The Double Food and Environmental Pyramid 125

SIGHT AND LIFE | VOL. 32(2) | 2018 THE DOUBLE FOOD AND ENVIRONMENTAL PYRAMID 125

The Double Food and Environmental Pyramid Addressing the double burden of malnutrition and achieving the SDGs

Marta Antonelli and Katarzyna Dembska BCFN Foundation, Parma, Italy

Key messages

> The number of undernourished people in the world has risen to 821 million people, 2 billion people lack key micronutrients and 2 billion people are overweight or obese and at risk of diseases related to overconsumption.

> The agricultural sector accounts for one-third of greenhouse gas (GHG) emissions, for the largest share of freshwater withdrawals (70% on average) and for 90% of the water footprint of humanity, as well as 12% of land use.

> The food system is where the spheres of health and the environment intersect. The Double Pyramid shows that the foods with the lowest environmental impact are the same as those that are recommended for increased consumption.

> The link between nutrition and the environment is bidirectional. Eating patterns impact the environment, but the Besides being nutritionally healthy, the Mediterranean Diet environment can also impact dietary choices. has been highlighted as rich in biodiversity

> Food fundamentally connects people and the planet. Not 2050 and nearly 100% in low-income countries to meet growing only will the SDGs not be achieved if malnutrition persists, demands.1 At present, food production is falling short of meet- but the SDGs are also fundamental for reversing the current ing nutritional requirements and guaranteeing long-term health route of food systems, as they offer a vision of a sustainable, for almost one-third of people worldwide. equitable and prosperous world where silos are broken The 17 Sustainable Development Goals (SDGs), adopted by and societal goals are pursued simultaneously. the representatives of the 193 member states of the United Na- tions, guide the actions of various stakeholders to guarantee Introduction: challenges of the global food system long-term prosperity for people and the planet. They have food Global food systems currently face the unprecedented challenge systems at their very core. From ending poverty and hunger to of feeding a growing and increasingly urbanized population, guaranteeing health and well-being, to responding to climate with global food production expected to increase by 70% by change and preserving life on land and under water, to more 126 THE DOUBLE FOOD AND ENVIRONMENTAL PYRAMID

figure 1: The Double Food and Environmental Pyramid

ENvIRONMENTal PYRaMID

LOW HIGH Sweets Beef Beef

Fish Cheese Cheese Eggs Poultry Fish Pork Cookies Olive Oil Poultry

Dried Fruit Legumes Eggs Milk Yogurt

Sweets ENvIRONMENTalYogurt IMPaCT Olive Oil RECOMMENDED CONSUMPTION Pasta Dried Fruit Cookies Rice Bread, Pasta, Milk Potatoes, Rice Bread Legumes

Potatoes Fruit Fruit Vegetables Vegetables

HIGH LOW

Source: Barilla Center for Food & Nutrition Foundation, 2015

responsible production and consumption patterns, food and excess of food intake, with 2 billion people who are overweight sustainable diets lie at the heart of the 2030 Agenda. However, or obese and at risk of diseases related to overconsumption. we are far from achieving these global targets. On a global scale, obesity has nearly tripled since 1975, while there has been a more than tenfold increase in the number of “Food and sustainable obese children and adolescents aged 5–19 years in the past four decades.3,4 diets lie at the heart of the 2030 Agenda.” “The agricultural sector is in the spotlight, with an In 2017, the number of undernourished people rose to 821 urgent need for change” million people, up from 804 million in 2016.2 Globally, 151 million children under the age of five are stunted, too short for their age, and 51 million children under the age of five are wast- Against this background, the agricultural sector is in the ed, too light for their height.4 At the same time, 2 billion peo- spotlight, with an urgent need for change and calls for global ple lack key micronutrients3 with iron, iodine, folate, vitamin A action. Faced with the challenge of providing adequate and nu- and zinc deficiencies being the most widespread micronutrient tritious food for the world population, the sector accounts for deficiencies (MNDs).5 A lack of these essential vitamins and one-third of greenhouse gas (GHG) emissions. Agricultural pro- minerals often results in ‘hidden hunger,’ where the signs of duction is also intensive from a water and land point of view. It undernutrition and hunger are less visible.6 Low- and mid- accounts for the largest share of freshwater withdrawals (70% dle-income countries have the highest burden of MNDs; how- on average)7 and an astonishing 90% of the water footprint of ever, underestimated MNDs pose health risks in high-income humanity,8 as well as 12% of land use.1 The agricultural sector, economy settings as well.5 The other side of the coin is the together with forestry and other land users, is responsible for SIGHT AND LIFE | VOL. 32(2) | 2018 THE DOUBLE FOOD AND ENVIRONMENTAL PYRAMID 127

about a quarter of human-made GHG emissions due to defor- ly consumption of fish and dairy products and white meat and estation and agricultural emissions from livestock, soil and nu- a low, occasional consumption of red meat and foods high in trient management.9 The composition of diets determines the sugar content. The environmental (inverted) pyramid has been environmental impact of food. Global average dietary GHG emis- built in relation to the environmental impact of food, in terms of sions from crop and livestock production will increase by 32% ecological footprint, listing the items that have a higher impact between 2009 and 2050, on a per capita level, if global dietary at the top and those with a lower impact at the bottom. The eco- patterns continue in line with current trends.10 logical footprint measures the assets that are required to pro- Importantly, over the last 30 to 40 years, energy-dense foods duce the natural resources that a given population or individual have become cheaper, more affordable and more available, com- consumes (e.g., plant-based food, livestock and fish products) as pared to fruits and vegetables. Energy-dense food cheapness has well as to absorb its waste.15 proved to be problematic and has become linked to both food The DP clearly shows that the foods with the lowest envi- waste and overconsumption.11,12 ronmental impact are the same as those that nutritionists rec- ommend for greater consumption, while those with a higher Sustainable and healthy diets: the Double Pyramid environmental footprint are those that should be consumed in The food system is where the spheres of health and the environ- moderation.14 Food behavior change has been recognized as sig- ment intersect. The need to address environmental and nutri- nificant for improving the status of the environment16 together tional issues has led to a growing interest in identifying strate- with improving public health. gies aimed at promoting healthy and sustainable diets, defined as “diets with low environmental impacts which contribute to Pathways towards better food systems food and nutrition security and to healthy life for present and As previously stated, the link between nutrition and the environ- future generations”13 and which optimize food quality, health, ment is bidirectional. Eating patterns impact the environment, environment, sociocultural values, economy and governance.11 but the environment can also impact dietary choices. Besides The Food and Environmental Double Pyramid (DP) devel- the above-mentioned effects on human health and the envi- oped by the Barilla Center for Food & Nutrition (Figure 1) pro- ronment, sustainable diets can be considered a precondition vides a tool for informing and educating citizens on how to eat for long-term food security.17 The environment, and especially in a healthy and sustainable way. Food items are arranged ac- climate and the presence of natural resources, are a precondi- cording to their contribution to a healthy diet (left pyramid) and tion for the availability of food as well as the preservation of their environmental impact (right pyramid). The food section of biodiversity.18 the DP was derived by pooling different international nutritional guidelines that can be traced back to the model known as “One of the basic principles the Mediterranean Diet, explicitly cited by FAO as an exemplary sustainable diet12 and internationally recognized as a compass of nutrition is dietary diversity” for a healthy diet, regardless of how the model is interpreted, according to different geographic locations, cultures and tradi- tions.14 It is widely upheld that high adherence to the Mediterra- nean Diet can lead to tangible health benefits, including reduced incidence of cardiovascular diseases, metabolic conditions and certain types of cancer.

“The nutritional pyramid encourages a high daily consumption of fruits and vegetables, legumes, nuts, extra virgin olive oil and cereals”

The nutritional pyramid encourages a high daily consump- Nuts and spices can add variety and interest tion of fruits and vegetables, legumes, nuts, extra virgin olive oil to a diet low in meat and cereals (50% of which are wholegrain), a moderate, week- 128 THE DOUBLE FOOD AND ENVIRONMENTAL PYRAMID

Some of the key flavors in the Mediterranean Diet. It is widely upheld that high adherence to the Mediterranean Diet can lead to tangible health benefits.

Besides being nutritionally healthy, the Mediterranean Diet has studies have suggested that demand-side approaches may be been highlighted as rich in biodiversity.6 The preservation of more effective than technical agricultural mitigation options biodiversity can play a significant role as a strategy for foster- in reducing global emissions.24 Some authors have suggested ing sustainable agricultural development and food security, as that only with a significant reduction in demand will it be pos- well as protecting against malnutrition.19 The recognition of the sible to prevent an increase in agricultural expansion and ag- value of biodiversity for improved nutrition is one component riculture-related GHG emissions.25 It has been suggested that of the shifting paradigm in approaches to malnutrition. From a the reduction of meat consumption could be achieved through nutritional standpoint, biodiversity is intended as a variety of the application of economic incentives (e.g., a carbon tax), and food and nutrients with a focus on wild and gathered species, the livestock sector should be included into a comprehensive and underutilized and underexploited food resources, leading climate mitigation policy.26 For instance, Mexico introduced in to one of the basic principles of nutrition: dietary diversity.19 2014 a sugar-sweetened beverages tax of 1 peso per liter as a Past efforts to address micronutrient deficiencies have response to the alarming overweight and obesity trends (affect- largely been based on a medical model, focused on dietary for- ing 70% of total population), with the largest decreases in pur- tification and supplementation, or on increasing the micronu- chases of soft drinks in the poorest households.27 These inter- trient content of staple crops (biofortification). While all these ventions need to be coupled with policy instruments focused on approaches have their merits, agricultural biodiversity has the increasing awareness through education on healthier food and potential to provide a valuable complement. It has been rec- lifestyle choices, particularly for children, to effectively achieve ognized that increasing the availability and consumption of a an improvement in public health. Moreover, the externalities of variety of micronutrient-rich foods will not only have a positive agri-food systems should also be unraveled and accounted for in effect on micronutrient status but also contribute to improved order to understand the true (and huge) hidden cost of food.28 nutrition in general.20 This approach goes beyond the use of spe- These mitigation options may be especially relevant to high-in- cific food components, looking into including greater diversity come countries, and they require sound commitment at the pol- of nutrient-dense foods. A food-based approach can effectively icy level. In low- and middle-income countries, the challenge is deliver improved nutrition, with micronutrients and other im- to overcome food insecurity and malnutrition by ensuring equi- portant components, such as fiber,21 in the context of different table access to a sustainable and nutritious diet. forms of malnutrition. Despite the evidence backing the health and environmen- “The SDGs are key to reversing the tal benefits of the Mediterranean Diet, the nutrition transition is increasingly common as more countries shift towards more current direction of food systems” Western-style diets involving increased consumption of meat, sugar, fats, and processed foods and beverages.22,23 At the same Not only will the SDGs not be realized if malnutrition persists, time, the scarcity of resources, compounded by the effects of but the SDGs themselves are key to reversing the current direc- climate change, lends urgency to the call for new, innovative, tion of food systems. Guaranteeing nutritious, safe, and sus- and sustainable practices at the agricultural level. A number of tainable food can result in collaborative work in the sectors of SIGHT AND LIFE | VOL. 32(2) | 2018 THE DOUBLE FOOD AND ENVIRONMENTAL PYRAMID 129

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