Spring/Summer 2003    Vol. 11, Issue 1
Reversing the Nutrition Transition:
Advocacy and Action, Not Reports, Are Key

The March 2003 World Health Organization/Food and Agriculture Organization Joint Expert Consultation's report is a wake-up call to citizens and governments around the globe, reminding them that over-nutrition is a major cause of lost quality of life, illness and premature death. (Indeed, for non-smokers, diet is the leading cause of death in many countries.)

The report does not break new ground. Yet it is especially significant, because never before has an authoritative global agency weighed in so clearly on diet as a cause of chronic disease.

The report focuses on the main dietary culprits that cause hypertension, stroke, heart disease, certain cancers and diabetes -- in brief, the consumption of too few fruits, vegetables and whole grains, and too many salty foods, fatty meats, dairy products, soft drinks and other foods made with refined sugars. And it comes to essentially the same conclusions that other influential reports published by the U.S. Congress, U.S. National Academy of Sciences, U.S. surgeon general, World Cancer Research Fund and the World Health Organization (WHO) itself reached during the two decades spanning 1977 to 1997. Regardless of objections from the food industry and some nutrition professionals, the consistency in message in these reports reflects the near unanimity among scientists on the dietary contributors to chronic diseases.
"A ton of soft drinks -- an anathema to obesity, diabetes, heart disease..."

Scientific consensus on the causes of chronic disease should set the stage for policy action to reduce rates of these diseases. However, the WHO report does not include recommendations for policies that governments could adopt to help their citizens consume healthier diets. That absence is no oversight. A draft of the report recommended nutrition labeling on packaged foods, taxing less healthful foods and restricting their advertising to children, and subsidizing the costs of healthful foods. But more than 20 American food trade associations urged U.S. Secretary of Health and Human Services Tommy Thompson to tell WHO not to include such recommendations in its report. On July 2, 2002, Thompson acquiesced, saying, "... it is premature to use available data to develop national food and nutrition policy without further evidence." The food industry in the United States and possibly elsewhere also pressured WHO directly.

WHO plans on putting policy advice in a future report, but nongovernmental organizations and health experts need not wait to advocate sensible measures to help turn the tide of diet-related chronic diseases.

A Nutrition Transition Gone Wrong
The seemingly inexorable drift toward unhealthy eating habits is happening everywhere, from wealthy countries in North America and Europe to developing nations in Asia and Latin America. Populations that once ate diets low in salt and saturated fats, and high in whole grains and legumes have undergone a "nutrition transition"; today they consume diets high in salt, saturated fats, and refined sugars and flours, and low in fruits, vegetables and legumes. In the wake of this transition comes, in the words of The Wall Street Journal, "an explosion in preventable diseases once found mainly in developed nations."

The nutrition transition has many causes, from the seductive taste of fatty, sugary and salty foods to inflated industry marketing budgets. Preventing and reversing the transition, and protecting the health of people in developing nations, will take more than learned reports and earnest, wishful thinking. It will take citizen outrage and government action.

The Road to Redemption Is Clear
In the United States, the nonprofit Center for Science in the Public Interest sponsored media campaigns in several communities that led to major increases in the proportion of low-fat milk consumed (see http://www.cspinet.org/reports/obesity.pdf). And even with paltry funding, programs like "5 A Day" have contributed to increased fruit and vegetable consumption.

But the impact of campaigns in a few small communities is negligible compared to the need. Major funding and creative laws are necessary if healthy diets are to become the norm rather than the exception. To this end, health advocates should consider:
  • Price subsidies or consumer rebates to encourage fruit and vegetable consumption, as well as providing schools with free fruits and vegetables to promote better dietary patterns in children
  • Paid-media campaigns to promote the consumption of more fruits and vegetables, and less meat, whole milk, cheese, butter, soft drinks, candy and processed foods
  • Restrictions or taxes to discourage the use of hydrogenated shortening, coconut oil and other highly atherogenic, or artery-clogging, fats
  • Duties on foods high in saturated fats or added sugars to generate revenues to sponsor dietary-change campaigns or to subsidize the costs of healthful foods
  • Nutrition information, as well as alerts, on products high in saturated fats, added sugars and salt
  • Requirements for chain restaurants to post the calorie content next to every item on menu boards and menus.
Such actions could help reverse the nutrition transition -- and its impact on chronic-disease rates -- before it's too late.

The authors invite nutrition advocates around the world to contact them for further information or assistance on policy advocacy via e-mail at mjacobson@cspinet.org.

© 2003 CECHE
Center for Communications, Health and the Environment
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