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