The Food Environment: How Does It Influence the Dietary Transition?
Laurian UnnevehrSenior Research Fellow, IFPRI
Presentation to the OECD Food Chain NetworkOctober 26, 2012
Rising U.S. Childhood Obesity
All 2-5 yrs 6-11 yrs 12-19 yrs0
5
10
15
20
25
198020002008
% of children
Global Burden
• 1.5 billion people overweight or obese• WHO estimates deaths from overnutrition
exceed those from undernutrition• Diet related disease has a global cost
estimated at $1.4 billion
Source: WHO, World Economic Forum and Harvard School of Public Health, 2011
The Dietary Transition
• Agriculture-based economy– Starchy staples based diets– Undernutrition, esp women and children
• Transforming economy– Diet diversification improves diet quality– Emergence of double burden
• Urbanized economy– Diet includes too many calories, fats, sugars– Non-communicable disease burden
2005
87
38
525
53
85130
24
Bangladesh: Food Group Shares of Total Food Supply (kcal/capita/day)
Grains, Roots, and TubersLegumes and NutsDairy ProductsFlesh FoodsEggsFruits and VegetablesSugarsOils and FatsMiscellaneous
1257
268
69
65
2151
93
16863
Tanzania: Food Group Shares of Total Food Supply (kcal/capita/day)
Grains, Roots, and TubersLegumes and NutsDairy ProductsFlesh FoodsEggsFruits and VegetablesSugarsOils and FatsMiscellaneous
Data Source: FAO Food Balance Sheets, 2009
1596
10056
515
75
285
63
468
90
China: Food Group Shares of Total Food Supply (kcal/capita/day)
Grains, Roots, and Tubers
Legumes and Nuts
Dairy Products
Flesh Foods
Eggs
Fruits and Vegetables
Sugars
Oils and Fats
Miscellaneous
Data Source: FAO Food Balance Sheets, 2009
Meat, Eggs, and
Nuts
Dairy
Fruit
VegetablesFlour and Cereal
Products
Added Fats and Oils and Dairy Fats
Caloric Sweeteners
Less than HALF the recommendedamount
TWICE the recommended amount
United States: Food Group Shares of Total Food Supply (kcal/capita/day)
Source: USDA/ERS
0 10 20 30 40 50 60 70 801500
2000
2500
3000
3500
4000
% Overweight Adults Follows Caloric Intake Per Capita Across Countries
High Income
Middle Income
Low Income
% Adults Overweight (BMI ≥ 25)
Calo
ric In
take
(Kca
l/Pe
rson
/Day
)
Sources: FAO; WHO
Indonesia
Egypt
Zambia
Nicaragua
Countries at the same level of incomehave different outcomes
Why are Consumer Choices Constrained?
• Affordability– Prices– Income
• Knowledge– Habits– Limited information
• Access– Nutrient dense foods– Modernization of food system
Do we have an “Obeso-genic” Food Environment?Illustration by Meredith Nelson
What are the Proposed Policies?
Major Reports• National Academies 2012• World Bank 2011 • OECD 2010• World Economic Forum
2011
Common Recommendations• Nutrition labels• Advertising controls• Public information• Regulation of school /
workplace meals• Tax unhealthy/ subsidize
healthy foods
Recent EATWELL review found most of these policesare in widespread use in high income countries.
What Do We Know about the Factors that Shape the Food Environment?
• Prices• Information• Access
How do these factors play out differently across different kinds of food economies?
Soda
10% price drop 20% tax5% more
consumed
16% less consumed
Sources: Dong and Lin (2009); Andreyeva et al. (2010); Dharmasena and Capps (2012)
Very modesteffects on caloriesor weight.
Fruits and Vegetables
Prices Have Modest Impacts On Diets
But They Do Shape Consumption
• Prices shape long run consumption habits, preferences, health outcomes– Higher prices for vegetables associated with more
diabetes in U.S. (Meyerhoefer and Leibtag, 2011)– Lower food prices associated with higher rates of
obesity in OECD countries over the past 20 years (Huffman et al., 2010)
Prices in Transforming Economies
• Greater response to price changes expected in low income countries– 2008 price increases reduced nutrient density of
diets (Ianotti et al. 2011)• Emphasis on keeping staple prices low may
discourage diet diversification– Pulses prices relatively high in India (Kadiyala
2011)
Information
• Nutrition education has resulted in greater awareness, but little change in diets
• Behavioral approaches to “nudge” consumers towards better food choices
• Product and menu labeling have brought changes mainly through product reformulation
Information Influences Supply
• Mandatory labeling motivates food producers to change product formulation
• Benefits all consumers whether they read the label or not
• Trans fat label in 2006 led to rapid substitutions in major brands
• CDC reports reduction in trans fat in blood in 2009
Sources: Golan and Unnevehr 2009; CDC 2012.
Information in Transforming Economies
• Behavior change communication is key element of many nutrition interventions
• When combined with value chain interventions, can address constraints to change– Orange-flesh Sweet Potatoes in Mozambique
• Efforts to monitor, certify packaged food attributes – GAIN’s Access to Nutrition Index
Intervention: • Production:
(dissemination of vines and farmers’ training)
• Demand creation (nutrition education)
• Marketing and product development
Source: DeBrauw, Gilligan, et al. 2012
Reached: 14,000 hh (Mozambique) 10,000 hh (Uganda) Doubled Vit A intake
OFSP in Mozambique and Uganda(HarvestPlus)
Access
• Socio-economically disadvantaged areas have fewer food retail options for healthy food
• Access to unhealthy options leads to poor diet and health outcomes for low income women, teens in US (Currie 2010)
• Increased supermarket access in low income countries associated with greater diet diversity, both healthy and unhealthy (Toiba et al. 2012)
Is a Healthy Dietary Transition Possible?
• Dynamics of food system in transforming economies provides scope for changing path
• Promising food environment policies:• Targeted productivity and value chain development for
nutrient dense foods • Market institutions that incentivize nutritional quality and
safety• Monitor food access for vulnerable consumers as system
modernizes• Learn from the many policy experiments underway in OECD
countries