• 6.5 % of the regional population suffers hunger, which is equivalent to 42.5 million people. 2018 marks the fourth consecutive year in which hunger has risen.
• Moderate or severe food insecurity in Latin America grew considerably: it increased from 26.2 % to 31.1 % between 2014-2016 and 2016-2018, a total of 187 million.
• Stunting in girls and boys under 5 years old decreased from 16.7 % to 9 % between 2000 and 2018; Child wasting affects 1.3% of the region's children under 5.
• Malnutrition due to excessive weight in the Region is one of the highest in the world and continues to increase.
• 4 million girls and boys in the Region are overweight. In adults, the prevalence of overweight and obesity increased from 49.6 % to 59.5 % between 1990 and 2016, a total of 262 million people.
• Obesity affects women more: 27.9 % versus 20.2 % for men. Of the 105 million adults living with obesity, 59 % (62 million) are women.
• It is estimated that around 600,000 adults died from causes associated with inadequate diets in 2017 in Latin America and the Caribbean.

• Latin America and the Caribbean has enough food to feed its entire population. The average number of calories available per capita per day is 3,000.
• Cereals, sugar and fats and oils are the three most consumed food groups in the regional diet. The proportion of energy from sugar (14.2%) exceeds the limit of 10% recommended by WHO.
• It is estimated that consumption of ultraprocessed food and beverages increased more than 25% between 2000 and 2013.
• Supermarkets and convenience stores have shown significant growth in the last two decades in the region, being the main channel for the sale of ultraprocessed products.
• Public food supply and marketing systems and school feeding programs have the potential to guarantee access to food for the population with the highest degree of vulnerability.

• In Latin America and the Caribbean there are signs of deterioration in the populations purchasing power in the last five years.
• The increase in extreme poverty since 2014 indicates that the population faces difficulties in accessing the basic food basket to cover their food needs.
• In countries with high income there is a lower contribution of cereals as a source of calories, as well as a greater contribution of meats and dairy products.
• Micronutrient-dense and healthy diets tend to have a higher calorie cost than diets with densely caloric, processed and less healthy foods.
• The price difference between healthy and unhealthy products has tended to increase: it is now easier for households to access food with relatively lower nutritional contributions and higher-calories.
• As the per-capita income increases, the problem of undernourishment tends to decrease, while the problems of overweight and obesity tend to increase.
• Taxes and subsidies that promote adequate food can be key fiscal policies to reduce the consumption of foods high in critical nutrients and to cope with overweight, obesity and non-communicable diseases.
• Social protection policies and programs improve food access of population groups with greater vulnerability, and have the potential to improve their nutrition.

• Children are especially vulnerable to the influence of advertising and the promotion of unhealthy foods: in the region, overweight affects 18 million children over 5 years and 32 million adolescents. Obesity rates in both childhood and adolescence tripled between 1990 and 2016.
• Food labeling with frontal nutritional warning systems in the region can inform consumers easily and quickly when products contain excessive amounts of sugar, fat and/or salt/sodium.
• Nutrition labeling and frontal nutrition warning labeling can contribute to a healthy food environment that empower consumers.
• Measures to regulate the advertising and marketing of food and beverages are key strategies to address the problem of childhood obesity and the development of noncommunicable diseases.

• The Region loses more than US $ 7 billion dollars annually in loss of human capital due to foodborne diseases.
• Lack of food safety or poor quality foods affects the poor especially, as they eat in informal markets, which increases their exposure to food contamination.
• Access to drinking water, surveillance and early warning systems for food and animal health and the improvement of infrastructure and environmental hygiene are key.
• It is essential to reformulate the food produced in the region to improve its nutritional properties, either through voluntary agreements with the different sectors of the food industry or through mandatory regulations.

The World Health Organization recognizes that the fundamental cause of overweight and obesity is the energy imbalance resulting from the calories consumed and the energy spent by the body.

In the Region, there has been a rapid increase in the consumption of ultraprocessed foods and fast food, which are densely caloric, high in fat and sugar. Physical inactivity has increased. The rapid increase in income, growing urbanization, improvements in infrastructure, liberalization of market regulation policies and the increase of rural non-agricultural employment, have transformed the region's food system and changed food consumption patterns. Given these changes, prepared food and out-of-home meals have become attractive alternatives. There is also a disproportionate and unequal amount of cultivated areas destined for the production of basic inputs for processed and ultraprocessed products (oils, flours, sugar) in contrast to the reduction of the areas dedicated to produce fruits, vegetables and legumes.

All subregions suffered increases in the prevalence of obesity, for all age groups. The increase is especially critical among adults in the Region. For example, in just one generation -from 1990 to 2016- obesity in the Caribbean went from 11 % to 25 %, in Mesoamerica from 14 % to 27 % and in South America from 12% to 23%.

Globally, the prevalence of obesity is higher in women than in men. The Region is no exception to this pattern. In fact, of the 105 million adults with obesity estimated to exist in Latin America and the Caribbean in 2016, 62 million were women and 43 million were men.

Obesity has presented an increase in all groups, with obesity in children between 5 and 9 years old being 15.4% (12 million) in 2016, while in adolescence the rate is 10.3% (11 million).

Finally, it is important to highlight that obesity is increasing in the rural areas of the Region. This trend is observable in middle and low-income countries. Therefore, malnutrition from food deficit in rural areas is today being accompanied by overweight and obesity.

Mesoamerica has the highest prevalence of obesity in adults (26 % in 2016), which means that 32 million people live with obesity in the subregion. South America concentrates the largest number of adults with obesity: 68 million people.

The fastest growth in obesity has occurred in the Caribbean. The prevalence of obesity in adults quadrupled between 1975 and 2016, from 6 % to 25 %, with significant increases in the last 15 years. This means that adults with obesity in that subregion increased from 760,000 to 6.6 million in said period.

Adult deaths in Latin America and the Caribbean due to causes associated with inadequate diets are estimated at almost 600,000 people a year. The most frequent food risk factors were low intakes of whole grains, nuts, seeds and vegetables, along with a high sodium consumption.

Globally, total deaths related to inadequate diets accounted for 22% of total adult deaths in 2017. Inadequate diets and poor nutrition explain 53% of deaths from cardiovascular diseases, 33% of deaths from diabetes and 10% of those deaths from various types of cancer. In the case of adult mortality rates attributable to eating habits, a similar behavior is observed.

At the subregional level, we know that the highest mortality rate due to inadequate diets was observed in the Caribbean: it is estimated that 240 adults per 100,000 die in that subregion due to this cause.

The evolution of hunger, overweight and obesity is closely linked to the transformation of food systems that, in turn, have changed the patterns of food consumption of the entire regional population. The transformation of these systems are mainly the result of the growth of average income, the improvement of infrastructure, urbanization, trade liberalization and the increase of rural non-agricultural employment.

From a long-term perspective, food availability has grown considerably in the Region, and the population suffering from hunger dropped from 62.6 million to 42.5 between 2000 and 2018, in spite of the recent uptick seen from 2014 onwards.

However, alongside the increase in food availability, the supply of foods with high caloric density and low nutrient content has also increased. This has given rise to a great increment in overweight and obesity in all age groups, especially in adults, school-age children (5 to 9 years old) and adolescents (10 to 19 years old).

From a short-term perspective, hunger increases are mainly due to the economic deterioration experienced by some countries in the Region. This is especially noticeable in the Bolivarian Republic of Venezuela, where the number of hungry people multiplied by more than two, from 2.9 million people in 2013-2015 to 6.8 million in 2016-2018.

There is no magic recipe, the causes of malnutrition are varied and some of them have their origin in the functioning of the food system. Therefore, it is necessary to understand how the processes that occur from production, distribution to food consumption are related to malnutrition. Food systems should promote forms of production and eating habits that favor healthy and sustainable diets from an economic, social and environmental point of view.

In that sense, the food environment is a propitious space for the design of these policies since it represents the physical, economic, political and socio-cultural context in which the interaction of individuals with the food system occurs. This environment determines the possibilities and decisions of people on how they acquire, prepare and consume food. In addition, to effectively address the growing problems of overweight and obesity, and to prevent them from perpetuating from one generation to another, a life-cycle approach is needed to promote access to nutritious food and optimal nutrition for infants, to improve healthy growth from the development of the fetus to adulthood.

The region has reacted to the rise in malnutrition through a series of public policies. Countries like Chile, Ecuador, Peru and Uruguay have implemented food labeling laws, which allow consumers to make better decisions when buying their food.

Meanwhile, Brazil, Chile, Costa Rica, Ecuador, Mexico, Peru, Panama and Uruguay have improved regulation on food advertising, and multiple countries are improving child nutrition with measures such as school feeding programs and have boosted healthier school environments. At least 13 countries in the region have adopted fiscal and social measures that seek to favor adequate food, while social protection programs, school feeding programs, public food supply and marketing systems and policies that promote food safety and quality are essential to improve nutrition.

All the countries of the Region face considerable problems in terms of prevalence of overweight. For example, the countries with the highest prevalence of overweight in adults - with rates above 60% - would be: Argentina, Bahamas, Chile, Costa Rica, Mexico, Dominican Republic, Uruguay and Venezuela (Bolivarian Republic of). Meanwhile, the countries with the lowest rates, which are in a range between 45% and 50% are observed in: Antigua and Barbuda, Guyana, Saint Lucia and Trinidad and Tobago. In all cases, we are talking about very high levels of overweight prevalence if we consider that the global rate of overweight for adults is 39%.

The undernourished population in the Region fell from 62.6 million to 42.5 million between 2000 and 2018. That is a 32% decrease in the number of hungry people. The reduction in the number of undernourished people is attributable above all to the progress achieved in South America. This subregion reduced its undernourished population by almost 19 million people. It went from 42.6 million people in 2000 to 23.7 million people in 2018. In contrast, the other two subregions report moderate changes in these figures. In the Caribbean, hunger went from affecting 8.9 million people to 7.8 million respectively, and in Mesoamerica, the undernourished population was reduced by about 200,000 people, but remained at 11 million for almost the entire period.

The countries of Latin America and the Caribbean have promoted different public policies and legal frameworks to favor healthier food environments. Since food environments are the fundamental spaces in which consumers face options to choose certain types of food or others, they represent a window of opportunity for States to develop public policies that protect and promote adequate food. These policies can increase physical and economical access to nutritious food, improving access and use of information and developing skills for citizens to exercise their right to healthy eating.

It is precisely in food environments where discussion and implementation of new policies and regulatory frameworks to address malnutrition, especially related to overweight and obesity, have proliferated in recent years. Public food supply and marketing systems, school feeding programs and nutritional standards for food supply in schools are some of the policy options that States have implemented. Through these, the availability and physical access to adequate food is improved, promoting food safety and maintenance of proper food consumption patterns.

Likewise, taxes and subsidies on food consumption are mechanisms that have been implemented to influence consumer behavior at the time of purchase and to reorient the food system, thus promoting healthier eating habits. For example, social protection systems make it possible to improve people's access to food in crisis situations or during periods of income shortage. In addition, they have the potential to improve the nutrition of populations with higher degrees of vulnerability if a nutrition-sensitive approach is included in their design.

Governments have also begun to regulate food and beverage advertising practices by recognizing that these practices have effects on the consumption of foods that contain high levels of as fats, sugar and salt. This regulation has been one of the most important and high-impact strategies to address the problem of childhood obesity and the development of non communicable diseases. In addition, through nutritional labeling and frontal nutrition warning labels, it is possible to contribute to promoting a healthy food environment by delivering understandable information to citizens about their food's content, allowing them to make informed decisions that help protect health; these laws can also motivate manufacturers to produce foods that contain healthier nutritional profiles. Meanwhile, the policies associated with promoting food safety seek to reduce harmful effects on the health of the consumer due to contaminated food. Regulatory measures or voluntary guidelines aimed at improving food composition improve the nutritional quality of food in the food environment.

The countries of the Region have made considerable progress in reducing child malnutrition. Today, the prevalence of wasting and stunted growth of girls and boys under 5 are below the global averages and follow a downward trend. If this continues, the countries of the Region are expected to achieve the goals of the SDGs in reducing child malnutrition. In addition, despite recent deterioration in the prospects for hunger reduction and food insecurity, both indicators are below the global rates/prevalence.

The challenge of LAC will be to continue reducing hunger, food insecurity and malnutrition while stopping and reversing the growth of overweight and obesity in all age groups.

The food systems have undergone several changes, with a greater presence of ultraprocessed products being one of the main ones. Likewise, it has been possible to observe a greater intensification of production and increased productivity, and greater technological innovation in the food industry that has contributed to a greater degree of processing for food, improvements in infrastructure and marketing channels, and the expansion of supermarket chains and fast food stores. These changes have facilitated the supply of food products and beverages at lower relative prices, but that are often high in sugars, fats and salt, contributing to the epidemic of overweight and obesity and non communicable diseases.

In addition, urban and some rural areas of the Region are undergoing rapid transformation. Income growth, infrastructure improvement, urbanization, trade liberalization and the increase of rural non-agricultural employment are the main drivers of this transformation, which is affecting the food system and food consumption patterns in Latin America and the Caribbean. As societies become more urbanized, there is greater consumption of ultraprocessed foods and fast food; disposable income, travel times and the proportion of employment among women increase, and prepared and out-of-home meals become attractive alternatives.

The price difference between healthy and not-so-healthy products has tended to increase as processed and calorie-dense products have decreased their prices and that of healthy foods has increased. This has widened inequalities, with healthy diets becoming less affordable.

Citizens should inform themselves and take advantage of the means at their disposal to know their duties and rights and demand that their food environments promote healthy diets and nutritious food. The public sector must develop public policies that protect and promote adequate food by expanding physical and economic access to nutritious foods, improving access and use of information and developing skills for citizens to exercise their right to healthy food. In addition, food environments must be regulated and gave greater oversight. The private sector has made progress in terms of product reformulation and innovation with the aim of offering food options that help people eat a more nutritious and balanced diet. However, it is necessary to consider the political economy of each country since, in practice, not all food industries have the capacity or willingness to promote nutritious food, and these industries are important actors in food environments.

If the current trend is maintained, it is estimated that the prevalence of obesity in adults would reach 30% by 2030. In the same vein, the prevalence of overweight in adults (which includes people with obesity) would rise from the current 60% to 70% in 2030

Regarding child malnutrition, in the Region the prevalence of wasting and stunting of girls and boys under 5 are below the global average and follow a downward trend-

On the contrary, overweight in children under 5 years is increasing and went from 6.2% to 7.5% between 1990 and 2018. Likewise, overweight in children, girls over 5 years and adolescents has doubled since 1990, in the case of children (between 5 and 9 years old), obesity went from 17.5% to 33.7% between 1990 and 2016 and in adolescents (from 10 to 19 years old) it went from 15, 5% to 29.1% between 1990 and 2016. The above is related to the fact that, at present, children and adolescents frequently grow up in obesogenic environments that promote weight gain, overweight and obesity.

This is the result of various processes that occur due to changes in food patterns, in the types of food consumed and their availability, social values ​​and cultural norms, more sedentary activities and less physical activity, among others. In addition, the availability of food in the environment, advertising and education exert pressure on certain food patterns, positive or negative. Children are exposed to a large volume of advertising of food products that do not promote adequate food, through techniques specially designed to persuade them. Given that children and adolescents spend an important part of their lives in school spaces, and that food preferences develop at an early age and tend to persist throughout life, implementing policies that promote the incorporation of healthy habits into school environments is essential.

In Latin America and the Caribbean, various measures have been implemented to improve school feeding environments, either through mandatory or voluntary mechanisms. Countries such as Brazil, Chile, Costa Rica, Ecuador, Jamaica, Mexico, Peru, Trinidad and Tobago, and Uruguay have mandatory standards for food available in schools, including restrictions on food products that do not promote adequate food. In addition, Chile, Costa Rica, Ecuador, Jamaica, Trinidad and Tobago and Uruguay have mandatory regulations for advertising and / or marketing of food in schools and Bolivia (Plurinational State of), Brazil, Colombia, Costa Rica, El Salvador, Grenada, Mexico, Paraguay and Peru established guidelines and / or standards of nutrition in school feeding. There are several opportunities for local governments (municipal, state, provincial) to also adopt legislation and actions to protect and promote the appropriate school food environment. Depending on national legal norms, states and municipalities may restrict the marketing and advertising of unhealthy foods not only within schools but also in the surrounding area. They can also intensify the inclusion of these issues in the school curriculum to promote autonomy and critical thinking in students.