Former Director-General  José Graziano da Silva
An opinion article by FAO-Director General José Graziano da Silva
How to create equitable healthy food systems

The modern industrial food system that now determines food supplies and dietary patterns throughout the world is broken. This is my conclusion after seven and a half years as director-general of the Food and Agriculture Organization of the United Nations (FAO).

The system is driving what have become global epidemics of obesity, diabetes and other chronic diseases, with their devastating effects on human health and life. With all its technical advances, the system has also failed substantially to reduce the overall global burden of dietary deficiencies. Well over 820 million people still suffer from hunger. It is also contributing to the depletion of natural resources, and to the immiseration of rural populations in lower income countries, including the hundreds of millions of family farmers who supply most of the food consumed in the world.

But these crises do not only impoverish populations within low-income countries. Obesity and all other forms of malnutrition and their consequences are rampant in almost all both developing and developed countries.

FAO willbe publishing a review on Ultra-processed Foods, Diet Quality and Human Health. This sets out the results of population studies initiated in Brazil, a very large country where since the 198os rates of obesity have risen rapidly. This work has been done at the University of São Paulo by a team at its School of Public Health headed by Professor Carlos Monteiro. The findings of this team are now supported by over 80 published studies undertaken in the USA, Canada, Mexico, the UK, France, Belgium, Spain, Sweden, Norway, Chile, Colombia, Australia, New Zealand, Japan, Taiwan, and Lebanon whose results are consistent, significant, graded and plausible, and have been recently backed by the findings of a randomised controlled trial conducted by the prestigious US National Institutes of Health.

What all this research shows, as set out in the report, is that with nutrition and public health in this era, what matters most is what is done to food after it is separated from nature and before it is prepared and consumed: specifically meaning the nature, extent and purpose of food processing.

The studies show that the displacement of unprocessed or minimally processed foods and freshly prepared meals by ready-to-eat or heat ultra-processed food products leads to profound deterioration of diet quality and to greater risk of obesity, diabetes, high cholesterol, heart attacks, hypertension, stroke, the metabolic syndrome, overall and breast cancer, gastrointestinal disorders, depression, asthma, frailty among the elderly, and also premature death.

I first became aware of this work in 2014, when the Brazilian federal government published new official national dietary guidelines.  As explained in Food Systems and Diets: Facing the Challenges of the 21st Century, a 2016 report produced by an expert panel of which I was a member:

     The Brazilian Food Guide… recommends that high-quality diets contain minimal amounts of ‘ultra-processed foods’. The term ‘ultra-processed’ was coined to refer to industrial formulations manufactured from substances derived from foods or synthesized from other organic sources. They typically contain little or no wholefoods, are ready-to-consume or heat up and are fatty, salty or sugary and depleted in dietary fibre, protein, various micronutrients and other bioactive compounds. Examples include: sweet, fatty or salty packaged snack products, ice cream, sugar-sweetened beverages, chocolates, confectionery, French fries, burgers and hot dogs, and poultry and fish nuggets.

The Ultra-processed Foods report gives a full list of ultra-processed foods, and provides a practical guide to identify them based on their list of ingredients.

 There is no time to lose. As the Food Systems report says:

     In 2000, sales of ultra-processed foods and beverages in the upper-middle-income countries were one-third of those in the high-income countries. Fifteen years later, they were more than half…  Sales of ultra-processed food and sugar-sweetened beverages are growing. This growth is almost exclusively found in lower-middle income and upper-middle-income countries... Sales of ultra-processed foods in East and South East Asia are expected to approach those of high-income countries by 2035.

The lesson to learn now and always is that regulations are needed in food systems. These should be global, but can take many forms. Subsidies should be withdrawn from producers and manufacturers of ultra-processed foods and their ingredients, and instead given to co-operative and family farmers and others responsible for growing, distributing and selling unprocessed and minimally processed foods. Taxes should be levied on ultra-processed food products, and we must encourage programmes in schools and communities designed to enable the acquisition, preparation and enjoyment of freshly prepared meals. And perhaps above all, healthy staple foods should have prices  at levels that all can afford.

I am not suggesting that global food supplies will be transformed solely by sharply reducing manufacture and consumption of ultra-processed foods. But I do believe that this will be one essential part of an equitable healthy Zero Obesity Plan. These are critical times. They require radical actions.