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.

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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?

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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:

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  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

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

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):

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  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.