The Nutrition Transition and Global Food System Dynamics: The Accelerating Speed of Change and Global Challenges We Face for Creating a Healthier Global Diet Barry Popkin W. R. Kenan, Jr. Distinguished University Professor Department of Nutrition Gilling's School of Global Public Health School of Medicine Department of Economics The University of North Carolina at Chapel Hill THE W RLD IS FAT Outline: Why Do We Need Large-Scale Changes to Improve Our Diets? • Introduction: the nutrition transition and major mismatches: modern technology vs. inherited biological preferences • Physical activity: a major concern but not the solution • The modern food system and how it has shaped our diet • Major dietary shifts of the past 2-3 decades • Regulatory and tax options: global lessons from Chile and Mexico • Chile may be the first country to reverse obesity and all the diet and obesity-related NCDs, but there are key gaps to fill. Role of Our History Mismatch: Biology which has evolved over the millennia clashes with modern technology Core biochemical and Biology Evolved Over Modern Technology has taken physiologic processes 100,000 Years advantage of this biology have been preserved Sweet preferences Cheap caloric sweeteners, food from those who processing create habituation to appeared in Africa sweetness between 100,000 and Thirst, hunger/satiety Caloric beverage revolution, sweetening 50,000 years ago. mechanisms not linked of beverages consumed Fatty food preference Edible oil revolution — high yield oilseeds, cheap removal of oils, modern processed food/restaurant sector Desire to eliminate Technology in all phases of work and exertion movement reduce energy expenditure, enhance sedentarianism Stages of the Nutrition Transition Urbanization, economic growth, technological changes for work, leisure, & food processing, mass media growth Pattern 1 Pattern 2 Pattern 3 Pattern 4 Pattern 5 Collecting Food Famine Receding Famine Chronic Disease (NCD’s) Behavioral Change • Diverse wild plants • Monoculture ag. • Starchy, low • Increased fat, sugar, • Reduced refined carbs, sugar & animal food diet • Cereals variety, low fat, processed foods diet • Unhealthy fats↓, increased high fiber diet • Drink water dominate diet • Drink sugary fruit, veg, whole grains, • Labor-intensive • Drink water • Drink water beverages, juices legumes • Shift in technology • Labor-intensive • Labor-intensive • Drink water, low kcal bev. work/leisure of work and leisure • Sedentarianism high • Replace sedentarianism with purposeful increases in activity Lean & Nutritional MCH deficiencies, Obesity & NR-NCD Reduced body fatness robust, tall, deficiencies weaning disease, emerge, and medical & NR-NCD’s, improved high disease emerge, stature stunting cures keep us alive disease prevention rate declines Low fertility, High fertility, high Slow mortality Accelerated life expectancy, Extended healthy aging, low life expectancy MCH mortality, decline shift to increased NR-NCD, reduced NR-NCD low life expectancy increased % disability years Source: © (copyright) Barry M. Popkin, 2015 The Struggle Over the Millennia to Eliminate Arduous Effort Could Not Foresee Modern Technology US Adults MET-hours/Week of All Physical Activity, and Hours/Week of Time in Sedentary Behavior: Measured for 1965-2009 and Forecasted for 2010-2030 250 45 1965: 235 MET-hr/wk 40 200 2009: 160 35 MET-hr/wk by 2020: 142 30 MET-hr/wk 150 by 2030: 126 MET-hr/wk 25 hours per week per hours - 20 100 15 Active Leisure PA Average MET Average 10 50 Travel PA Domestic PA Occupational PA 5 Average hours per week being sedentary being week per hours Average Sedentary Time (hrs/wk) 0 0 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020 2025 2030 Year Source: Ng S.W. & Popkin B.M. Time use and physical activity: A shift away from movement across the globe. Obesity Reviews 13 (8):659-80 Chinese Adults Met-hours/Week of Physical Activity & Hours/Week of Time in Sedentary Behavior: Measured for 1991-2009 and Forecasted for 2010-2030 450 30 1991: 399 MET-hr/week 400 25 350 20 300 hours per week per hours 15 - 2009: 213 MET- 250 hr/week by 2020: 200 by 2030: 188 MET-hr/week MET-hr/week 10 200 Active Leisure PA Average MET Average Travel PA 5 150 Domestic PA Average hours per week bring sedentary bring week per hours Average Occupational PA Sedentary Time (hrs/week) 100 0 1991 1994 1997 2000 2003 2006 2009 2012 2015 2018 2021 2024 2027 2030 Year Source: Ng S.W. & Popkin B.M. Time use and physical activity: A shift away from movement across the globe Obesity Reviews 13 (8):659-80 Global TV Viewing Time of Adults India China Brazil UK US 60 50 40 30 20 Sedentary Time (hrs/wk) Time Sedentary 10 0 1961 1966 1971 1976 1981 1986 1991 1996 2001 2006 2011 2016 2021 2026 2030 Source: Ng S.W. & Popkin B.M. Time use and physical activity: A shift away from movement across the globe Obesity Reviews 13 (8):659-80 Physical Activity: A Major Cause, Not a Solution • Our work in China and elsewhere has convinced me that a major component of global obesity increase is linked with reduced physical activity at work, home, and transport along with increased sedentarianism • At the same time we cannot turn back the clock on technology at work, home, transportation, leisure • Thus the need is to create new activity—marginal gains at work and home, but major increased activity must come from purposeful recreational movement, energy expenditure. Very hard to offset modern diets’ effects. Diet: Major Conflict among Diet People • Most dietary guidelines focus on increased produce, whole grains, minimal red meat, healthy fats, more plant food. • Michael Pollan: “Eat food. Not too much. Mostly plants.” • Monteiro, PAHO guidelines, others pushing the same, possibly could interpret PREDIMED results similarly as a push for minimally or unprocessed food-based diet • The reality: the enormous rapid shift in our food system discussed next runs completely counter to these pushes. • Unanswered question: Can we have any type of highly processed foods as part of a healthy diet? Or does such a diet with excessive highly processed food even exist? • All this is being played out in nutrient profiling and FOP policies will note later but seeing negative and positive logos as separate but joint efforts emerging finally to address both sides of this issue— remove junk food, promote truly healthy food. What is driving our increased obesity globally • The modern agricultural and entire food system has changed remarkably not only in the US and higher income countries but globally. • Every village, location in the world now faces many of the same packaged and processed junk foods and beverages Stages of Modern Global Agricultural and Food System’s Development Scientific and technological change, economic change, urbanization, globalization Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 1800’s mainly 1900-1944 Post WWII massive investments Systematically Commercial sector shifts Healthier food scientific underpinnings modern system transmitted globally major drivers of system supply (1955-2008) change (present) Create the modern Retailers, agricultural Price incentives, taxation, Farm research, Expansion food system focused input & processing, other regulatory controls Science and extension systems, technologies; on staples, animal businesses, and food (e.g. marketing healthy institution building and education mirror food only) and system source foods, and manufacturers science those of the West investments cash crops dominate farm-level decision-making Fossil energy, Extensive funding for Food industry Investment training, modern genetics, Expansion of major infrastructure, institutions, infrastructure, farm links drive Investments in fertilizer, beginning science; develop systems, input and CGIARC (Consortium production and infrastructure agricultural science reaper; many enhanced seeds, marketing Global International and training and experimental other technologies and major technology Agricultural Research) decisions, work, & land development incentives and grant/agricultural economic universities drivers change Farming systems High income countries see Reduced Green revolution, rapid mechanization; noncommunicable developed; irrigation, credit, farm Farming remains Production linked to diseases, reduced underpinnings post development of new food extension, and the major source of the needs of food climate footprint, WWII revolution processing technologies (e.g. agricultural institutions manufacturers and achieve total the food supply; extraction of edible mirror those of the added modernization retailers, ignoring industrial/large- oils from oilseeds); and west; modernizing of sustainability, fewer of agricultural climate, sustainability, scale monoculture investment in transportation/ food processing animal source foods production inputs and health concerns initiated irrigation/electrification/ consumed and machinery modernization of agriculture Source: © (copyright) Barry M. Popkin, 2015 See Anand,Hawkes et al, J Am College Card (2015) 66; Popkin (2017) Nutr Reviews Major Food System Changes Occurred Different Times, Similar Now Four big players drive food • Global agribusinesses and agricultural systems in • Retailers LMICs and the US: • Food manufacturers (agricultural economists have documented) • Large restaurant chains • Trend in disappearing fresh markets being replaced by small stalls, convenience stores and supermarkets all selling ultra-processed foods and beverages • Mexico and China: packaged foods with bar codes based on nationally