FAO Regional Office for Europe and Central Asia

FAO expert talks about malnutrition’s ‘triple burden’

FAO Food Safety and Consumer Protection Officer Eleonora Dupouy talks about this week’s Second International Conference on Nutrition (ICN2) and why balanced nutrition is rapidly replacing undernutrition as the next big challenge facing Europe and Central Asia.

You will travel to Rome this week for ICN2. What’s in store? At a time when 805 million people are still hungry and two billion people suffer from vitamin or mineral deficiencies, high-level policy-makers from around the world will meet at ICN2 to deliberate on global and local solutions to eradicate malnutrition. Representatives of member countries will adopt the Rome Declaration on Nutrition and ICN2 Framework for Action and commit to concrete steps to improve nutrition.

Twenty-two years after the first conference in 1992, ICN2 will be the most significant international discussion on nutrition in the last two decades and a unique opportunity to address the whole spectrum of malnutrition issues. Undernourishment and obesity are the most visible types of malnutrition, but we must call attention to micronutrient deficiencies as a “hidden hunger”.

What do you mean by ‘hidden hunger’? Micronutrient deficiencies often have no visible or immediate warning signs, but the health and socioeconomic consequences are devastating. Nutrients like zinc, iron, iodine and vitamins A and D are essential to human growth and development, especially for mothers and children, and for wellbeing in adults.

What kind of nutrition problems do you see in Europe and Central Asia? Though much of the improvement is a recovery from the economic and social turmoil following the collapse of the Soviet Union, this region has made tremendous progress in reducing undernutrition levels. In the Caucasus and Central Asia, there are four million fewer undernourished people than in 1992. But undernutrition is still a pressing issue, as stunting among children under five remains more than twice as high as in Eastern Europe.

While most developing countries around the world still focus primarily on combating undernourishment, the dominant challenge in Europe and Central Asia is trending toward overnutrition. Kazakhstan, Ukraine, Romania, Balkan countries and other transition economies are undergoing what experts call a “nutrition transition”. They are now facing a unique triple burden of malnutrition:  undernutrition, micronutrient deficiency and obesity.

A triple burden? That sounds concerning. It is very concerning. Even if people in the region have enough to eat, they may be limited to monotonous diets that depend heavily on starchy foods for energy. As a result, they become deficient in essential micronutrients like amino acids, minerals and vitamins that come from animal products and protect against health problems.

At the same time, FAO projects that low-income and middle-income countries in Europe and Central Asia will have some of the highest rates of obesity in the world by 2050. High body mass index (BMI) raises the risk factor dramatically for diabetes, hypertension and heart disease and will place a heavy burden on healthcare systems in these countries. The countries bearing a triple burden of malnutrition already face the highest social burden in the region from high BMI, even though their obesity rates are lower than in developed European countries.

Wait a second, how can the social burden be higher if BMI rates are lower? While BMI rates are higher in developed European countries, countries with transitioning economies spend less on healthcare and their health systems cannot effectively mitigate the adverse effects of overnutrition.

The need for improvements in healthcare and the growing burden of micronutrient deficiency and overnutrition reveal how malnutrition has effectively capped life expectancy in the region. To gain one year of life expectancy at birth, transition economies will need to increase healthcare expenditures between 99 percent and 144 percent, which is a fiscal impossibility right now.

What realistic steps can the region take? With limited resources, health policy and nutrition education need to focus on early prevention rather than treatment. In Europe and Central Asia, three of the top five risk factors for non-communicable diseases are related to malnutrition: dietary risks, high blood pressure, and high body mass index (BMI). Counteracting all forms of malnutrition reduces these risks and creates long-term health benefits for the population.

Look at how we tackled undernutrition in this region: over the last twenty years, a 6 percent yearly decrease in child and maternal undernutrition has translated into a 69 percent decrease in the health and social consequences of undernutrition. Just as the ICN2 motto declares, better nutrition means a better life for all.

So, what are some possible policy solutions to prevent malnutrition? From agriculture to consumption, countries have many long-term, cost-effective and sustainable policy options at every point in the food value chain. Before food reaches the consumer, governments can launch programs to produce more nutrient-dense crops and livestock, fortify foods like salt, milk and flour with key vitamins and minerals, and reduce the amount of salt, trans and saturated fats, and sugar in processed foods

Public health information campaigns, nutrition education in schools and food assistance programs successfully promote healthy eating habits to a wide audience but also target vulnerable populations such as pregnant women, new mothers and children. As consumers learn more about good nutrition, they will make healthier choices and perhaps even start gardening for themselves.

These policies and more will surely be on the table at ICN2. When discussion turns to action after the conference, any policy solution should be tailored to local needs and will require close cooperation between the agriculture, health, education and social protection sectors. Above all, ICN2 will reinvigorate countries to address malnutrition head on and FAO will be ready to support them every step of the way.

17 November, 2014, Budapest, Hungary