Marie RuelIFPRI

Healthy Diets for Urban People

“Towards Healthy & Sustainable Food Systems in an Urbanizing World”

Wageningen, October 19, 2018

The Challenge

IFPRI

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The Challenge

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The Challenge

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Lindsay’s presentation provided an excellent introduction to my presentation, so this will allow me to jump right in.

The presentation draws upon a synthesis paper that Carol Levin and I worked on recently with the objective of reviewing the experience with food based approaches for the control of vitamin A and iron deficiencies.

to

Urbanization continues to accelerate

Projected urban shareof global population

Urban67%

20502014

Urban54%

Growth of urban population in major regions

The double burden of malnutrition refers to coexistence of:

2 BILLION adults

are overweight or obese

38 MILLION children

are overweight

88 PERCENT of countries

face a serious burden of either two or three forms of

malnutrition

2 BILLION people

lack key micronutrients like iron and vitamin A

151 MILLION children

are stunted

51 MILLION children

are wasted

Sources: UNICEF/WHO/World Bank Group 2018

MALNUTRITION IN ALL ITS FORMS

PresentatorPresentatienotitiesMALNUTRITION

Persistent calorie and nutritional deficiencies alongside rising rates of overweight and obesity are creating a triple burden of malnutrition.

2 billion people lack key micronutrients like iron and vitamin A151 million children are stunted51 million children are wasted2 billion adults are overweight or obese38 million children are overweight88 percent of countries face a serious burden of either two or three forms of malnutrition

Sources: UNICEF/WHO/World Bank Group 2018

Obesity Trends

Source: NCD Risk Factor Collaboration 2016 (in GLOPAN 2017)

Urban malnutritionThe burden of malnutrition is shifting from rural to urban areas

Source: Ruel, Garrett, and Yosef 2017

• Urban poor suffers from all forms of malnutrition• Stunting in urban areas: 1 in 3 children

o urban share increased from 23% (1985) TO 31% (2011)• Micronutrient deficiencies (no data)• Overweight/obesity:

o children: prevalence 1.08> in urban than rural areaso women: prevalence of overweight> in urban areas

• Large economic disparities in urban areaso Urban poor sometimes have worst nutritional status than rural poor

Urban dietsThe nutrition transition is accelerating in cities

The “nutrition transition” is characterized by:changes from traditional monotonous diets:

rich in coarse grains, staple cereals, and pulses to:to more modern diets:

more diverse, including more animal sourced foods (meat, dairy), oils, refined cereals, added sugars, saturated fats, processed and ultra-processed foods

Photos: Michelle Holdsworth, U. Sheffield; Ghana

DefinitionsProcessed –Ultra Processed Foods

NOVA classification:

1) unprocessed or minimally processed foods: fresh fruit and vegetables; legumes, starchy roots and tubers; nuts and seeds; fresh meat, poultry, fish, and seafood; milk

2) processed culinary ingredients: vegetable oils; butter; sugar and salt3) processed foods: canned and bottled vegetables, fruits and legumes; salted or sugared nuts

and seeds; processed meats and fish; cheeses; 4) ultra-processed foods: all sweet or savory packaged snacks; flavored sweet drinks; breakfast

cereals; pastries; fast foods such as sausages, burgers, hot dogs, and pizza.o “Ready to consume” industry formulations manufactured from ingredients extracted from

foodso Typically contain several additives with little or no whole foods content

Source: Monteiro et al. 2018

Why are urban diets changing?Supply factors

• Globalization: o Trade liberalization have influenced national food production, transport,

processing, imports, exports and investments between countrieso This has affected food availability, prices, promotion of different types of

foods (e.g. oils, processed/ultra-processed foods, sugar-sweetened beverages

• Urban food environments: o Greater diversity in food supply (animal sourced foods, year round fresh

fruits & vegetables, processed/ultra-processed foods)o Offer range of purchasing options: retail stores, markets, informal sector

food vendors, fast food restaurants, street foodso More aggressive food marketing and advertising

Why are urban diets changing?Demand factors

• Incomes rise – demand changes • Employment away from home, women’s time – need for

convenience• Limited access to cooking facilities – eating away from home, street

foods, informal vendors, fast food restaurants (food safety risks)• Greater exposure to food marketing and advertising

Influences norms and preferences on what is desirable, healthy/not healthy• More sedentary lifestyles

Should lead to reduced energy consumption, but does it?

Drivers of Dietary Choices

Food Environment: Prices Food availability, quality, taste Food safety Industry practice and policies:

promotion, marketing, labeling

Consumer characteristics: Preferences Income and affordability Health and nutrition knowledge Time and convenience Physical accessibility

Source: IFPRI Urban Food Systems for Better Diets, Nutrition and Health

Food procurementThe role of urbanization and Income

Source: GLOPAN 2016, based on data in Tschirley et al. 2015

Ethiopia, Uganda, Tanzania, Mozambique, Malawi, South Africa

Source: GODAN 2016, based on data from Masters 2016

Changes in consumptionBy National Income

Source: Barry Popkin, University of North Carolina at Chapel Hill; data from Euromonitor International Limited 2018

Ultra-processed foodsPackaged junk food sales in Asian countries

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Sweet Biscuits, Snack Bars and Fruit Snacks

Salty Snacks

Confectionery

Cakes & pastries

Ultra-processed foods Diet and health risks

Sources: Cediel et al. 2017; Steele et al. 2017; Monteiro et al. 2017

% Energy from protein (USA)

% Energy from sugar in Chile

Obesity (13 European countries)

SummaryGlobal dietary changes (LMICs)

Added Sugars (caloric sweeteners in beverages, packaged foods, pastries, etc. Fats and oils (through fried foods) Snacking: > 22% of kcals (processed foods, beverages, added sugar, fried foods) Animal source foods (dairy, red meat) – often in excess Ultra-processed foods (high sugar, salt, fat, low protein) Convenience foods, away-from-home eating, prepared meals (nutritious? safe?)

Traditional foods: whole grains, legumes, vegetablesMeals prepared at home from fresh foods

In spite the wide range of foods available in urban areas, healthy diets are often unaffordable for the poor

For the urban poor, the most accessible, affordable, convenient diets are often the most unhealthy

Research gapsData on diets and consumer choices

Diets: What, where, why? • What: do urban dwellers eat (especially the poor)? What is the quality, safety,

price of foods/meals they buy?• Where: do they procure their food/meals (urban agriculture; informal vendors,

markets, restaurants; formal supermarkets, fast food restaurants, etc.)? • Why do they make the choices they make: what are the drivers of healthy or

unhealthy) food choices (individual, household, food environment & systems)?

Dearth of data on consumers’ choices and food procurement; disaggregated by gender, socioeconomic and demographic characteristics, location of residence, city sizeDearth of data on global consumption trends in urban areas,

globally, by region, country, city size

Research gapsOpportunities

• What are the opportunities for leveraging food systems and food environments to improve urban diets, especially for the poor?

• What can we learn from experiences with policies to address the nutrition transition (e.g. food labeling; taxes on unhealthy foods; school meals programs; restrictions on marketing to children)?

• What is the role and contribution of informal food sector; how can it be supported to provide livelihoods for vendors and healthy and nutritious foods for consumers?

• How can the large retail networks be leveraged to supply affordable healthy food choices and promote healthy diets?

Research gapsData and metrics

Food environments• How do we map and characterize quality of food environment?• How do we measure dietary intake accurately and efficiently?• How do we quantify and model individual, household, and food environment

characteristics and their contribution to diets, health, and nutrition?• How do we asses impacts of food environment and food system policies and

interventions on diet quality, safety, health, and nutrition?• How do we apply systems thinking to analyses of urban diets, health and

nutrition, their drivers and the impacts of interventions?Limited experience, tools, approaches, and metrics for measuring

food environments, their contributions to healthy/unhealthy diets and nutrition and health outcomes, and impacts of policies and interventions to support healthy diets

There is an urgent need to build the evidence base to guide policy efforts to ensure healthy diets for urban people

Dianummer 1The ChallengeUrbanization continues to accelerateDianummer 5Dianummer 6Obesity TrendsUrban malnutrition�The burden of malnutrition is �shifting from rural to urban areasUrban diets�The nutrition transition is accelerating in citiesDefinitions�Processed – �Ultra Processed FoodsWhy are urban diets changing?�Supply factorsWhy are urban diets changing?�Demand factorsDrivers of Dietary Choices�Food procurement�The role of urbanization and IncomeChanges in consumption�By National IncomeUltra-processed foods�Packaged junk food sales in Asian countriesUltra-processed foods �Diet and health risksSummary�Global dietary changes (LMICs)Dianummer 19Research gaps�Data on diets and consumer choicesResearch gaps�OpportunitiesResearch gaps�Data and metricsDianummer 23