How the food system shapes nutritional outcomes
Updated at 1516982825
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Recent years have observed a constant increase of obesity and overweight rates in developing countries, coexisting with lingering rates of wasting and stunting. Around the world, almost a billion people are suffering from hunger and over 2 billion have nutrition deficiencies, but at the same time, almost 2 billion are overweight or obese. The question of malnutrition has thus transitioned toward diet composition rather than just insufficient caloric intake. In 2015, the Committee on World Food Security (CFS) asked the High-Level Panel of Experts on Food Security and Nutrition (HLPE) to develop a report on Nutrition and Food Systems.

The report, published in September 2017, provides a framework on how food systems shape people’s dietary patterns and identifies policy opportunities to affect these systems. Globalization, income growth, and food industry consolidation have resulted in longer food supply chains, with increasing complexity of the food environment. All food systems have three core components: the food chain, the food environment, and consumer behavior. The food supply chain encompasses all activities and actors involved from food production to consumption of food and disposal of waste. This includes production, storage and distribution, processing and packaging, and retail and markets. The food environment includes all the conditions that shape people’s dietary choices and thus nutritional outcomes. For some people, the food environment is what they produce and are able to acquire at their local market, whereas for others, the food environment is broader, incorporating imports from international markets. Determinants of the food environment include not only economic and physical access but also advertising, quality, and safety. Consumer behavior includes the decisions that consumers or households make regarding food acquisition, preparation and consumption, including differential consumption by gender or age.

Food systems are incredibly diverse and complex, including different scales: household, local, and global. The report includes three types: traditional food systems, mixed food systems, and modern food systems. In a traditional food system, food production takes place in the area by smallholders, with seasonal and local food. Mixed food systems are more present in peri-urban and urban areas, where food can be purchased from other markets due to better infrastructure for distribution and storage. A modern food system has a global supply, with no seasonal goods. In a modern food system, food is easily accessible and represents less of the household budget; in these systems, there is a higher presence of processed food, and food safety is more closely monitored.

Although traditional food systems tend to be associated with higher prevalence of undernutrition and micronutrient deficiency, the report found that the prevalence of obesity and overweight in these systems is around 28 percent. In comparison, modern systems are usually linked to higher rates of obesity, and although there are fewer micronutrient deficiencies in modern systems, anemia still affects almost 20 percent of the population.

Changes in the supply and demand sides of food systems have also resulted in changes in consumers’ dietary patterns. Across all countries, some of these changes have resulted in better health outcomes, such as a more diversified diet; others have resulted in negative outcomes, such as increasing overweight and obesity. The concept of the nutrition transition explains much of the observed transformation, associating traditional food systems with higher prevalence of infectious diseases, wasting and stunting to higher vulnerability to famine due to dependence on locally produced foods. Mixed and modern food systems often come with urbanization and income growth and are accompanied by increased food demand, especially for animal-source foods [1]. Greater food demand results in lower undernutrition but increasing rates of overweight, obesity and non-communicable diseases, as people often start consuming more processed foods with higher calorie count and lower nutritional value [2].

The changes in the supply and demand sides of the food systems can be classified in five categories. Biophysical and environmental drivers refer to the natural resources available and are directly affected by climate change and natural disasters. Innovation, technology, and infrastructure drivers are key to overcome issues of resource scarcity, access, and diversity. Political and economic drivers involve trade, globalization, governance, and food security, as well as all other policies that affect the use of resources and nutritional outcomes. Socio-cultural drivers refer to cultural cues that shape food choices, with a constant interaction between culture and food systems. Population growth and changes in population composition constitute the demographic drivers, which are critical to consider when designing a sustainable food system.

Due to the complexity of food systems, there is no single solution to solve the burdens of malnutrition. Interventions should be planned after considering all components of the food system and the drivers in each particular situation. A food system can be affected in different stages of the food value chain (at the production, storage, or market level, for example) through interventions in the food environments (through information dissemination or facilitation of access) or through influencing consumer behavior (involving nutritional education, traditions, etc.). The report details a range of interventions, as well the evidence available for each concept.

Written by Florencia Paz.

[1] Timmer, C.P., Falcon, W.P. & Pearson S.R. 1983. Food policy analysis. Baltimore, USA, Johns Hopkins University Press; Peter, T.C. 1981. Food Prices and Food Policy Analysis in LDCs. Food Policy 30. Baltimore, Maryland: Johns Hopkins University Press; Gaiha, R., and Young, T. 1989. On the relationship between share of starchy staples, calories consumed and income in selected developing countries. Journal of International Development 1.3; pp 373-386; Tilman, D. & Clark, M. 2014. Global diets link environmental sustainability and human health, Nature, 515(7528): 518–522.

[2] Popkin, B. 2006b. Global nutrition dynamics: the world is shifting rapidly toward a diet linked with noncommunicable diseases. The American Journal of Clinical Nutrition, 84(2): 289–298.