety of the food system. Forecasts of the future climate— whether short-term seasonal anomalies or long-term climate change scenarios—may also impact production and consumption patterns, price hikes of food staples, and social stability. And with climate change, the length and intensity of our seasons are getting harder to predict and harder to control. Farmers are challenged and will continue to be challenged.

Seasons. They are essential for the foods we grow, the diets we consume and our overall wellbeing. Seasons fill in the gaps and pauses that the world makes. But they are shifting, shaping and changing. Much of that due to the anthropocene.

My favorite season? You guessed it. Summer. But that summer feeling haunts me. As much as I want to hold onto it and its cumulative memories, it is gone as soon as it arrives. Although I tend to get sad when summer ends, I am glad when it comes around with each passing year.

How much does it cost to eat a decent meal?

The incredible Alex Honnold, also a vegan… Copyright: The great Jimmy Chin for National Geographic

The answer to that question turns out to be a lot for some people. There are have been some recent projects and papers as a result aimed at trying to understand whether or not people can afford the kind of diets recommended in national food-based dietary guidelines, the EAT Lancet, and other publications. Many have pontificated that these healthy, higher quality diets — promoted in such guidelines and Commissions made up elitist scientists — are unaffordable for most of the world. Some argue the recommendations are just downright dangerous (beef industry responding to the EAT Lancet) or unfair. GAIN argued that meat is important for child growth, and athletes. I don’t think they meant it is an absolute essential for athletes, as Alex Honnold is a vegan and that dude climbed El Capitan with nothing but sheer muscle strength, stamina and maybe an insanely lack of feeling of fear. If you have not seen the documentary Free Solo, I highly recommend it. What a human feat, and with no meat! Yes, I wax poetic.

This debate is not new, and there has been a lot of science articulated the cost. And there are more papers to come. But a few new papers are looking beyond just a specific country, a specific national dietary database or a specific population, and looking at the costs of foods and diets around the world from low- to high-income countries, whether they fulfill nutritional needs, and if not, what disease outcomes are they associated with.

IFPRI’s Derek Headey and Harold Alderman, two pretty stellar researchers in nutrition, published a fantastic piece in the Journal of Nutrition. They tested relative caloric prices (RCPs) for different food categories across 176 countries. One will have to read the methods in some detail to understand how they come up with this calculation but one key piece is how they calculate the RCP. They measure the ratio of the price of 1 calorie of a given food (the edible portion) to the price of 1 calorie of a representative basket of starchy staple food in each country. As the authors articulated: an RCP of 5 for eggs implies that it is 5 times as expensive to obtain a calorie from eggs as it is to obtain a calorie from starchy staples. Easy yes?

While the authors find that there is a lot of variety in the food prices nationally, in high-income countries, most non-cereal foods were relatively cheap, including sugar- and fat-rich foods. In contrast, in low-income countries, healthy foods were expensive, especially most animal-sourced foods and fortified infant cereals. Oils/fats were notably very cheap in all regions as were unprocessed red meat, which was moderately cheap in all regions. As the authors wrote in a recent blog:

“As countries develop, their food systems get better at providing healthier foods cheaply, but they also get better at providing unhealthier foods cheaply. Hence the problem in less developed countries is that poor people also live in poor food systems: Nutrient-dense foods like eggs, milk, fruits and vegetables can be very expensive in these countries, making it much harder to diversify away from nutrient-sparse staple foods like rice, corn and bread. The problem in more developed countries is rather different: Unhealthy calories have simply become a very affordable option. In the U.S., for example, calories from soft drinks are just 1.9 times as expensive as staple food calories and require no preparation time.”

The authors then looked at the association of these prices with nutrition outcomes, controlling for confounders like education, urbanization and income. Higher milk and fortified infant product prices were positively associated with childhood stunting. They also found that little children consume less of these important foods when expensive. An increase in soft drink prices was associated with a reduction on overweight prevalence.

Headey and Alderman show the association of milk prices with childhood stunting. Copyright: IFPRI

A few years ago Adam Drewnowski and Nicole Darmon published a study, using very different methodology and from French databases, showing that foods of lower nutritional value and lower-quality diets generally cost less per calorie and tended to be selected by groups of lower socioeconomic status. A number of nutrient-dense foods were available at low cost but were not always palatable or culturally acceptable to the low-income consumer. Acceptable healthier diets were uniformly associated with higher costs. They argue three things:

  1. Energy-dense foods composed of refined grains, added sugars, or fats are cheaper per calorie than are the recommended nutrient-dense foods.

  2. Lower-quality diets, with a higher content of added sugars and fats, were generally less expensive on a per-calorie basis.

  3. Cheaper and more energy-dense diets, often devoid of vegetables and fruit, tend to be selected across different countries by lower-income groups.

Another paper coming out in the Lancet by IFPRI (including Headey) and Tufts colleagues including the great Will Masters, examined retail prices of foods and identified the most affordable foods to meet EAT-Lancet targets. They compared the total cost per day of these foods to each country's gross national income to see if the MOST affordable EAT-Lancet diet exceeded household incomes.

Here is what they found: Examining 744 items across 159 countries, revealing that the most affordable EAT-Lancet diets cost a global average of $2.89 per day ($2.44 per day for low-income countries and $2.77 for high-income countries). The largest share was the diet cost was fruits and vegetables (31.2%), followed by legumes and nuts (18.7%), meat, eggs and fish (15.2%) and dairy (13.2%). While this is a pretty cheap diet in high-income countries, it is not affordable for 1.56 billion of the poorest households in the world where this diet would cost households 70% of their daily income (national averages)! Where is this diet unaffordable? Mostly in sub-Saharan Africa and South Asia.

On the left side is the cost of the EAT-Lancet diet by country income levels and major regions. On the right side, is the cost of the EAT-Lancet diet as a percentage of Gross National Income per capita. Copyright: Lancet.

They also concluded that the EAT-Lancet diet would cost 64% more than achieving minimally adequate levels of essential nutrients and is currently unaffordable in low-income countries, because “it requires larger quantities of higher-cost food groups such as dairy, eggs, meat, fish, fruits and vegetables than the near-subsistence diets that are currently consumed by very low-income people.” The authors argue that:

“Our findings indicate that a widespread global shift to the EAT-Lancet diet recommendation is feasible only through some combination of higher earnings, more favorable market prices and nutrition assistance for low-income people, in addition to changes in local and global food systems that drive food choice among more affluent populations. Meeting EAT-Lancet targets in low-income areas will require higher farm productivity and improved access to markets, plus greater non-farm earnings and social safety nets, allowing people to shift consumption away from starchy staples and increase their intake of more nutritious but currently unaffordable animal-sourced and vegetal foods.”

Sam Bloch tested out the EAT-Lancet diet in early 2019 and wrote up a great piece in the New Food Economy (love this site). He found it hard to follow and it was more expensive. And he is probably a high-income consumer (living in New York City) and his wife is a chef!

A group at World Food Programme is doing a “Fill the Nutrient Gap” (FNG), which aims to “support identification of strategies to increase availability, access, and choice of nutritious foods, to ultimately improve nutrient intake.” This approach looks at the nutrient intake of different target groups, and then uses linear programming to look at the barriers to nutrient intake including the availability, cost and affordability of nutritious diets for households and target groups with higher nutritional needs. They then model potential interventions to improve them. I have heard they have done at least 25 countries. So they are taking it further as compared to these other studies. They are not only looking at the cost of diets, but why they are expensive and what households can do about it.

In last year’s Global Nutrition Report, we showed some preliminary data on the range of non-affordability of a nutritious diet across areas in different countries. The data shows a range of non-affordability depending on the region in each country – for example, across different regions of El Salvador, 9% to 44% of households cannot afford a nutritious diet, whereas the range is much greater in Lao People’s Democratic Republic (17% to 95%).

The range of “non-affordability” of the typical diet in select countries. Copyright: GNR 2018

There are others working on the cost of a diet. Marco Springmann will also test out the cost of the EAT-Lancet diet, as an EAT-Lancet Commissioner. I think his study will look more at the cost of dietary patterns - vegetarian, pescetarian, omnivorous etc. So keep your eye out on that publication!

Food Bytes: July 8 - July 20

Food Bytes is a weekly blog post of “nibbles” of information on all things food and nutrition science, policy and culture.

Food environments seem to be on the tip of the tongue for everyone these days. Food environments are the “collective physical, economic, policy and sociocultural surroundings, opportunities and conditions that influence people’s food choices and nutritional status.” Or to put it more simply, it is the place where consumers go to buy or order food - a market, a restaurant, a cafeteria.

The UN Standing Committee on Nutrition, also known as UNSCN, has just published a collection of papers on the food environment. It splits up the food environment into two entry points - the food supply shaping these environments and the consumer demand side - and what it would take to make change, also known as the enabling environment. The publication is chock-full of case studies from all over the world. I like the ones on Mexico, the private sector last mile, the flathead reservation, cash transfers, and the digital influence.

Food Environment Framework showing supply and demand. Source: Marshall et al 2019 UNSCN report

In South Africa’s Soweto hood, women struggle to be healthy. Food environments are pretty dismal (fries, fries and more fries), and exercising outside can be dangerous. It is not just about supply and demand of healthy foods, which the UNSCN publication focused on, but the whole built environment, the way women are treated in our society and urban safety. At the same time, its seems many South Africans are taking food security into their own hands. One study found that 2.2 million households have recently constructed food gardens at their homes in order to avert food insecurity.

While we are on the lovely UN, the UN Committee on Food Security is rolling out a series of regional consultations on what is known as the Voluntary Guidelines on Food Systems and Nutrition. This stems from the High Level Panel of Experts on Nutrition and Food Systems report which called for these guidelines to be developed by governments collectively and collaboratively. These voluntary guidelines are meant to create a global norm of reference in the governance of food systems and nutrition/diets. The guidelines outline principles and practices that governments can refer to when making laws and administering food systems. These guidelines should be seen as an internationally negotiated soft law or a set of guidelines in which all governments have reached a common ground. So, they can be important, and quite powerful. Anyone can comment on the zero draft - far from its final - here. The regional consultations started in Africa, Ethiopia. Then, Asia, Bangkok. Then Central and South America, Panama, North Africa, Egypt, Europe, Budapest and last but not least, North America. I had the pleasure of being at the Ethiopia meeting and it was quite fantastic to have so many African countries in one room talking about African food systems. Amazing stuff.

Source and Copyright: Johnny Miller, NYT 2019

Speaking of Africa, the diversity of cuisines and culture is what makes the continent so amazing. Take Nigeria. Reading Yewande Komolafe’s recipes made me want to jump on a plane to Lagos and eat my way through it.

But it is not always a rosy picture for Africa. The continent is still struggling with food insecurity, while at the same time, obesity is creeping up, up and up. The FAO State of Food Insecurity (SOFI) 2019 report just came out, two months early. It was reasoned that it came out to line up with the High Level Political Forum. Yeah sure. I think it was timed to be released right before the Director General, José Graziano da Silva stepped down to celebrate his 8 years as the leader of FAO. However, the report is nothing to celebrate. I digress…The major findings of the SOFI were the following:

  • More than a quarter of the world’s population now struggles to eat safe, nutritious and sufficient food.

  • Hunger is on the rise in most of Africa, in parts of the Middle East and in Latin America and the Caribbean. The situation is most alarming in Africa, where since 2015 undernourishment has steadily increased in almost all subregions. In Asia, undernourishment has been decreasing in most regions, reaching 11.4 percent in 2017. In Latin America and the Caribbean, rates of undernourishment have increased in recent years, largely as a consequence of the situation in South America.

  • Economic shocks are contributing to prolonging and worsening the severity of food crises caused primarily by conflict and climate shocks.

  • No region is exempt from the rising trends of overweight and “obesity rates are higher in those countries where moderate food insecurity is also higher.”

We see this in the United States too. I just wrote a piece for Bloomberg Opinion (I didn’t choose the photo.) showing that food insecure adults in the U.S. are 32% more likely than others to be obese — especially if they are women. Poverty and unemployment have driven the dual rise in food insecurity and obesity since the 1960s, especially in rural America. But many city dwellers subsisting with inadequate social services and support structures are also susceptible. Every time I write a piece in Bloomberg Opinion, I always get lots of interesting email comments. For this piece, most commenters feel that if you are fat, it is your fault. If healthy foods are available, affordable and easy to access, “these people” will always make the wrong choice. My reaction? WOW. It is so hard to eat healthy in our perverse food environments. Blaming and shaming is not going to make things better. But it seems, consumers are catching on in the U.S. - diet quality is improving.

But what does the latest evidence suggest for those who are overweight and want to lose weight? I will soon dedicate a longer blog to this issue because the literature is confusing. Is it a keto diet? Is it intermittent fasting? Is it low-carb? Is it putting a teaspoon of oil in your coffee every morning? New evidence suggests that cutting 300 calories per day, from any food, can lead to substantial weight loss in adults (7.5 kilos over two years) compared to the control group. Tamar Haspel of the Washington Post, argues that eating ultra-processed foods comes down to increased calorie consumption. We consume more of those foods, and they are calorically dense. She wrote:

“In a nutshell: The root of obesity is palatability and calorie density, combined with ubiquity and convenience. Satiety hormones and other metabolic machinations have much less to do with it. We’re responding to cues from without, not from within. One new study doesn’t prove it, of course, but it’s the hypothesis that best fits the preponderance of the evidence.”

I really appreciate this article that “Being Fat is Not a Moral Failure.” Damn straight. This Scientific American article argues “Individual behavior change is ineffective in the face of social and structural barriers that constrain individual choice. These barriers are uniquely relevant among racial and ethnic minorities and impoverished adults who are more likely to be obese.”

A bunch of scientific papers and media articles came out this week on diets, nutrition, and food systems. Here are some highlights.

Kathmandu food stall - healthy and unhealthy foods. Source and Copyright: Jess Fanzo

  • “Ultra-processed” foods or what I call, junk food, are in the news again. This article outlines four dangers with food reformulation - redesigning an existing processed food product with the objective of making it healthier. This article argues that reformulation just tinkers around the edges, and isn’t really fixing the root problems of the food system, and what the authors say is food and beverage industries.

  • Case in point? Nearly 10,000 cases of heart disease and stroke and 1,500 cases of cancer could have been avoided in England if the government had not switched to a voluntary deal (as opposed to mandatory) with the food industry to cut salt in food. England is doing so much good stuff in the food space right now, but man, there are potential setbacks with Brexit and political shifts. This BMJ post by Annie Purdie and colleagues is concerned about Boris Johnson’s recent decision to look at “sin taxes” and creating a nanny state. The authors argue that the public health community needs to “move beyond debating the cost-effectiveness of interventions, and engage with the underlying political nature of the issue.” We need to pay more attention to the language (sin, nanny, liberties etc) used to highlight the problem and the proposed solutions like taxes on soda and regulating the levels of salt and sugar in foods. As Bob Marley sang, “don’t let ‘em fool ya.”

  • There is more and more coming out that nutritional sciences is “broken.” In this article, they use the “eggs are again bad for you” study that came out in JAMA. Waah. Is it? I disagree! Of course, when we focus on specific foods and nutrients, the data is not clear, but dietary patterns show basically the same thing. Give it a rest dudes.

  • While these researchers argue that more evidence is needed, they did find that snack foods and sugar‐sweetened beverages are providing a substantial proportion of energy intakes (ranges from 13 to 38%!) among children below 2 years of age in Latin American and South‐east Asian low and middle income countries.

  • A study in the capitol of Nepal, Kathmandu, showed just that consumption of unhealthy snack foods and beverages contributed 47% of total energy intake among the wealthiest consumers, compared with 5% among the poorest. This pattern of junk food consumption among young children was associated with inadequate micronutrient intakes. The reason that mom’s give these foods to their children? Convenience - they are easy to prepare and easy to feed. Makes sense. Looks like even among very poor countries, we are seeing the nutrition transition play out in real time. Ever try making dal bhat from scratch? Not easy and incredibly time consuming…

  • I love that the Lancet is calling on oral health researchers to review the evidence and conflicts of interest of the impacts of what we eat on our dental health and the caries that come with sugar consumption. The lead scientist argues, and this goes back to the infant studies: “A particular concern is the high levels of sugar in processed commercial baby foods and drinks which encourage babies and toddlers to develop a preference for sweetness in early life. We need tighter regulation and legislation to restrict the marketing and promotion of sugary foods and drinks if we are to tackle the root causes of oral conditions.”

  • New microbiome research shows that a specialized food made up of chickpeas, soy, peanuts, bananas and a blend of oils and micronutrients substantially boost microbiome health in severely malnourished children. Yummy.

  • Do cookbooks need nutrition labels? Great question but sort of takes the fun out of cookbooks no?

Some things have improved for food security and nutrition. Source: Byerlee and Fanzo, 2019 GFS Journal

Derek Byerlee and I wrote a piece looking back 75 years on commitment to hunger when the first international commitment to ending hunger was made at the UN Conference on Food and Agriculture, at Hot Springs, Virginia, USA in 1943. That conference set the goal of ‘freedom from want of food, suitable and adequate for the health and strength of all peoples’ that should be achieved ‘in all lands within the shortest possible time’ (US Department of State, 1943). It is sobering and shameful that 75 years after this clarion call, as well as the dozens of similar global declarations since 1943 for ending hunger, some 800 million persons are estimated to be undernourished and over 2 billion adults and children suffer from other forms of malnutrition be it obesity or micronutrient deficiencies. We remind readers of the significance of the Hot Springs conference and briefly trace the long road that has led us back to the original vision of ending hunger that recognized the several dimensions of nutrition, from undernourishment to micronutrient deficiencies. While there has been progress, this reflection over 75 years helps appreciate the fact that today for the first time, the links of agriculture, health and nutrition outlined in 1943 are again at center stage in the global hunger challenge as embraced in SDG2. Accordingly, SDG2 offers a better foundation for accelerating progress in reducing malnutrition in its several dimensions, although we recognize major gaps in knowledge, financing, and implementation capacity for realizing SDG2 targets.

Someone else is realizing the importance of agriculture. It seems Bill Gates has woken up to the fact that the CGIAR exists. His article is titled “You’ve probably never heard of CGIAR, but they are essential to feeding our future.” Hate to spoil it Billie Boy, but we have heard of the CGIAR…and I don’t confuse it with the word “cigar,” cigarillos, ciggies, or ziggie stardust.

Country ratios of fruit and vegetable availability to WHO age-specific recommendations. Source: Mason-D’Croz et al 2019

Country ratios of fruit and vegetable availability to WHO age-specific recommendations. Source: Mason-D’Croz et al 2019

On the environmental and climate change front, lots going on. The World Resources Institute released a mother of a report - 564 pages - on Creating A Sustainable Food Future. You may have seen the abbreviated version released 6 months ago. But this one goes into great detail a 22-item “menu” which is divided into five “courses” that together could close the food, land and greenhouse gas gaps: (1) reduce growth in demand for food and agricultural products; (2) increase food production without expanding agricultural land; (3) protect and restore natural ecosystems; (4) increase fish supply (through improved wild fisheries management and aquaculture); and (5) reduce GHG emissions from agricultural production. Richard Waite and Janet Ranganathan are seriously my heroes in creating these action oriented solutions. Well done.

Following on the heals of that report, two Lancet Planetary Health papers came out. One paper shows that even under optimistic socioeconomic scenarios future supply of fruits and vegetables, central components of a healthy diet, will be insufficient to achieve recommended levels in many countries. Consequently, systematic public policy targeting the constraints to producing and consuming fruits and vegetables will be needed. The second paper shows climate change and increased atmospheric CO2 will impact the availability of protein, zinc and iron availability. The many countries that currently have high levels of nutrient deficiency would continue to be disproportionately affected.

This expose by the Guardian shows that Brazil’s huge beef sector, and the appetite for beef, continues to threaten health of world’s largest rainforest, the Amazon. This is just downright sad.

And while those of us in nutrition don’t really get to the larger social determinants of food insecurity and malnutrition, it is important to do so. This article in NPR’s Goats and Soda delve into the practice of trading sex for fish in Lake Chilwa in Malawi. This is driven by poverty and food insecurity and the impacts are catastrophic in this southern African country - HIV, violence and stigma - for these women.


Food Bytes: July 1 - July 7

Food Bytes is a weekly blog post of “nibbles” of information on all things food and nutrition science, policy and culture.

Ever wonder why the nutrition community doesn’t play nice with each other? I do. Phil Baker at Deakin University just published an interesting, but heady, paper trying to understand nutrition action networks and what it would take to make them more effective in garnering political commitment towards ending malnutrition. Just take a look at the figure below looking at the context in which nutrition sits. Talk about complex! They argue for four things to improve political commitment to nutrition:

Complex contexts for the nutrition world

  1. Coordinating bodies that are better at advocating resources can of course, get more money and strengthen the networks in which they work.

  2. Coordinating and governance bodies need to be more inclusive and transparent in their decision making.

  3. Civil society should work to influence decision makers. Helps when transparency is in place.

  4. Finances matter and create powerful incentives for us to play in the sandbox together.

I may have gotten all this wrong, but like I said, the paper is intense, but super important to better understand why nutrition hasn’t seen massive progress like other sectors. I really do think that the grand nutrition architecture has some serious issues around coordination, cooperation, and reality checks it needs to come to grips with. Not Phil’s words, but mine…For another blog post!

Of course, the nutrition community doesn’t just struggle with political commitment. It also struggles with delivering key interventions to those populations most in need. A recent study by Stuart Gillespie and colleagues looked at 24 different nutrition interventions to see if their coverage is measured and tracked in major health surveys done at the national level. These interventions are things like vitamin A and iron supplementation, growth monitoring, and infant feeding counseling. Basically the answer is no. The coverage of these interventions are not collected and not in any standard way across countries. The paper presented a few case studies including India. The figure on the right shows the scatter of data collection of key nutrition actions (counseling, growth monitoring and food supplements) typically not included in the core national health surveys. The bars show the national coverage of data and the dots are the states of India. Another paper published in PLoS medicine looked not only at whether or not a health intervention coverage was captured in surveys, but looked at need, use, and quality of those interventions. It would be great to see these authors do a follow up looking at those three measures to assess effective coverage of nutrition indicators.

And while we are ripping on the functionality of nutritionists and their work, let’s discuss the indecisiveness of the science they dabble in. The Atlantic published a piece on why nutritional sciences is so confusing for consumers. There have been a lot of articles on this recently, and I think it started with Michael Pollan’s book In Defense of Food a decade ago. The Atlantic argue that doing the science is very hard - figuring out what people eat and the consequences of those eating patterns - is not so straight forward and as the article highlighted “inexact.” But the evidence over decades has accumulated and most nutritionists agree largely on what is considered a healthy diet and the healthful habits that people should take on. But that is sort of boring isn’t it. The article also highlights the emerging role of the microbiome. But more on that later.

There have been a few recent papers looking at the impact of interventions to improve food environments. One was a systematic review and meta-analysis on sugar‐sweetened beverage - SSB - taxes and their impact on beverage purchases and dietary intake. A suite of different taxes were examined mainly in Europe and US cities. What the researchers found was that a 10% SSB tax was associated with an average decline in beverage purchases and dietary intake of 10% in 6 jurisdictions. This tax was associated with a 2% increase in total untaxed beverage consumption (e.g. water) but this was not significant. Another study looked at the anticipated impacts of implementing a 2016 Chilean Law of Food Labeling and Advertising mandating front‐of‐package (FOP) warning label for products high in sodium, total sugars, saturated fats, and/or total energy. Researchers photographed packaged food and beverage products from six different supermarkets in Santiago, Chile before the law went into effect. They found that basically very little reformulation by industry occurred before the law went into action and <2% of products would have avoided at least one warning label with reformulation. A similar study looked at the food supply ahead of the law implementation and found similar issues.

While we are on the topic of FOPs, a really interesting study looked at how realistic would it be to mandate these types of labels in the U.S. The study found that: “Certain interpretive FOP labels which provide factual information with colors or designs to assist consumers interpret the information could similarly withstand First Amendment scrutiny, but questions remain regarding whether certain colors or shapes would qualify as controversial and not constitutional. Labels that provide no nutrient information and only an image or icon to characterize the entire product would not likely withstand First Amendment scrutiny.” Wow. Interesting. Gotta love the ol’ US of A’s constitution.

The U.S. is not always the asshole in the room. Well, maybe we are. Let’s talk USAID. For those of you who are not familiar with them, they are the United States Agency for International Development and self describe as “the world's premier international development agency and a catalytic actor driving development results.” Okay…they are also the agency driving around in white trucks all over Africa and Asia with the cringe-worthy signage “From the American People.” Awkward. USAID has done some not so good things in international development but it has done some good things too, dammit. They have been committed to nutrition. The Official Development Assistance (ODA) numbers that are reported in the Global Nutrition Report each year demonstrate their financial commitment. They have supported many programs at a significant scale in low- and middle-income countries. Some impactful, some, not so much. I am really screwing myself over here to ensure I never get USAID money aren’t I. Anyways, they just published the history of USAID in nutrition. It is a nice story. Check it out.

Speaking of food environments and obesity, with the Chicago Council on Global Affairs, I did a one-minute video on why is obesity such an issue globally and the importance of food systems in solving, not just contributing to the issue. If your attention span lasts the whole one minute, you can find out my favorite food. It involves a food rich in zinc!

It’s not just food systems that need to improve if we want to make a dent in the obesity pandemic, it is what is inside our bodies as well. The microbiome is the next frontier for science and its role and relationship with obesity is a complex Game of Thrones TV series - it is going to take some time to dig into the history, to understand the future and who really rules us. Some researchers argue that our microbiota is associated with the propensity of being overweight. Others argue that diet is a big driver of the biome composition and species richness, maybe more so than the biological state of nutritional status - i.e. overweight and underweight. But unraveling this game requires us to be brave, yonder north of the wall, and live in peace with the Wildlings. And John Snow. Rrrrrrr.

And as always, I throw in something just to scare the hell out of any of you who are still living in la la land thinking the world is just bliss. Check out this paper. The title reads: "Global warming has increased global economic inequality.” Boom. Do I need to say more? Now you can go back to your mind-numbing regular programming.

Just so you don’t think I am a vindictive person, I leave you with Google’s Stories of Yoga. For any of you yogi gurus out there, this is everything you want and need to know about yoga, its history, its practice and its inspiration. See? I can be nice. NAMASTE!

Everybody wants to rule the world

As we approach this year’s climate summit, the Tears for Fears song “Everybody Wants to Rule the World” keeps running through my head.

Welcome to your life.

There’s no turning back.

When it comes to climate change, we are now moving on a linear path. No looking back, as painful as it is. While scientists have been warning us for decades — bordering half a century of ‘red flags’ in both evidence and advocacy — here is where we now sit. In the midst of a massive climate breakdown which will change the world as we know it.

The headlines read: Climate emergency. Climate breakdown. Climate crisis. Global heating, not global warming. It took a young girl, Greta Thunberg, to push governments — the rulers of our world — to take notice. It took an older gent, David Attenborough to scare the hell out of all of us. Fish stocks and biodiversity collapse, wildlife extinction, and with that, human extinction not being far behind.

But is anyone listening? Is there anyone out there? It seems rulers just want to keep ruling their kingdoms, playing that fiddle while Rome burns. Literally.

“All for freedom and for pleasure.

Nothing ever lasts forever.

Everybody wants to rule the world.”

Top on the list of Nero-like impersonators is Donald Trump. A buffoon, but a dangerous one. He has completely ignored the science, and refuses to cooperate with other nations by not ratifying the COP Paris agreement in which the the United States signed in 2015. By signing onto the COP, each country has in principle, agreed to reduce greenhouse gas emissions, use green energy sources and keep the world well below 1.5 degrees. This signing was an “intent.” But ratification is key. Since 2015, there are still some countries who have not legally ratified their agreement and they include Angola, Eritrea, Iran, Iraq, Kyrgyzstan, Lebanon, Libya, Oman, Russia, South Sudan, Suriname, Turkey, and Yemen. Trump is wanting to completely pull out let alone ratify. His next opportunity to do so will be in November 2020. Interesting timing yes?

This is all sad nonetheless. It would be one thing if the United States solely suffered from their silly political choices, but that is just not the case with climate (among other things). Everyone suffers from decisions of powerful rulers who just don’t give a shit.

The UN Secretary General’s remarks at the Climate Summit Preparatory Meeting said:

“It is plain to me that we have no time to lose. Sadly, it is not yet plain to all the decision makers that run our world. On the plus side, we have the Paris Agreement on climate change and a work programme agreed last year in Katowice. But we know that even if the promises of Paris are fully met, we still face at least a 3-degree temperature rise by the end of the century – a catastrophe for life as we know it. Even more worrying is that many countries are not even keeping pace with their promises under the Paris Agreement.”

The UN SG has reason to worry if one were to actually look historically at the data and trends. And the science holds up. Twenty-five years ago in 1992, the Union of Concerned Scientists comprised of 1700 independent scientists, wrote a canary in the coal mine (excuse the analogy…) piece entitled “World Scientists’ Warning to Humanity.” This group called on our global society to stop the environmental destruction being witnessed back then if we are to ensure that “vast human misery is to be avoided.” They expressed concern about past and future damage to the planet and outlined areas of concern involving ozone depletion, freshwater availability, marine life depletion, ocean dead zones, forest loss, biodiversity destruction, climate change, and continued human population growth. These scientists argued that we are fast approaching the limits of the biosphere and we may not be able to reverse the damage done.

Source: Ripple, W.J., Wolf, C., Newsome, T.M., Galetti, M., Alamgir, M., Crist, E., Mahmoud, M.I., Laurance, W.F. and 15,364 scientist signatories from 184 countries, 2017. World scientists’ warning to humanity: a second notice.  BioScience ,  67 (12), pp.1026-1028.

Source: Ripple, W.J., Wolf, C., Newsome, T.M., Galetti, M., Alamgir, M., Crist, E., Mahmoud, M.I., Laurance, W.F. and 15,364 scientist signatories from 184 countries, 2017. World scientists’ warning to humanity: a second notice. BioScience, 67(12), pp.1026-1028.

Fast forward to 2017, another group of scientists looked back at their warning and evaluated the human response since that time by exploring available time-series data across a series of environmental indicators. Since 1992, with the exception of stabilizing the stratospheric ozone layer, humanity has failed to make sufficient progress on almost all of the environmental challenges outlined in the Warning paper, and in most cases, the situation has become much worse. The figure to the left shows the different trends tracked before and after 1992 in gray and black lines, respectively. Pretty dismal and downright scary to see the the massive deforestation, declines in species, increases in dead zones, and the steep rises in greenhouse gases and temperature.

How did our world get to this state? We are in the middle of a new experiment -- a democracy free fall in which global freedom, open political systems and free societies are threatened. The world experiences ebbs and flows in the history of time, and let us hope that the decisions of rulers, the political institutions that provide the checks and balances on these rulers, and our planet survive this ebb. As the UN SG said, we have to. We are in a battle for our lives.

The joys of flaneuring

Taking walks does wonders for the soul. One can walk in nature, in a park, or flaneur a city. The idea of flaneuring has always intrigued me. It is the art of noticing. Flanueuring comes from the French word, flâneur, which means "stroller", "lounger", "saunterer", or "loafer". Flânerie is the act of strolling, with all of its accompanying associations. Charles Baudelaire described the flâneur in Le Figaro in 1863.

The crowd is his element, as the air is that of birds and water of fishes. His passion and his profession are to become one flesh with the crowd. For the perfect flâneur, for the passionate spectator, it is an immense joy to set up house in the heart of the multitude, amid the ebb and flow of movement, in the midst of the fugitive and the infinite. To be away from home and yet to feel oneself everywhere at home; to see the world, to be at the centre of the world, and yet to remain hidden from the world—impartial natures which the tongue can but clumsily define. The spectator is a prince who everywhere rejoices in his incognito. The lover of life makes the whole world his family, just like the lover of the fair sex who builds up his family from all the beautiful women that he has ever found, or that are or are not—to be found; or the lover of pictures who lives in a magical society of dreams painted on canvas. Thus the lover of universal life enters into the crowd as though it were an immense reservoir of electrical energy. Or we might liken him to a mirror as vast as the crowd itself; or to a kaleidoscope gifted with consciousness, responding to each one of its movements and reproducing the multiplicity of life and the flickering grace of all the elements of life.

To see the world. Yes. Exactly. Now, most people “see” the world through their iPhones. Rarely observing through their own self. There is something about exploring, noticing the details, getting a little lost, that evokes freedom. It also feels really good to have walked the distance of half a marathon, at your pace, in a day. Walking is good for physical and mental health. This has long been known. Needless to say, my partner and I take walking very seriously.

maphattan project

maphattan project

For those of you who know us, you know we have embarked on a few “walking projects.” First was the MaPhattan Project in which we walked every street in Manhattan. We tackled one neighborhood at a time. We made it fun - it wasn’t a mundane thing. We did some reading up on each hood we would tackle to ensure we spotted famous landmarks - Andy Warhol’s factory on the east side, where Lou Reed scored heroin in Harlem, where Charlie Parker lived in the village, etc etc. We also ate at a restaurant that was either a classic gotham spot or represented the nabe well. Dominican food in Washington Heights for example. Sometimes we would do 20 miles in a day, sometimes, 10. Matt Green took it one step further and walked every street in NYC - all five boroughs. Hero. It was the best way to see one of the greatest cities on earth - the colors, the smells, and the transitions of an American city constantly on the move. And so were we.

Roaming every rione

Roaming every rione

We also did the Roaming Rione Project where we “roamed each rione (Italian for neighborhood) of Rome, street by street, taking in the sights, sounds, textures, smells + tastes.” There were 22 rioni and then after, we did one last giro around the Aurelian wall encompassing Rome which we did on 31 Dec 2018, as well as a few long walks into the quartiere beyond the wall. Food was always involved of course. And our research on the neighborhoods? Hard. Remember. Rome has been around a good long while. The accumulation of history was beyond comprehensible. Rome was also a lot harder to navigate than Manhattan. New York is for a large part, on a grid, so it was easy to find the breaking points. Rome, not so easy. Lots of twisty-turning streets and small avenues to navigate. Sometimes, going in circles. We tried to not use our google map, because that just takes the fun out of it. My partner would print out maps. Yes, we are old fashioned. We also still get DVDs. Stop the snickering. The printed version helped us get our boundaries. But that was it. Bodies of water helped. For Manhattan, you are surrounded by water. With Rome, you had to lean on the Tevere River as your guide post. The Rome project didn’t take us as much time as New York interestingly. It just wasn’t as big. Okay, maybe we cheated a little…There are so many sneaky alleys in Roma.

Now, we are onto our next adventure. We live in Washington DC which is littered with natural park spaces that often connect up with one another. We find ourselves most weekends exploring these parks, staying off man-made roads as much as possible. As Henry David Thoreau wrote, "In wildness is the preservation of the world.” But we are contemplating an epic DC city walk. It would involve all the embassies/consulates, all the state named streets (interesting that DC is not a state but a microcosm of the world), hitting each quadrant - NW, NE, SW, SE. The name of this epic project? Microcosmic DC Pyschogeography. We will document it of course, eat some good food, and learn a little US history using only our walking shoes and a printed out map.

And with that, I leave you with one of my fav songs — Horst Langer by Poem Rocket on their album…get ready for it…PSYCHOGEOGRAPHY.

Food Bytes: June 3 - June 30

Food Bytes is a weekly blog post of “nibbles” of information on all things food and nutrition science, policy and culture.

The month of June was filled with lots of food-related action - meetings, conferences, prizes and elections. Let me tell ya, it was hard to keep up. The question is, what is the result of all these meetings and the environmental footprint of moving all these bodies from meeting to meeting? Does it actually shift the agenda in positive directions? Are we all just talking to our friends? Is it just a way to keep us busy posting photos and videos on twitter? I wonder sometimes. I am not criticizing. I am a part of the problem. But I do think it is time to rethink what all this effort is amounting to, and for who.

The UN Food and Agriculture Organization, also known as FAO, hosted a Future of Food Symposium with some dynamo speakers, but not a lot of action coming out of it. FAO also just announced the election of their new Director General. His name is Qu Dongyu from China. He is currently the Vice Minister of Agriculture and Rural Affairs of China. Makes sense. China is a giant and is greatly shaping the world’s food system. Looking forward to seeing his vision. He has a lot of work to do…

The American Society of Nutrition @nutritionorg hosted their annual nutrition conference, right upon Johns Hopkins doorstep in Baltimore. Lots of diverse science being presented and also lots of controversy around sponsporship of events and significant presence by industry. I was only there for a day but that was about all I could take sitting in an over air-conditioned window-less conference center looking at powerpoint after powerpoint. That said, it is a great way to get caught up on the latest science. And Marie Ruel, a stellar international nutrition scientist at IFPRI, was awarded the Kellogg Prize for Lifetime Achievements in International Nutrition. Well deserved. Her talk is here. I highly recommend reading Marie’s incredible body of work. Much of it can be found here. You will see why she got the award - she accomplished so much over the last 30+ years. And she still has more to do!

The @EATforum Stockholm Food Forum, also an annual affair, took place. Glitz? Check. Grand? Check. Aspirational? Check. But what’s next? The impact of EAT is yet to be seen and it remains unclear on where they will go from here. Do they do advocacy? Policy? Science? I did the opener with Johan Rockstrom or also known as Johan Rockstar. It was fun. The video is below. One thing is clear to me, if they are advocating for a better food future for all, they need to take the show on the road.

Speaking of EAT, the EAT Lancet Commission fall-out keeps churning. Some of the authors of the Commission provide some explanation of issues raised by other scientists on the environmental targets here in a Lancet short response/commentary. Another study put the EAT-Lancet reference diet to the test among a large prospective cohort of British adults. The researchers found that the diet has beneficial associations for ischaemic heart disease and diabetes, but no association with stroke and no clear association with mortality. The media continues to churn out pieces on sustainable diets and mentioned the EAT Lancet report. Great that the work is garnering so much attention in the popular press but what now? Some highlights in the last few weeks:

  • This Vox piece closely examines what our diets will look like in a hotter, drier climate. Lots of talk (literally - it is an interview style piece) on the future of food and technology.

  • The Eater highlights the rise of the plant-based burgers in particular, the Impossible Burger, and how fast it went viral. Seems everything David Chang touches turns to gold.

  • Stepanie Feldstein also wrote for Yes Magazine about the plant-based burgers and argues that while it won’t save the course we are on with climate, small individual actions do matter, and manifest in different ways.

  • This Devex article asks about the relevancy of the EAT Lancet report to the global south. Good question. One expert from Liberia indicated that many in her country don’t even know about the report. That is not a surprise. That said, in the talks I have given on the report, I have emphasized what it does and does not mean for Africa and Asia (as well as what the report did and did not do), as a researcher who squarely works in both continents. Still a lot of work to do to ensure the global findings of the report translate in appropriate ways that ensure livelihoods and culture are considered right along with health and environmental challenges for particular, diverse country contexts.

  • I had to laugh at the title of this Guardian article. “Most 'meat' in 2040 will not come from dead animals, says report.” Why does that sound scary when taken at face value?

Okay enough on that! The @WorldFoodPrize 2019 winner was announced this month. The prize will go to Simon Groot, a Dutch vegetable “seedsman” where he started the East-West Seed Company reaching over 20 million smallholder farmers. More about his life can be found here. Not sure how the World Food Prize calculates the reach. I recall last year they credited shared prize winners Haddad and Nabarro, with “reducing the world’s number of stunted children by 10 million between 2012 and 2017.” While these two giants definitely made contributions, how did they get to that number?

Two publications on India just came out that I highly recommend. The first is a book, published by the great Prabhu Pingali and colleagues on Transforming Food Systems for a Rising India. It is a part of a book series by Chris Barrett at Cornell, on Agricultural Economics and Food Policy. I will publish a book on food systems for nutrition in mid 2020. At the same time, the Global Food Security Journal just published an article on future diets in India. They show that by 2050, there will be projected increases in per capita consumption of vegetables, fruit and dairy products, and little projected change in cereal (rice and wheat) and pulse consumption. Meat consumption is projected to remain low. The question remains, what will that mean for their production and food supplies and their nutrition outcomes?

Future direct consumption trends in India by Alea-Carew et al 2019 GFS Journal

Much being written about the food system front these days. To start, Nicholas Kristof, Opinion Columnist for the New York Times, in all of his eloquence highlighted the obscene inequities of our food system. He wrote:

“If some distant planet sends foreign correspondents to Earth, they will be baffled that we allow almost one child in four to be stunted, even as we indulge in gold leaf cupcakes, $1,000 sundaes and half-million-dollar bottles of wine.”

Guido Schmidt Traub and colleagues from the Food and Land Use Coalition argue that there are three ways to fix the food system in Nature. I agree with their three pillared approach (see figure below) but how? and with what investment? More details please! And if you don’t even know what I am talking about when I say “food system”, Corinna Hawkes and colleagues lay it all out in a policy brief. She also has another brief on why food systems matter for policies. I really like these - and there are more to come. Marion Nestle also lays out what it would take to change the United States food system. Marion is so practical. I would love to see her do more global work. Maybe we all need a dose of her realism.

What it would take to change the food system. Schmidt-Traub et al 2019 nature

The SDSN Network hosted an online conference on nutrition-sensitive agriculture from 3-5 June, 2019. Nutrition-sensitive agriculture offers great potential for achieving SDG 2, as it connects agricultural development to improved nutrition outcomes. Many nutrition-sensitive agriculture interventions have been applied in recent years. This e-conference aimed to turn the evidence coming from these interventions into concrete recommendations for practitioners. Close to 1,000 people from all over the world registered for this e-conference, taking part in three live sessions and interacting via an online conference platform. We had great speakers — Matin Qiam, Harold Alderman, and Agnes Quisumbing — who highlighted the latest research. Missed it? All the powerpoints and videos can be found here.

Speaking of SDSN, they are also responsible for the SDG Index. The 2019 report just came out. Do indices really do much? Do they spur action?Guess who ranked number one in the world in moving towards achievement of the Sustainable Development Goals? Denmark followed by Sweden. What a shocker! Last? Central Africa Republic. Second worst? Chad. Triste…Looking at the OECD countries, the USA is awful. Yo Trump, I thought you were going to make America great again. Yah, right.

OECD Progress on the SDGs (2019)

But it ain’t just America my friends, Italy is struggling on many fronts. Just coming back from Rome, I am reminded about the scale of the rubbish there. And now it seems the trash problem is becoming a public health hazard. Such a beautiful dazzling city ruined by poor management. Oh, and tourism. Mamma mia.

Speaking of indices, Bioversity just released their Agrobiodiversity Index Report which assesses dimensions of agrobiodiversity in ten countries to measure food system sustainability and resilience. Strangely, only 10 countries are shown. Not sure why there are not more. Would be interesting to know if this will be more widespread. And if you think dedicating a day to biodiversity is important, think again. @AgroBioDiverse lays out why he dislikes the International Day for Biological Diversity. I actually completely agree with him. I have very similar sentiments with the Decade of Nutrition…

Food Bytes: May 26 - June 2

Food Bytes is a weekly blog post of “nibbles” of information on all things food and nutrition science, policy and culture.

Loved this NYT article about Africa’s millennials who are making their way back to farming. “We are making farming sexy.” Hallelujah. Welcome you “agripreneurs.” Make Africa the world’s breadbasket.

Speaking of leading newspapers, if you live in L.A., the city of angels, you will like the new Food section of the LA Times. It is more about where to eat and cook and less about politics and there is a paywall. While LA is having a renaissance on all things food creation, Gotham city is shutting many of its old school diner doors. “A luxury rental tower called the Frontier stands on the site of the old Frontier Diner in Murray Hill.” The New York we all loved died long ago…

Addicted to the joe? Here is everything you ever wanted to know about coffee and its expansion from Africa to the Americas.

Policy does matter. Did you doubt that? Bloomberg Philanthropy highlights the new Task Force on Fiscal Policy for Health – co-chaired by Mike Bloomberg and economist Larry Summers – to address the growing health and economic burden of noncommunicable diseases with fiscal policy tools that are currently underutilized by governments and their leaders. Lots o’ case studies including good stuff on sugar tax.

We know America is struggling. The Brookings Institution has published an interactive exploration of how she is doing. The Hamilton Project’s Vitality Index is a measure of a place’s economic and social wellbeing. It combines a county’s median household income, poverty rate, unemployment rate, prime-age employment rate, life expectancy, and housing vacancy rate. What does this have to do with food? Well, everything. Check it out.

Vitality Index of America. The bluer, the better.

The last food bytes posting highlighted the research on processed foods, and impacts on weight gain. This thoughtful NPR piece talks about how hard it is to move away from processed foods, even when Americans are cooking more. Sarah Bowen and colleagues discuss the barriers: cost, time, and culinary resources. It just ain’t that easy to cook wholesome, from scratch meals day after day. You just can’t beat convenience sometimes. As the authors say: “… inequality is baked into our food system.” And ain’t that the truth.

Our favorite Tamar Haspel over at the WashPo is keeping it real. Now she is delving deep on the plant based burgers which seem to be all the rave. There are two - The Beyond Burger (peas) and Impossible Burger (soy). She takes both to task on environmental impacts, nutrition impacts and cost. And then there is steak. Will we ever replace it or our craving for it?

CSIS’s Take As Directed has a great podcast with Chris Murray at IHME on global diets and risk of disease. He discussed this paper that was highlighted previously on Food Bytes. “Diets account for more deaths [cardiovascular and cancers] than any other risk factor.” He argues the medical community is surprised and skeptical of this message. Interesting!

The Economist breaks down taxes on sugary drinks. Mexico was the trendsetter and now, 40 countries and seven American cities have started to tax sugary drinks. They argue that those that are not in favor of the tax argue that taxes are a “fun-killer, souring people’s pleasure” and can be regressive, because poorer people spend a bigger share of their incomes on soft drinks. But if demand is sensitive to increased prices, then a tax will change behavior, in a positive direction. Let’s see how it all plays out. The bigger question is, will taxes make a dent in the obesity pandemic. Hard to tell.

For any of you who collect and analyze child growth data (also known as anthropometry) in the field, the WHO has finally released a technical report that defines basic criteria and standards for sampling, training and standardization of anthropometrists, data collection, supervision, for data management including quality assessment and analysis, interpretation and reporting of anthropometric data. FINALLY. This is LONG overdue. Well done WHO. 

And last but not least, GAIN has started a new site called Nutrition Connect. Its purpose is to mobilize knowledge, share experiences, and stimulate dialogue on public private engagements (PPE - not be confused with PPP!) for nutrition. Links can also be found in the Food Archive’s Resources page.

Food Bytes: May 6 - May 25

Food Bytes is a weekly blog post of “nibbles” of information on all things food and nutrition science, policy and culture.

The Annual Reviews have just released a special issue on the Future of Food. Presents 20 articles on "Research & efforts to ensure a safe, nutritious, & affordable global food supply, while preserving biodiversity & minimizing environmental damage." Keen to read these by some stellar scientists!

Processed food is having its moment. New research shows that those who eat ultra-processed foods gain more weight than those who ate whole or minimally processed foods. Researchers at the National Institutes of Health, tested this using the randomized, controlled trial approach. Study participants on the ultra-processed diet ate an average of 508 calories more per day and ended up gaining an average of 2 pounds over a two-week period. People on the unprocessed diet ended up losing about 2 pounds on average over a two-week period. Fantastic food writer Bee Wilson has a new book entitled: The Way We Eat Now: How the Food Revolution Has Transformed Our Lives, Our Bodies, and Our World. She writes about how these processed foods, ala junk food, has taken over traditional diets everywhere in the world, and is having impacts on health, at a very alarming pace.

Another study highlighted the impacts of poor diets on health. An estimated 80,110 new cancer cases among adults 20 and older in the United States in 2015 were attributable to eating a poor diet. Other research supports this claim. The study found that decreasing dietary fat and eating more fruits and vegetables may lower a woman’s risk of dying of breast cancer. They tracked 48,835 women ages 50 to 79 without breast cancer since the 1990s.

The way we eat is changing. There is a fantastic piece by the Guardian looking at how more and more people are eating alone, and it has quite dramatic changes on the way we eat, what we eat and why we eat. Netflix is involved in this equation…

Let’s discuss individual foods. Are you obsessed with vanilla? Check this out. Like citrus? You may be disappointed after reading this. With 70% of America consuming bananas, they can’t be that bad right? Think again. Do you dig on swine? This may scare you.

Some places, as we know still are food insecure in the world. The UN FAO reports 815 million people go to bed hungry. Venezuela, sadly is not immune, and is really in a free fall. NYT is reporting that “Butchers have stopped selling meat cuts in favor of offal, fat shavings and cow hooves, the only animal protein many of their customers can afford.” Terrible times for the country. Let’s hope things turn around soon.

On the polar opposite, but strangely, very much on the same side of the coin, it always thought that urbanization is driving the obesity pandemic. A very impactful Nature study has shown that 55% of the global rise in mean body mass index since the mid-1980s—and more than 80% in low- and middle-income regions—was due to increases in body mass index in rural areas. The team of scientists argue that: “There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.”

The difference between rural and urban mean body mass index in women. Figure A is 1985. Figure B is 2017.

Nature is on a role. They also just published a really important paper nothing related to food, but on HIV. The researchers used a high spatial resolution across the continent to look at HIV prevalence sub-nationally. They already published a similar study examining undernutrition. They show that the epidemic is very unevenly spread. Of the 25 million HIV-positive people in sub-Saharan Africa, one third live in very small, highly concentrated pockets. The remaining two-thirds are spread out more broadly. This work will help hone in on the hotspots and where attention should be drawn to continue progress on halting the spread of HIV.

As for furthering education and building capacity, the London School of Hygiene and Tropical Medicine is starting a new Center on Climate Change & Planetary Health and the University of Washington has a new degree program on Food Systems, Nutrition and Health. Google them if you are interested in these new academic programs!

The Sustainable Development Solutions Network is hosting a 3-day webinar on Nutrition-sensitive agriculture. Sign up! We have three stellar speakers who will be talking about:

  • Smallholder production and Dietary Diversity

  • Market Challenges and Solutions to Nutritious Food Access

  • Women’s Empowerment for Better Nutrition

And on a personal note, I was sad to hear about the passing of Kenyan writer Binyavanga Wainaina. He has some famous stories, including How to Write About Africa. But his most defining moment has been his coming out as a gay man, in a letter to his mum, raising awareness and rights of LGBTQIA throughout the continent.

FOOD BYTES: WEEKLY NIBBLES FROM APR 22 - May 5

Food Bytes is a weekly blog post of “nibbles” of information on all things food and nutrition science, policy and culture.

We saw a lot of really great stuff being written in the diet space this week by mainstream media. First, Thomson Reuters Foundation, and particularly Thin Lei Win published a great piece entitled, and get ready for it, “Death by Diet.” Gothic meets food. Love it. But seriously. The article and accompanying pieces highlight the fact that our diets are now so unhealthy, they are causing illness, disability and death. I really liked this figure below from the report showing what we should be eating and what we are actually producing.

Second, the NYTimes hit it big and right this week with a Food and Climate series. One article highlighted what we should eat for health and the environment and answer lots of pesky questions that we have about diets and what is considered more sustainable or not. Got a question about the impact of different milk products on different environmental indicators? They show you the path. Grass or grain fed beef? They have you covered. Check it out and take the quizzes. Clearly, diets are “hot” (no pun intended) at the moment.

The Economist had an interesting piece on global meat consumption and the transitions in demand. While some high-income countries are moving away from meat consumption, other countries are and will continue to see an increase in the demand for pork and beef. Countries like China, and continents like Africa will continue to demand meat as incomes rise, and imports make their move to these parts of the world. The impacts on undernutrition can be profound - with animal source foods filling important nutrient gaps. However, the environmental effects cannot be underestimated. So what do we do? Trade-offs are inevitable. As the article states, the consequences “will be global.”

Speaking of diets, many women in the world do not get enough iron, resulting in anemia which has serious health ramifications. This past week, I participated in a webinar hosted by the WHO and The Accelerated Reduction Effort on Anaemia (AREA) Community of Practice. I talked about how double duty actions can be done to address anemia and obesity or undernutrition in women. Marion Roche focused on adolescent anemia and gave an excellent overview. My slides are here.

Antimicrobial resistance, is getting more attention these days. The UN just came out with a report and the NYT highlighted it in scary detail. The report argues that overuse of antimicrobial drugs in humans, animals and plants is fueling resistant pathogens that could kill 10 million people annually by 2050. Yikes. Food system actors, beware.

I did a fun podcast with my former student Khris at UNC Chapel Hill. The podcast is called “We All Gotta Eat .” We talked about food but more largely development, youth movement sand just being a bit more punk rock if you really want transformational change.

"EAT"ing my banoffee pie

I had the pleasure of launching the EAT Lancet Commission report in beautiful Cork Ireland at the University of Cork College, hosted by Nick Chisholm at the Center for Global Development. It was a really great event attended by a diverse set of individuals including those from the livestock sector and dairy farmers, advocates, students, professors and researchers.

I presented the overall findings from the EAT Lancet Commission report but I also gave two additional perspectives. The first was my personal view on what I thought the EAT Lancet did not cover adequately or ignored, but should not have. The second was the Ireland perspective - what does the EAT Lancet mean for the future of Ireland’s food system? My slides are here.

On what I thought the EAT Lancet did not adequately do. It did not:

1. Address the confused space of sustainable diets and the epidemiology and science to support it. This was the most contentious aspect of the report and continues to be questioned. I don’t think the report cleared up the debate of what are considered sustainable diets and may have made things more contentious and perplexing.

Inequities in meat consumption

Inequities in meat consumption

2. Tackle the inequities in food systems. The report did not at all go into how people experience difficulties in accessing healthy foods and the inequities in which they bring. It is easy to say eat less meat, but it really depends on where you are in the world, who you are, how contexts and situations can be more or less vulnerable, and what you can afford and access.

3. Take on the entirety of food systems. The EAT Lancet Commission just covered food production and consumption — the head and the tail of the food system — but we know there is this whole middle piece that drives health, sustainable and economies: food supply chains, food environments and drivers of food system transition. The EAT fell short in covering the full scope of food systems but if we did, the report would be 500 pages, not the current 50, in which still, no one read…

4. Focus on who will feed us and their livelihoods. The report did not at all go into the impacts of this type of diet and earth system change on food producers and their livelihoods, ways of life, and traditions. Nor did it go into women producers, small and medium sized producers or rural development/impacts.

5. Examine the actors, especially, consumers and behavior change. The diet really looked at supply side changes and not much on how consumers can take on such a diet, how behavior change is needed and what nudges should be put into place.

6. Consider the local social determinants, and the trade-offs. The report was lofty, ambitious and global. But local nuance, decision making and context is needed, and the report just didn’t have the bandwidth to take on local to global perspectives.

On Ireland. It was fascinating to launch the report in Ireland for a few reasons. I took the train from Dublin to Cork and the landscape was riddled with black and white cows and green rolling hills. I knew the launch could be tough…Was I entering a snake pit?

Bountiful beef cows!

Bountiful beef cows!

First, the cattle and dairy industry is strong here. And for good reason. The agriculture sector contributes significantly to the GDP of the country. The Irish beef sector currently accounts for over 30% of the value of Irish agricultural output at producer prices. Number of cattle heads here. The beef output of Irish farming provides the key input to the Irish meat processing industry. In 2014 the Irish meat processing employed over 13,000 people. Irish agriculture is dominated by family-owned farms.  There are almost 140,000 farms, with an average land holding of 32.5 hectares.  Pasture-based farm enterprises dominate, and as a result, Irish output is dominated by dairy and livestock, especially beef.  Dairy and beef account for two-thirds of gross agricultural output and similar proportions of agri-food exports. Ireland is currently one of the world’s fastest-growing dairy producers and exporters.

Second, the impacts on climate change should not be taken lightly. They have seen a 25% and 9% increase in dairy and cattle head numbers. As a result, their agriculture sector contributes 33% of GHGe in Ireland. Methane is 64% of that. Nitrous oxide from N fertilizer application and excretion of manure is 31%. Energy contributes less - 20% and transport 19% of GHGe. GHGe have been increasing 3.5% every year since 2015 in Ireland. Ireland can play a lead role in fulfilling the “sustainable intensification” goal but so far, they are falling short on the climate agenda. Irish farmers are aware of the need to produce more from less and are addressing their carbon footprint. There is a lot more to do. A Teagasc blueprint on how to make Irish farming carbon neutral is a roadmap, but stakeholders have not signed up to the necessary timelines which will cause them to be fined 600 million for not adhering to the targets set out during the Paris COP agreement. 

The insanely delicious banoffee pie

The insanely delicious banoffee pie

Third, we know that the traditional Irish diet is not sustainable. Some of the top risk factors of death and disease in Ireland are related to diet. And have you ever had banoffee pie? Enough said.

While I was there, there were a lot of the questions about the “hangover” of the report. More of the questions asked by media were about the political backlash of the report findings, why WHO pulled their consensus of the report, and what it means for Ireland’s livestock industry. I found myself defending a report that while I feel fully responsible for what it says, I too find not helpful when we get into the nitty gritties, the realities and the nuance needed to make such transformational changes.

I have never been in something so high profile that I have had to defend but don’t have complete ownership over its content. I am glad to take the fall on things that I believe in or that I have been solely responsible for. But this is a different beast.

FOOD BYTES: WEEKLY NIBBLES FROM APR 5 - 21

Food Bytes is a weekly blog post of “nibbles” of information on all things food and nutrition science, policy and culture.

After all the chaos of the Mueller report and sanctuary cities here in the U.S., I found much joy in tuning out, and instead reading about our fellow friend, the coyote’s diet. Turns out, they eat a lot of cats. Not so much roadrunner. Talk about the new urban hunter! The researchers who investigated the scat of these stealthy creatures also found that their diets consisted of “baseballs, shoes, furniture, and bedazzled jewels.” Hide your pets…

National Academy of Sciences, Engineering and Medicine report: Sustainable Diets, Food and Nutrition

The National Academy of Sciences, Engineering and Medicine held a a public workshop in Washington, DC, in mid 2018 on sustainable diets, food, and nutrition. Workshop participants reviewed current and emerging knowledge on the concept of sustainable diets within the field of food and nutrition; explored sustainable diets and relevant impacts for cross-sector partnerships, policy, and research; and discussed how sustainable diets influence dietary patterns, the food system, and population and public health. This publication summarizes the presentations and discussions from the workshop.

This week, climate change was on the minds of many, with young people marching in the streets and young, but wise Greta Thunberg showing her courage in the fight, hence being honored by Time magazine as one of the 100 most influential people.

We at Johns Hopkins hosted an event on food and water security in the era of climate change. We had some really fantastic experts speaking at the event. I was hoping for a sold out house, but no such luck. We had good attendance but I guess people don’t care that much about the changing climate. I have no other explanation. Here is what the event was about:

The media headlines in the last two weeks showing Nebraska and Mozambique underwater are tragic glimpses of a new era - the era of climate-related natural disasters. Climate change is and will continue to impact the lives of everyone, and will have significant ramifications on both water and food security globally. Climate-related impacts affect water availability in regions that are already water-stressed, as well as the productivity of both irrigated and rain-fed agriculture. Rising temperatures translate into increased crop water demand and have consequences for food availability, and potentially, the nutritional content and quality of crops. Likewise, insufficient and compromised food access and utilization influence households and individuals ability to access healthy diets and drinking water, which can have detrimental health outcomes. No one is immune — both the livelihoods of rural communities and food security of urban populations are at risk of water insecurity linked to climate variability. The rural poor, in particular, are disproportionately affected by climate effects. It is likely that climate variability and change will continue to exacerbate food insecurity in areas currently vulnerable to hunger and undernutrition. There is an immediate need for considerable investment in adaptation and mitigation actions toward “climate-smart agriculture, water and food systems” that are resilient to climate-related shocks. This seminar will delve into water and food security in the midst of a changing climate and what we can do as a global community to adapt and mitigate.

Speaking of climate change, I really liked this piece by Richard Waite and Janet Ranganathan of the World Resources Institute (a speaker at our event) on beef and climate. They unpack 6 common questions about the contentious topic of the sustainability of beef production systems and climate change. Here they are:

  1. Q: How does beef production cause greenhouse gas emissions? A: Through the agricultural production process and through land-use change.

  2. Q: Is beef more resource-intensive than other foods? A:Yes.

  3. Q: Why are some people saying beef production is only a small contributor to emissions? A: Such estimates commonly leave out land-use impacts, such as cutting down forests to establish new pastureland. I think it is politics and some denial there too…

  4. Q: Can beef be produced more sustainably? A: Yes, although beef will always be resource-intensive to produce.

  5. Q: Do we all need to stop eating beef in order to curb climate change? A: No.

  6. Q: Would eating less beef be bad for jobs in the food and agriculture sector? A: Not necessarily

If you want to read their long responses, check out the article! They also have a ton of solutions in their Creating Sustainable Food Futures report and in the figure below.

World Resources Institute’s Menu of Options from their most recent report: Creating Sustainable Food Futures

And climate change is definitely real. Farmers are feeling the effects. A NYT article looked at Honduran coffee farmers are being hit hard. Estimates suggest that least 1.4 million people will flee their homes in Mexico and Central America and migrate during the next three decades. But if Trump has his way, they will be met with a Game of Throne like wall…

Johns Hopkins Global Food Ethics and Policy Program newsletter

Last but not least, there is a lot of talk about cultural appropriation around food these days. A restaurant opened in New York called “Lucky Lee's”, a new Chinese restaurant, not run by Chinese but a Jewish American couple who wanted to have a Chinese restaurant that served “clean” food that was healthy. Not sure what the hell they were thinking. You can’t really mess with food particularly because it is so deep rooted in people’s culture and tradition. It holds a special place in society and it gets quickly politicized when you remove it from its core identity.

And last, last but not least, the Global Food Ethics and Policy Program at the Berman Institute of Bioethics at the Johns Hopkins University puts out a weekly newsletter on interesting articles in the food space, much like this one. It is curated by Claire Davis at the Berman, and I find it to be a rich source of information on ethics and politics of food and nutrition. I encourage you to sign up for it. It is also in the Food Archive resources section.

Why Hunger Amidst Plenty?

I had the pleasure of doing a keynote talk at the “Ending Global Hunger Conference” at the Center for Global Food Security of Purdue University . My talk was entitled “Why Hunger Amidst Plenty?” My slides are here.

The punchline of the talk was this: We are living in a complex world made up of multiple burdens of malnutrition. While the obstacles to address the burden are daunting for citizens, there are tools to solve it. We just need political will, global cooperation, and immediate action.

Screen Shot 2019-04-13 at 2.52.50 PM.png

The malnutrition burden is massive. But the story is mixed - there is the good, the bad, and the ugly. Let’s start with the good. Stunting is coming down - in some places quite fast - like Ethiopia, Bangladesh and Nepal. Also, the risk of dying from a famine has become much, much smaller than at any time in history. Then there is the bad. For the third year in a row, there has been a rise in world hunger. The absolute number of undernourished people has increased to nearly 821 million in 2017, from around 804 million in 2016. These are levels from almost a decade ago. Further, “hidden” hunger remains significant but is shrouded in mystery. We don’t know the state of micronutrient deficiencies, particularly among the nutritionally vulnerable populations, such as children under five years of age, women and adolescent girls. And now the ugly. Overweight and obesity is rising everywhere and among every stage of life. No country has stopped the trends we are witnessing.

The question remains why?

  • Why do we still have hunger & undernutrition?

  • Why are we not seeing improvements? And in some cases reversals of progress?

  • How did we get to this place of paradox: hunger & obesity?

  • What can we do about it?

Screen Shot 2019-04-13 at 2.53.16 PM.png

I argue that hunger is still rampant because of poverty, conflict change, conflict, poor infrastructure, unstable markets, food loss and waste, and periods of seasonal hunger in rural places.

But how did we get to this place of paradox? That is complex but in a nutshell, our lives and lifestyles are transforming as are our diets and food systems. Many in the world are now consuming sub-optimal diets, exercising less and hence are more sedentary, and these contribute to the risk of disease and death. At the same time, healthy diets are not accessible to all.

As a result, many people are now affected by both food insecurity and obesity at the same time.  Food-insecure populations, really no matter where they live, are subject to the same, but unique influences in trying to consume a healthful diet:

  • Limited resources and lack of access to healthy, affordable foods

  • Cycles of food deprivation and overeating

  • High levels of stress, anxiety and depression

  • Limited access to health care

  • Fewer opportunities for physical activity

  • Greater exposure to marketing of obesity-promoting products

The question remains, what to do? There is no one simple measure that can successfully shift the burden at the national or global scale. Rather, a constellation of different approaches and strategies, operating across scales and supply chains, and targeted at different people and organizations will be required. I argue for 10 actions:

Screen Shot 2019-04-13 at 2.53.37 PM.png
  1. Care. We need governments, industry and citizens to care about their diets and their nutrition, climate change and food systems.

  2. Push for countries to develop a food systems policy. No country has implemented a full range of updated, comprehensive, and evidence informed strategies to encourage a healthier and more equitable food system.

  3. Consider the situation a “Syndemic” and take on triple duty actions.

  4. Consider options for keeping the food system within environmental limits. Dietary, technological change on farms, and reductions in food loss and waste are critical to reduce environmental impacts of our food system on the planet.

  5. Don’t forget about who will continue to feed the world. As Ruth DeFries eloquently wrote: “Now we are transforming from farmers to urbanites. Our newest experiment-to feed massive numbers of people from the work of a few-is just beginning. The outcome is yet to be seen.” Who will feed us when the average age of the world’s farmer is 60?

  6. Invest in small and medium holder farmers. Smallholder farmers have more diversified landscapes, making important contributions to the overall dietary diversity for the world’s population. 53-81% of micronutrients in the food supply are produced by small and medium farms. These farms make up 84% of all farms and 33% of the land areas globally and are more predominant in Asia and sub-Saharan Africa.

  7. Maximize net increases of nutrition along value chains. Identify points in the chain that can be “leveraged for change.” Leverage points can cause nutrients to be lost or exit the value chain as well as enhance the nutritional value of select nutrient-rich foods.

  8. Engage and empower women in on- and off-farm opportunities. Women need social capital including information and access to new technologies and farming practices and tapping into social networks that may assist in times of hardship. Women need access to credit with greater ability to invest in infrastructure and to smooth consumption or production shocks. And last, we need to improve their human human capital and agency - give them opportunities for education, and increase their ability to get health and nutrition services.

  9. Help consumers navigate this complex web. Give them the information and knowledge the make healthy choices. Make them affordable, accessible and culturally appropriate. But consumers are super, duper confused

  10. Dig deeper. We must address the underlying social determinants that impact malnutrition. Every country is impacted by poverty but its determinants may be different, or the same…

Food Bytes: Weekly Nibbles from Mar 25 - Apr 4

Food Bytes is a weekly blog post of “nibbles” of information on all things food and nutrition science, policy and culture.

This week’s food bytes focuses on the complications of understanding what is a healthy diet because there seems to be much havoc and confusion in the space. The more havoc, the more people want to dissect the havoc or relish in it. And we seemed to be inundated these last two weeks with diet news.

Tamar Haspel is a fantastic food columnist for the Washington Post. There was a lot of twittering and conversation, which she does not shy away from, about her recent article entitled “Here’s what the government’s dietary guidelines should really say.” She hauls the science of nutrition over the coals leaving no one left standing. In her article, she presents two main criticisms. Her first issue is the flawed nature of nutritional sciences. Errors abound in the way diet data is collected, the way observational studies assess impacts of those diets on outcomes, and the ways in which confounding factors are taken into account. Her second issue is the conflicts of interest in nutritional science. She highlights not just perverse industry-funded research, but also, the nutrition experts’ often ideological world views, or “fanatical opinions that abound in nutrition” which shape interpretations of the data in misleading ways. These two issues, the imperfect science and the conflicts of interest, interact and influence each other.

Following her merciless critique, Haspel concludes that “In the two decades I’ve been writing about nutrition, my confidence in what we know about food and health has eroded.” She is not alone. Many people are very confused about what is healthy and what is not. What will kill you and what will keep you alive. What is sustainable, and what will ruin the planet. She is left feeling certain about three simple things: (1) eat a wide variety of foods with their nutrients intact; (2) keep your weight down; and (3) get some exercise. Sounds about right.

Timeline of the nutrition science field

Do former New York Times writer Mark Bittman and Yale Professor David Katz agree with these sentiments? Largely yes. They argue, “eating well remains difficult not because it’s complicated but because the choices are hard even when they’re clear.” But they have answers. Lots of them. They thought of every question imaginable about diets and health and tried to answer them. Many of the answers are a bit “take my word for it,” but I give them the benefit of the doubt. Although some could wonder why we trust Bittman over credible scientists, but I digress. They argue that future conversations are no longer needed. Yeah, if it were only that easy boys…

Katz also delves deep into why we are eating as if we know less about food than ever before. He argues that humans have been bamboozled by prominent ideologues in the field of nutrition who have built careers defending just one point of view. Similar sentiments to what Haspel highlighted. He argues:

“Where humans practice any reasonable variant on the theme of wholesome foods, mostly plants, in a balanced, time-honored assembly; wherever they eat mostly vegetables, fruits, whole grains, beans, lentils, nuts and seeds, and drink mostly water, they tend to live long, prosper with vitality, and go late and gentle into that good night.  It is not the job of “science” to tear down this established foundation: It is the job of science to build upon it.”

I think what Katz is getting at is that the science of nutrition has come a long way, and there is lot of agreement about the science, but we need to build further on that evidence base. At least, I hope that is what he means. Well-respected Dariush Mozaffarian (Dean and Jean Mayer Professor at the Tufts Friedman School of Nutrition Science and Policy) and colleagues have shown a timeline of the nutrition field and how far the science has come. In the final piece of their timeline - the future - they argue, “Public health future nutrition policy must unite modern scientific advances on dietary priorities with creative new approaches for trusted public communication and modern evidence on effective systems level behavior change.” Trusted public communication. Sounds quite similar to what is being argued by Katz and Haspel. The question is, how do we ensure the science and the way it is communicated by scientists, media and journalists, is trustworthy?

Global Burden of Disease Lancet study: impact of diets on mortality

But the chug and churn of nutritional sciences continues amidst the havoc. Here are three studies published these past two weeks that show the impact of diets on health, at three different levels: at the dietary pattern/whole diet level, the food group level and the individual nutrient level.

  1. The Global Burden of Disease project out of the University of Washington just published a Lancet paper on the impact of suboptimal diet on noncommunicable disease mortality and morbidity (Full discloser: The Food Archive archiver is an author on this paper). The estimates (and modeled data) show that 11 million deaths and 255 million disability adjusted life years (DALYs) were attributable to dietary risk factors. High intake of sodium (3 million deaths and 70 million DALYs), low intake of whole grains (3 million deaths and 83 million DALYs), and low intake of fruits (2 million deaths and 65 million DALYs) were the leading dietary risk factors for deaths and DALYs globally and in many countries.  

  2. Sabrina Schlesinger and authors published a systematic review looking at the impact of food groups on risk of overweight, obesity and weight gain. They found that increased consumption of whole-grains, fruits, nuts, legumes and fish consumption had a negative association with overweight and obesity. Positive associations were found for refined grains, red meat, and and sugar sweetened beverages and overweight, obesity and weight gain. 

  3. And last, a Nature paper examined the impact of carbohydrate, a macronutrient, quality on health. They argue that the quality of carbohydrate-rich foods (high in fiber and whole grains) rather than quantity has the strongest effect on decreased mortality and reduced incidence of cardiovascular diseases, type 2 diabetes mellitus and colorectal cancer.

Still confused? Everyone is sort of saying the same thing that Michael Pollan said so simply a decade ago, now a mantra for many: Eat food, mostly plants and not too much.

Soda, Celebrities and Sell Outs

pepsi sign

I wrote this piece two years ago on my urwhatueat blog, but I feel it needed to be updated and resurfaced.  So here it is.

A few years ago, Mark Bittman wrote: “Why Do Stars Think It’s O.K. to Sell Soda?” This was in response to Beyonce’s TV ad selling Pepsi to the masses. I couldn’t agree more. It is maddening actually. With the current culture being so obsessed with all-things celebrity, you would think that actors, musicians, and athletes would use that position, an enormously powerful one, to make positive change in the world. I was really surprised and disappointed to see one of my favorite actors, Steve Carell (with Cardi B and others), doing a Pepsi commercial during the 2019 Super Bowl yelling that Pepsi is “okay!” But is it Steve?

One out of every 4 people are overweight or obese globally – approximately 2.1 billion people. This “globesity” pandemic touches everyone including young children and teenagers. Obesity has more than doubled in children and quadrupled in adolescents in the past 30 years and now more than one third of children and adolescents were overweight or obese.

So what does obesity have to do with soda? Well…the evidence is pretty cut and dry at this point. Some would argue, and are often “paid” to do so, that soda doesn’t make a dent as a contributor to our waistlines but that is just hogwash. Much of the deleterious effects are due to the high content of sugar in these products. One single 12-ounce can of soda contains three-quarters of the daily added sugar the World Health Organization deems as safe. We know three things about soda and other sugar-sweetened beverages (SSBs such as soda, energy, sports drinks, sweetened teas):

can-of-coke-and-body.png
  1. Serving sizes have increased: Before the 1950s, standard soft-drink bottles were 6.5 ounces. Now, 20-ounce to 42 ounce bottles are the norm.

  2. People everywhere are drinking more soda: In one decade, calories from sugary beverages increased by 60% in children ages 6 to 11, and sugary drinks (soda, energy, sports drinks) are the top calorie source in teens’ diets.

  3. Soda does contribute to obesity and diabetes: Frank Hu at Harvard outlined the studies that make the case. Recent meta-analyses show that higher intake of SSBs among children was associated with 55% higher risk of being overweight or obese; A meta-analysis showed that one to two servings per day of SSB intake was associated with a 26% greater risk of developing type 2 diabetes compared with occasional intake (less than one serving per month); Two large randomized control trials showed that reducing consumption of SSBs significantly decreases weight gain and adiposity in children and adolescents.

Convinced yet? Unfortunately, some of the top-selling artists and athletes are clearly not convinced or just don’t care. Instead, they have sold their souls to the soda companies. Not that some scientists are any better. This whole fiasco of soda companies funding science and pushing the product in emerging economies is just beyond me. With all the commoditization of everything on the planet, isn’t there anything that remains pure and of sound truth? Science should remain untouched, un-monetized: an “immuno-priveleged” place where you just don’t tamper with evidence. Marion Nestle, professor at NYU, has written a whole book on the poltics of soda aptly entitled “Soda Politics” highlighting the perverse tactics used by soda industries to fund and push their products on the public. But I digress…

Selling products with saccharin-sweet pop music is so ubiquitous in our culture that you can even take quizzes on which celebrity sold Coke or Pepsi. Not sure the point of that but indeed a good time waster.

The 1980s saw pop music come to life (and further exploited) through our TV, not just our record players (cassette tapes in those days) thanks in large part to MTV. Commercials or mini videos followed. As an 80s teenager, the first massive star I remember selling soda was Michael Jackson and he took a pretty decent pop song, Billy Jean, and changed its lyrics from “Billy Jean is not my lover” to “You’re the Pepsi generation.” Swell. But it all didn’t work out so well for Mike. Remember the hair catching fire incident not to mention other controversies…Next up. Madonna aka self-proclaimed #rebelheart. Dancing in lingerie in front of burning, Catholic crosses and kissing a black Jesus proved to be a bit too racy for Pepsi in which her ad was banned. Mamma mia.

With each decade, the hits and the soda sales just escalated. Britney Spears, Beyonce, One Direction for both Pepsi and Coke (isn't that a conflict of interest?), Selena Gomez (sipping the slurpy stuff from a Coke bottle with a straw got over 7 million likes!) and Taylor Swift, to name a few. But Taylor is okay because she promotes diet soda. Taylor – don’t you know about the implications of diet soda on the profile of the microbiome? Sigh…

Biggie in da Bronx

Biggie in da Bronx

CSPI, a DC nutrition watchdog, published a list of celebrities, what they promote, and twitter feeds like Pittbull’s elegant tweets of poetry: “Hanging out at Club23 with Dr. Pepper.”  Nas and Drake for Sprite – Obey your thirst. In the ridiculous video, showing lots of young African American men drinking soda, Drake actually credits Sprite with his success. Maybe he should give himself more credit instead of belittling his talent to something so nutritionally deficient. Even the dead cannot RIP. I saw the below ad in the Bronx. Who gave Sprite permission to use Biggie’s image? His estate? Is that even legal?

Kendall Jenner, one of the Kardashians, did a Pepsi ad last year, that infuriated the #blacklivesmatter (BLM) movement. At the end of the commercial, Kendall walks to the front of the protest line, and hands a police officer a Pepsi. There is an exchange of peace, love and understanding. The crowd cheers on Kendall, who has saved the day, ending any resentment and policy brutality. Indeed art imitates life with this ad taking inspiration from a photo of a specific black woman, Leisha Evans, bravely standing up to riot gear adorned police at a BLM protest in Baton Rouge.  Live bolder, live louder, live for now. "Pepsi was trying to project a global message of unity, peace and understanding. Clearly, we missed the mark and apologize." Um…yah.

What makes this so infuriating is that they are targeting young, African Americans. But African Americans are not untouched by the obesity epidemic and often, suffer significantly more than other races due to poor access to healthy foods, poverty and inequity. Some stats in case you don't believe me:

  • African American adults are nearly 1.5 times as likely to be obese compared with White adults.

  • 47.8% of African Americans are obese compared with 32.6% of Whites

  • More than 75% of African Americans are overweight or obese compared with 67.2% of Whites

  • 35.1% of African American children ages 2 to 19 were overweight, compared with 28.5% percent of White children

#BlackLivesMatter – indeed they do. And if we continue to push junk food and soda on populations, racial health inequities will continue to persist.

On one hand, I understand the pull of profit. Celebrities make bank with these commercials. We could equally criticize all the sports players who promote equally unhealthy sugar sweetened beverages (Gatorade etc) and movie stars promoting fine Japanese whiskey (for a relaxing time, make it Santori time), but picking on pop stars is fun. And they earn so much money already. One Direction, a British pop boy band, was the highest grossing band in 2017 due to touring, which of course is always sponsored by somebody. Do they need to sell Toyota, Coke, and everything else that comes along, to sell their songs and get teenagers to come to their concerts?

I am not judging them. Well, maybe I am. I bet they are all great human beings and many have promoted important causes. One Direction is pushing Action 1 which is getting the young generation to take action and raise their voices to what future they want in the post 2015 development agenda. Commendable. Taylor Swift in her own right is empowering young women #GirlPower! The millennial generation, which Taylor and others are 'labeled' as, is impressive. I know. I teach them every day. What bothers me is the selling of their songs – their “art” – to sell soda. Why? They should really start thinking about their fans. If they want them to continue buying their records, going to their movies, and going to their shows, they should want their pre-pubescent and adolescent fans to be healthy. Especially our girls who are particularly vulnerable to obesity, with life-long repercussions.

We know celebrities care about their own health. They gotta look good with 25million+ Twitter and Instagram followers watching their every move. Most popstars are on special diets, have brutal trainers, do yoga and soul cycle. They probably don’t drink soda or for that matter, consume any sugar. Because well, that is what their personal nutritionist advised them to do…And advice given by "nutritionists to the stars" is ALWAYS of sound scientific evidence (Think Beyonce + Cleanse).

One could argue that there are efforts underway to counter these ads - companies are reformulating sodas to get the sugar content down or using alternative sweeteners, and national and municipal governments are taxing soda at the point of sale. Is this enough? I will write on these topics in some detail at a later date.

And maybe it is all just a bit unethical to be pushing soda on children? Marketing junk food and soda to children is generally considered pretty immoral in some circles, and wreaks of the same tactics used by tobacco to get kids to smoke. Check out this Coke 2018 ad called The Wonder of Us that promotes “the diversity of youth” and “there is a different coke for all of us.” Rafael Acevedo, the group director for Diet Coke in North America said “Millennials are now thirstier than ever for adventures and new experiences, and we want to be right by their side. We're making the brand more relatable and more authentic.”

Maybe celebrities need to be held accountable to what they are selling and to who?Young popstars should take a page from the songbook of Neil Young. Or at least watch "This Notes for You" and his rip on the commercialism of rock and roll.

 Ain't singin' for Pepsi


Ain't singin' for Coke


I don't sing for nobody


Makes me look like a joke


This note's for you.

Well sung Neil Young.          

Food Bytes: Weekly Nibbles from Mar 4 - 24

Food Bytes is a weekly blog post of “nibbles” of information on all things food and nutrition science, policy and culture.

The Chicago Council on Global Affairs released their annual report. This year focuses on water: From Scarcity to Security: Managing Water for a Nutritious Food Future. There are lots of nuggets on the links of water to food and nutrition. Definitely worth a read.

IFPRI has also launched a new book: Agriculture for improved nutrition: Seizing the momentum. I contributed a chapter on biodiversity and its importance for food and nutrition security.

I always like what Bee Wilson writes. She recently wrote a great piece in the Guardian on how modern food is killing us. The grape story is an interesting analogy of how our food system has changed.

I just can’t help myself, but the EAT Lancet continues to get press. This article hones in on how it spurred a global debate. Great. It did its job. Keep debating! The Guardian is going a bit nuts on the diet side. They also published a recent piece on “peak beef.” And the Hopkins HUB, published an article on proteins of the future where they warn us to “get ready for a menu of lab-grown steaks, "bleeding" plant burgers, and cricket smoothies!”

Speaking of animal source foods, eggs seem to be bad for us once again. The nutrition science field is just one big teeter totter. This JAMA study shows that eggs increase cholesterol and cardiovascular mortality.

If Africa doesn’t have it tough enough these days, my heart goes out to Mozambique with the cyclone devastation, the armyworm seems to be eating its way across the continent destroying staple crops like maize. Let’s hope R & D can be ramped up quickly with solutions.

I am a closet Chipotle lover and Tamar Haspel outlines the woes the chain has been dealing with.

Two other interesting papers came out last week. One is unpacking stunting - faltering of linear growth in children. The other is a paper in the journal I edit, Global Food Security, on the use and interpretation of dietary diversity indicators in nutrition-sensitive agriculture literature.

In the world of food ethics, with colleagues at Hopkins and Columbia University, we published two papers. The first is in the Oxford Handbook of Public Health Ethics. The chapter focuses on three key ethical challenges in the nutrition public health sphere: the prioritization of key actions to address the multiple burdens of malnutrition, intergenerational justice issues of nutrition-impacted epigenetics, and the consequences of people’s diet choices, not only for humanity but also for the planet. In the second paper, we unpack the meaning of nutrition and demonstrate that a standalone right to adequate nutrition does indeed exist in international human rights law as a sum of other rights. This right to nutrition is, essentially, the sum of the human rights to food, health, education, water and sanitation, a healthy environment, information, political participation, and social security, along with rights ensuring adequate protection of and nondiscrimination against specific groups, such as women, children, and indigenous peoples.


Nutrition and Agriculture Research: Some Thoughts

I recently was asked to provide some commentary at the International Food Policy Research Institute (IFPRI) at the ARENA-II (Advancing Research on Nutrition and Agriculture) project policy seminar. I thought I would post my speaking notes on what I think is a really fascinating set of research findings stemming from the project. The seminar presented new research on food markets and nutrition including cross-country studies of the costs of nutritious foods and nutritious diets as a whole, and case studies of fish, dairy, and poultry products. The event can be watched here.

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ARENA is trying to understand markets in low-income contexts. Markets play a key role in delivering food and nutrition, even for poor and remote rural households. But nutrient-rich foods, especially animal-sourced foods, are very expensive in poor countries, suggesting that markets for perishable but nutritious foods are not functioning well. Both scientific research and real-world programs have largely focused on farm-level interventions to diversify household production and consumption, not recognizing the important role of market purchases.

The major findings coming out of ARENA:

1. Nutritious foods are typically very expensive sources of calories in low income countries, although there are exceptions.

2. Consumption patterns are strongly associated with prices - price variations explains a LOT of the gap between low and high consumers.

3. Indirect evidence that non-price factors (also implicit price factors) matter a lot: e.g. refrigeration and water quality.

4. No single solution for improving affordability or increasing consumption:

  • Eggs: domestic productivity is key, often improving feed sectors (maize, soybean, fishmeal).

  • Dairy: production in some countries, but trade in others. Markets work incredibly badly in rural areas.

  • Fish: cheap and nutritious but under-appreciated by consumers.

  • Domestic and international value chains very important, but also important to think about industrial policy: e.g. How do we create a viable modern dairy industry that delivers affordable safe milk to both rural and urban consumers?

My talking points:

Diets are significant risk factors of morbidity, disability and mortality

The Global Burden of Disease based out of the University of Washington in Seattle has recently assessed the burden of malnutrition in all its forms for the Syndemic commission report in the Lancet. Globally and in the lower income countries, malnutrition in all its forms (shown as the contributions of undernutrition, high. body-mass index, and dietary risks) contributes as much disease burden as high blood pressure, tobacco, high fasting blood glucose and water, sanitation and hygiene combined. For countries with a low Socio-demographic Index, undernutrition incurs a much higher burden both in absolute terms and relative to the other leading contributors. The recognition that undernutrition and obesity are both due to poor diet quality and a low variety of healthy foods is a more helpful perspective to resolve nutrition problems collectively.

Our knowledge of diets is still a black box

Understanding what people are eating is important to shape food system and nutrition policies, including dietary guidelines. However, determining what people are eating, remains somewhat of a black box. We don’t know key questions such as, what are people actually eating? Where do they get their food from and how much do they pay, or are willing to pay for food? What influences their dietary choices? Does health or even the environment factor into their decision making? Data on diets and their sourcing and costs are developing with better use of metrics and surveys that feed into larger databases. We are learning more and more with each passing year. We still have significant gaps in low-income settings on many of these questions.

Diets are inequitable

We are really living in a time of haves and have nots. Globally, there is a significant debate going on about the impacts of animal source foods (mainly large ruminants) on climate change, the environment and on human health. Clearly, this debate sits with high-income countries and those countries which produce and consume vast quantities of meat that do not align with the sustainable development goals. However, we know that the production and consumption practices of some, will impact the many living in low-income countries who do not have the resources to adapt and change rapidly and are limited in their options. The inequities are staggering - the rural, the poor, the geographically isolated struggle to get enough animal source foods that are important, particularly for young children who are growing and developing and need nutrient-rich foods high in iron, zinc, protein, D, B12 etc. The ARENA study advances are understanding of the challenges that rural populations face in getting access to these critical foods – eggs, dairy and fish, rich in important nutrients and other health promoting properties – through both informal and formal markets. While the evidence is growing on the impacts of on-farm production to dietary diversity of households, we know rural peoples, smallholder farming families and day labor workers are net buyers of food and they need market that work.

 My questions

I know the ARENA is meant to of course shed and shine a light but it is also meant to set out a research and policy agenda. Here are some of my questions that I was left wondering about for future research:

  • Infrastructure is so important. Not just roads but technology and innovation along supply chains. What would be the role of the private sector or PPPs to accelerate action and get over the barriers to access?

  • We cannot think about commodities as stand alone. They interact (the ARENA shows how important feed sectors (maize, soybean, fishmeal) are critical for the growth of animal source foods). How do we grapple this with land use changes?

  • The enabling environment is key. What should policies focus on? Subsidies? Trade?

  • Changing food environments or markets. How shall we measure changes and rapid shifts that we are seeing in many rural places, with the encroachment and influence of urban hubs? I would be keen to see how processed, packaged foods are changing the diets and market landscape in rural places.

  • Many consumers all over the world are driven by the same issues - price, convenience, taste. Other factors matter too like reliability and safety. How do we get consumers to care more about nutrition or is that completely unrealistic? What are the trade-offs?

  • Eggs: Can these rural areas shift from scavenging systems to intensive systems? How realistic is that? How much does that cost? Is there infrastructure and investment to do this? There is new evidence showing eggs increase cholesterol and heart disease risk - once again, eggs are deemed to not be god for us. Should we be worried about future burdens if we are promoting these foods to children to improve nutrition?

  • Dairy: Lactose intolerance. The expression of lactase which digests lactose from milk in humans is generally lost after weaning, but selected mutations influencing the promoter of the lactase gene have spread into the human populations. This is considered a classical example of gene-culture co-evolution, and several studies suggested that the lactase gene has been under strong directional evolutionary selective pressure in the past 5000 to 10,000 years. These data indicate that a combination of socio-economic, ethnic and evolutionary factors converged to shape the genetic structure of lactase persistence in East African populations. A Lancet systematic review study in 2017 showed that lactose malabsorption is widespread in most of the world, with wide variation between different regions and an overall frequency of around two-thirds of the world's population. 63% (54–72) in sub-Saharan Africa. Lactose malabsorption was also widespread in Africa. including northern Africa (53–84%) and sub-Saharan Africa (77–100%), with the exception of Niger (13%), Kenya (39%), Sudan (55%), and Tanzania (45%) - pastoralist populations. I am keen to learn more about this?

  • Fish: What would be the strategies to improve the status of fish among consumers as they get wealthier? What role does aquaculture play in these areas and ensuring feed is affordable and more sustainable? What about alternative feeds?

  • Are there gender links to any of these commodities as they become commercialized and how does that change household intake of these foods?

  • How do we ensure these rural places thrive? Someone needs to feed this growing urban population. Who will it be and how if rural places struggle to feed themselves?

 

 

Food Bytes: Weekly Nibbles from Feb 25 - Mar 3

Food Bytes is a weekly blog post of “nibbles” of information on all things food and nutrition science, policy and culture.

Let’s look to the future but learn from the past of the American dietary guidelines. The 2020 USDA dietary guidelines are now in the works. Politico has unpacked who will serve on the Dietary Guidelines Advisory Committee, a panel of experts that “wields considerable influence over the guidelines.” Some are tied to the food and beverage industry. Tamar Haspel, one of my favorite journalists who writes on food for the Washington Post re-opened a can of worms about how the dietary guidelines have made Americans fatter, as opposed to promoting healthier diets. The argument goes: When the dietary guidelines decreased their recommendation on fat intake, Americans replaced those fats with added sugars and refined grains. Parallel to this, obesity increased. But Haspel points out that dietary guidelines always advised to limit sugar, and delves into the reasons why - was it calories? was it lower carb diets? She argues the guidelines are not the culprit. Thereafter a twitter war ensued.

Speaking of inducing obesity, taxes on soda have been adopted by many cities and countries now, and the question still remains, do they work? A study done on the soda tax in Berkeley showed a 52% reduction in self reported consumption of soda. Key words: SELF REPORTED, which we all know can bring about some skepticism of quality data. In Philadelphia, there was a 46% decrease in sales of soda, but just right outside the city, there was an increase in sales, insinuating that maybe people are driving outside the city to get cheaper soda. And people don’t want to call it crack…

The issues of unhealthy diets and their contributions to obesity and undernutrition are getting some mainstream press these days. Let food be thy medicine is a mantra that has some teeth. TIME magazine published an article about how health practitioners are starting to include healthy food and diets as part of the medical care they provide to patients. Cure no but maybe a miracle… This infographic from Tufts shows how the medical profession can take action. I also edited a special issue of the AMA Journal of Ethics in which David Katz explores “barriers to dietary counseling, strategies for improving medical education and clinical practice with respect to nutrition, and the ethical importance of sharing dietary information with patients.” He also did a great podcast on the ethical implications of NOT considering diets as part of medical care here.

Dan Glickman and colleagues are arguing that America needs an institute devoted to research on the top cause of poor health - that being nutrition. It would be called the National Institute of Nutrition, and it would be part of the National Institutes of Health. The institute will facilitate and help coordinate incisive research into nutrients, foods and their relationships to better health. They give some details in this NYT article. I could definitely be on board with that. Time for science to take nutrition seriously.

On the opposite end of the malnutrition spectrum, a new report published by the United Nations’ Food and Agriculture Organization (FAO) and the World Food Programme (WFP), show that 60% of the world’s hungry live in just 8 countries. They are: Yemen, the DRC, Afghanistan, South Sudan, Syria, the Lake Chad Basin, The Central African Republic, and Somalia. What do these countries have in common? Man-made conflict. Sadly hunger and sometimes starvation is used a tool to fuel civil wars. Very tragic and very preventable.

Another war being fought is to protect and conserve the biodiversity on the planet. An epic, FAO report on biodiversity for food security and agriculture was released last week along with 91 country & 27 organization reports. No time to read 576 pages? The digital short read can be found here. Crux: Biodiversity is under severe threat which means we are too.

The EAT Lancet saga continues, and I speak to eating healthy, sustainable diets for Australia’s ABC radio new show here. We also did an Let’s Rethink Food podcast on the future of food production

Food bytes: Weekly nibbles from Feb 18 - Feb 24

Food Bytes is a weekly blog post of “nibbles” of information on all things food and nutrition science, policy and culture.

Since the publication of the Food in the Anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems,” there have been some thoughtful critiques on the paper. Lawrence Haddad of GAIN and some other GAIN colleagues published what they felt were omissions but also the opportunities for more research, dialogue and debate. Over at the New Food Economy, Sam Bloch tried to eat the planetary health diet for one week. He struggled. He cooked almost all his meals, and he found the diet more expensive. I think he was a bit extreme, forgoing coffee and spices, which is not really recommended, but A effort in at least trying to take the lofty goals of the report and giving some practical insights into whether one can consume this diet on a daily basis. But don’t throw the baby out with the bathwater just yet. There are many attempts to ensure plant-based diets and vegan cuisine are tasty to our picky palates. Restaurants and food companies are trying new recipes and using new technology to ensure that vegetables make our mouths water just as much as those pavlov-dog-drooling juicy steaks do.

Another Lancet journal commission report was published last week on the “Global Syndemic of Obesity, Undernutrition, and Climate Change.” What is a syndemic one might ask? It is a synergy of pandemics that co-occur in time and place, interact with each other, and share common underlying societal drivers. Oh. Sounds serious. Well, in this case, it is. The pandemics are climate change and malnutrition - that being undernutrition and obesity. All three affect most people in every country. They give this example:

“Food systems not only drive the obesity and undernutrition pandemics but also generate 25-30% of greenhouse gas emissions (GHGs), and cattle production accounts for over half of those. Car-dominated transportation systems support sedentary lifestyles and generate between 14-25% of GHGs. Underpinning all of these are weak political governance systems, the unchallenged economic pursuit of GDP growth, and the powerful commercial engineering of overconsumption. The outcomes of obesity, undernutrition, and climate change interact. For example, climate change will increase undernutrition through increased food insecurity from extreme weather events, droughts, and shifts in agriculture. Likewise, fetal and infant undernutrition increases the risk of adult obesity. The effects of climate change on obesity and vice versa are currently uncertain.”

The Commissioners argue that double and triple duty actions are necessary to address The Global Syndemic. This figure below shows some options of triple duty actions. Some are very similar to what was recommended in the EAT Lancet Commission like reducing meat consumption and more sustainable dietary guidelines. Seems, most scientists are somewhat on a similar page on these recommendations. They do rip into both governments and food and beverage industries for not governing and not having public health concerns in mind respectively.

Triple duty actions to address the “global syndemic”

Triple duty actions to address the “global syndemic”

Dark cuisine. Copyright: NYT

Dark cuisine. Copyright: NYT

Of course, as part of these global conversations is the issue of meat production and consumption and the potential future technologies that could save the planet, animals and humanity. One report just released argues that lab-grown meat could accelerate climate change, more so than current cattle production. Shwoops. Not sure about the authors assumptions, but they do acknowledge the limitations of their modeling of different types of gases and the energy calculations to come up with such a sweeping conclusion. The podcast Freakonomics breaks down the potential future of meat - weighing the pros and cons. It is worth a listen. One thing they discuss in the podcast that I had not heard of is “finless foods” - where fish are produced from stem cells. With 33% of fish stocks overly fished, this could be a game changer. That is, if people want to eat cultured meats and seafoods….

And speaking of weird science, and the future of food, ever heard of stargazy pie? It is a pie made up of herring, half buried in the pie with their heads and eyes peaking up from the buttery crust. Underneath is the rest of their bodies “leaching their brine in a rich custard, larded with bacon and hard boiled eggs.” Yummmm. Welcome to the world of ugly food and “dark cuisine.” These ugly food concoctions are highlighted in the New York Times Fashion section no less.

Food Bytes: Weekly Nibbles from Jan 21 - 27

Food Bytes is a weekly blog post of “nibbles” of information on all things food and nutrition science, policy and culture.

Environmental effects per serving of food produced

Environmental effects per serving of food produced

The EAT Lancet Commission report entitled: “Food in the Anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems” came out this week. It was both praised and demonized but regardless, it made a big splash across many media outlets. I was part of the Commission and I must say, I felt pretty worn out with interviews and podcasts after the first week of its release. So what is the report? It was made up of 37 scientists that came together to do three things: The first was to quantitively describes a universal healthy reference diet that would provide major health benefits, and also increase the likelihood of attainment of the Sustainable Development Goals. The second was to define six scientific boundaries for food systems that would ensure a safe operating space within six Earth systems, towards sustaining a healthy planet. The third outlined five strategies needed for the “Great Food Transformation.” Establishing targets has its benefits but it also breeds controversy. I will write in some detail on the politics of the report at a later date, but for now, the link above has all the deets including a podcast I did with Professor Tim Lang.

On the same week as the EAT Lancet, a paper was quietly published in the New England Journal of Medicine by Andy Haines urging for a renewed focus on climate and health. The authors argue that “climate change is expected to alter…climate-sensitive health outcomes and to affect the functioning of public health and health care systems.” One could argue, we know this, but the fact that it was in a clinical medical journal shows the breadth of how climate change will impact all facets and medical professionals need to be thinking about how this will impact their patient populations, particularly the more vulnerable.

What wasn’t discussed much in the EAT Lancet were “food environments.” These are the places where consumers make a decision about what to buy, order or have delivered. Food environments are markets or cafeterias, or restaurants or food trucks. They look different everywhere. My colleague, Shauna Downs and I published an article in Public Health Nutrition looking at consumers’ perceptions of their food environments and their food consumption patterns and preferences in urban and rural Myanmar. The study shows that the availability of diverse foods had increased over time, while the quality of foods had decreased. Most consumers greatest concern about the foods available was the safety. Consumers preferred fruits, vegetables and red meat compared with highly processed snack foods/beverages. Although consumers reported low intakes of highly processed snack foods, Burmese street food was consumed in high quantities.

One food environment that could improve is the office. A study done by the CDC shows that nearly a quarter of respondents ate food obtained directly at their office. And the foods they ate were not necessarily healthy. Think the leftover pizza, the corporate snack bar, the candy in the jar, the cake for someone’s birthday. The study found that what they officemates ate during work hours was “high in empty calories, sodium, and refined grains, and low in whole grains and fruit.” Shocker? Not really but I do think work places need to stop making it so hard for their colleagues to eat healthy.

Enough with the studies! How about a podcast? A great one has just been started by our friends at NPR. It is called Life Kit and they “help you cut through all the nutrition noise” and provide guidance on how to eat healthy. And there is indeed a lot of noise out there. I listened to three of their podcasts - only about 20 minutes long - and they had some stellar nutrition experts including Dary Mozaffarrian who is the Dean of Tufts Friedman School and Doctors David Katz and David Ludwig. They are great, and I think provide sound advice on nutrition and what to eat. Listen to them on your way to work or even better, while exercising!

And speaking of eating healthy, here is an old video of Andy Warhol, eating a hamburger. Took him about 4 minutes.