Overfed and undernourished — the global issue of obesity and malnutrition
How does globalisation have an effect on what we eat? Dr Seferidi explains how international locations transition away from conventional diets to consuming extra ultra-processed meals, and the way meals preferences and behaviours could be influenced by promoting, TV and social media. Credit score: Shutterstock

A shift in world diets is seeing individuals swap to meals excessive in energy, however low in dietary worth, with unfavorable impacts on well being.

Historically, world well being has centered on two distinct points in vitamin, with seemingly little overlap: overnutrition, which incorporates being chubby or overweight; or undernutrition, which incorporates being underweight or having nutrient deficiencies.

Nevertheless, each circumstances are more and more being seen in the identical inhabitants, family and even in people, with researchers coining the time period ‘double burden of malnutrition’ (DBM). The problem is about to turn out to be extra problematic as poorer international locations develop, and a larger consumption of ultra-processed meals displaces conventional regional diets.

Ryan O’Hare spoke to Dr. Paraskevi Seferidi, from Imperial’s College of Public Well being, who’s a part of a staff this double hit of malnutrition.

Their newest research, printed this month, is the primary world evaluation of inequalities of DBM, and hints on the advanced impacts that globalization is having on individuals in low- and middle-income international locations.

Q: What did your research have a look at and what does it inform us about DBM?

Paraskevi Seferidi: We particularly checked out household-level DBM. That is when, throughout the similar family, a baby is stunted—that means they’ve a delay of their progress and are shorter than the typical for his or her age—however their mom is chubby, so that they have overnutrition. That is the most typical type of DBM which we will discover all around the world, however there are different varieties as effectively.

Our focus was on how family DBM varies throughout completely different socioeconomic teams inside a rustic and the way the earnings of the nation can affect this. As well as, we checked out how this double burden could be related to various kinds of globalization—issues like commerce and funding insurance policies, world connectivity and the way open a rustic is to exterior social affect.

We gathered printed well being information for greater than 1.1 million kids and their moms in 55 low- and middle-income international locations all over the world.

What we discovered was that there’s inequality in how DBM is distributed inside a rustic, and that this inequality is related to the nation’s wealth. Within the poorest international locations we discovered that DBM was extra more likely to exist in richer households, however within the richer international locations, DBM was extra frequent in poorer households. What we’re seeing is that as international locations turn out to be wealthier, there’s a shift on this inequality, from the richest to the poorest households.

Q: We have a tendency to think about globalization by way of finance and economics, however how does it have an effect on vitamin and what individuals eat?

PS: It’s a sophisticated image as a result of globalization can have an effect on completely different points of a rustic to various extents—resembling commerce and financial components, social connectivity, and consequently individuals’s diets.

Credit score: Imperial School London

For instance, globalization can affect the meals system instantly, with financial components resembling liberal commerce, funding and monetary coverage figuring out which meals can be found and the way a lot they value. However social points of globalization also can affect individuals’s behaviors or attitudes in the direction of meals. For instance, as a rustic turns into extra globally related individuals’s meals preferences could be influenced via promoting, however individuals may also be uncovered to completely different meals behaviors via the web, social media, even TV and movies.

Q: So what does your research add to the image, is it that globalization is the overriding issue?

PS:I believe the brand new ingredient right here is that after we have a look at the DBM and the way it’s related to globalization, we keep in mind each family and nation stage wealth.

Till now, research of DBM have not performed this, and the outcomes have been conflicting. For instance, in some international locations, research have discovered that the DBM is extra more likely to happen among the many wealthiest individuals, whereas in different international locations it happens among the many most disadvantaged. Additionally, some research discover associations with globalization, whereas others do not.

What we now have proven is that it’s context particular. So the existence of this double burden is related to each family wealth and the nation’s stage of wealth. Equally, globalization may have an effect on the DBM in another way throughout completely different teams of individuals, relying on their very own financial standing but additionally the financial standing of the nation they stay in.

Q: Do we all know what’s driving the underlying dietary adjustments in these international locations—is it that processed meals have gotten cheaper and extra available? Or is there one more reason?

PS:We’ve not examined that but, however we do have some hypotheses we’re exploring.

Firstly, by way of financial globalization, we could also be seeing the affect of multinational companies getting into into the markets of low- and middle-income international locations and introducing new ultra-processed meals. These markets are notably enticing to companies as they’re nonetheless not as saturated by these merchandise as larger earnings international locations, the place they’re much extra established.

When these meals are launched, they’re usually accompanied by aggressive advertising and promoting. However these international locations nonetheless have a legacy of undernutrition. As the amount of meals is elevated however the dietary high quality is decreased, we see the emergence of each of these kinds of malnutrition.

By way of social globalization, it’s seemingly that it is extra due to adjustments in individuals’s perceptions, in the direction of extra of a westernized, commercialized method to meals and away from conventional diets.

Then there are issues resembling mass media publicity to toddler milk formulation, and different limitations to breastfeeding, that are more likely to affect the DBM.

Overfed and undernourished — the global issue of obesity and malnutrition
Latin America has seen the affect of financial globalisation on meals, with multinational companies increasing into new markets and introducing ultra-processed meals merchandise, resembling this fashionable powdered milk product in Brazil. Credit score: Shutterstock

Q: So are individuals shifting away from conventional, maybe more healthy diets as their nation turns into wealthier?

PS: There’s a phenomenon known as the ‘vitamin transition’ by which we now have international locations which might be primarily primarily based on conventional diets after which they transition in the direction of westernized diets.

Nations in Latin America are an amazing instance of this as a result of they’re at this stage the place we now have seen the introduction of huge companies, and we will clearly see this transition—in Brazil, for instance, we now have seen a shift in consuming behaviors in the direction of extra ultra-processed meals and will increase in related dietary outcomes, like weight problems and diets low in vitamins. Different decrease earnings international locations, have not but seen this to the identical extent so there should be time to forestall this, via regulation, for instance.

It is taking place elsewhere and if we proceed on the similar charge, it is seemingly what we’re seeing in Latin America can occur in different international locations as effectively.

Q: How can international locations counter these results and scale back this double hit of malnutrition?

PS: First, I do not assume DBM is a widely known downside. The World Well being Group recommends insurance policies that handle each overnutrition and undernutrition on the similar time (termed double-duty insurance policies), however so far as I do know, there are not any such insurance policies broadly carried out in the intervening time.

Though there may be some dialogue throughout the analysis group, sadly, vitamin and public well being are sometimes not a part of discussions in relation to commerce and funding coverage. So I believe recognizing that extra liberal world commerce insurance policies can affect public well being and vitamin could be an essential first step.

Additionally, regulating company actions—particularly the liberty multinational companies have once they begin promoting and advertising merchandise in a brand new market—may shield the meals surroundings and vitamin in low- and middle-income international locations.

Basically, we should always not see malnutrition as two separate issues, however we should always goal them collectively as one. However one other essential factor I believe is to acknowledge that the issue is context particular. We discovered these associations are completely different throughout family wealth and nation wealth, so we’d like context-specific insurance policies that contemplate the wants and priorities of the communities they aim.

Q: So what is the subsequent step for the analysis?

PS: We’re working rather a lot on the sample of malnutrition. We now have a big concentrate on Peru, however we additionally have a look at world stage associations. What we wish to perceive to begin with is how different high stage components, resembling meals and transportation techniques or environmental drivers, may affect DBM.

Past this, we additionally wish to consider the double burden of malnutrition as a part of a fancy system. If we will acknowledge how overnutrition and undernutrition work together with one another over time, we could possibly construct a clearer image of what is going on on, and in the end, we could possibly assist cease it from taking place.

“World inequalities within the double burden of malnutrition and associations with globalization: a multilevel evaluation of Demographic and Wholesome Surveys from 55 low-income and middle-income international locations, 1992–2018,” by Paraskevi Seferidi et al., is printed in The Lancet World Well being.

Diet in adolescence: A number of challenges, lifelong penalties and the inspiration for grownup well being

Extra info:
Paraskevi Seferidi et al, World inequalities within the double burden of malnutrition and associations with globalisation: a multilevel evaluation of Demographic and Wholesome Surveys from 55 low-income and middle-income international locations, 1992–2018, The Lancet World Well being (2022). DOI: 10.1016/S2214-109X(21)00594-5

Overfed and undernourished: The worldwide challenge of weight problems and malnutrition (2022, February 17)
retrieved 17 February 2022
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