Global Forum on Food Security and Nutrition (FSN Forum)

Hello!

Here are some of my thoughts on the subject for what they are worth. Even though my main argument may not win many supporters, I hope it would be of some help.

Many thanks.

Lal.

Elements Crucial to Effectively Support Policies, Strategies and/or Programs Intended to Reduce Overweight and Obesity

In this submission, I would like to examine some of the elements that ought to be taken into account on policy formulation and the design of strategy directed at the reduction of overweight and obesity. As for the success of programmes that embody the implementation of such a strategy, I shall not comment, for it is a question of political will, technical competence and requisite resources.

As this is based on already well-established procedures of logical analysis and synthesis, I shall not burden my potential readers with outside references. My argument is based on two basic assumptions, on which there is a general agreement, viz., unless one suffers from a certain type of metabolic disorder, being overweight or obese is due to the inappropriateness of one’s eating or drinking habits.

The second assumption emphasises that other things being equal, being overweight or obese is a consequence of an individual’s own action. How important this is in combating our problem has until now not received the attention it deserves. Legal action such as high taxation on certain industrial food and beverages is merely palliative if successful, for it does not encourage a person to acquire appropriate eating and drinking habits for one’s own benefit, rather it compels one to do so in the prescriptive manner of a religion barring the sinners from sinning to enter a putative heaven.

So, the policy and strategy we are talking about, is concerned with increasing the number of people whose eating and drinking habits are appropriate. Their relevance to this end, depends on the policy maker and the strategist knowing what may justifiably said to cause inappropriate eating/drinking habits, and what legitimate means are at the disposal of the authorities to counter them. I shall try to address these two questions in turn.

Causes of Inappropriate Eating and Drinking Habits:

It is crucial to understand that these causes fall into two logically distinct categories, but some from both categories may co-occur. The first involves the situation in traditionally affluent countries, viz., affordable wholesome food and drink is available while some individuals do not take advantage of it due to several reasons. This represents inappropriate nutrition due to erroneous choice.

In the second, for a variety of reasons, an adequate supply of affordable wholesome food and drink does not obtain.  Under the circumstances,  one has no choice but to make use of what one could afford, which generally turns out to be the kind of item associated with being overweight or obese, i.e., starchy and/or fatty food. This represents inappropriate nutrition due to lack of choice.

It would be fair to say that intake of a balanced diet indicates that one’s eating and drinking habits are appropriate. However, what constitutes a balanced diet for a given individual depends on among other things, age, sex, current state of health, climate of one’s residence, nature of one’s work, etc. Moreover, there is some reason to believe that dietary balance may also have a racial determinant. Hence, it would not be possible to lay down a scientifically justifiable balanced diet having a universal validity.

However, human beings have managed to survive long without the benefit of formal scientific knowledge.  This in part, is due to the evolution of food culture among social groups, which empirically took into account what their habitat could best yield, and to achieve at least ‘a working balance’ among the available food items from animal and vegetable sources.

Therefore, it would be reasonable to suggest that  a balanced diet for a given person would have to be established with reference to one’s individual nutritional needs at a given period of time while keeping it as close as possible to the relevant food culture.

Having said that, it is possible to distinguish between two logically inseparable aspects of a balanced diet, viz., a qualitative and a quantitative one.  Please note the term qualitative as used here simply refers to the diversity among the victuals consumed. It is necessary, because one cannot always obtain all the nutrients one needs from a single source.

When one’s diet is sufficiently diverse to ensure an adequate quantitative access to the nutrients one needs,  it approaches being a balanced diet. Other things being equal, a quantitative change in any item in a balanced diet or its replacement with another having a different available quantity of the same nutrient would result in dietary imbalance.

Being overweight or obese then, is a result of dietary imbalance where the intake of certain nutrients  is excessive with respect to one’s actual needs. This excess is mainly in the intake of carbohydrates, fat or oils. If, we can agree on the discussion thus far,  we may then proceed to the possible causes of inappropriate eating and drinking habits included in the two categories described above.

Now, an obvious, yet an important point. Even if one has an easy access to all the food and drink one needs, it does not entail that one would select and partake a balanced diet. If one does so, it implies that one is willing and able to undertake those two tasks. This willingness is motivated by the belief that partaking of such a diet is desirable, hence it is of some value to oneself.

Having this belief implies the possession of prior knowledge of the value of a balanced diet, while having the ability to select a balanced diet implies the possession of a prior knowledge of what is constitutive of it. These two logically linked pieces of knowledge are not givens, and they have to be acquired through learning provided by relevant dietary education received at home or school.

1. Thus, inadequate dietary education can be an important cause of overweight or obesity. This seems to be particularly the case in affluent countries as well as among the relatively affluent in poor countries.
2. One often tends to deprecate the power of inherited  dietary habits to remain more or less unchanged even when  dietary knowledge takes into account changes in one’s energy needs, especially in affluent countries in the temperate zone. Central heating, motor transport, domestic labour-saving devices, automated blue-collar work, etc., have greatly reduced body’s daily energy usage while food intake does not seem to reflect it. The extent to which this may bring about overweight or obesity is difficult to quantify.

1. Greed had been openly acknowledged as a cause of being overweight or obese until it became fashionable to describe undesirable human behaviour in psycologistic terms.  Prior to  this unfortunate change, bringing up children  included training them to eat and drink appropriately. At present,  a considerable number of children do not receive such guidance.

Let us now consider the reasons for inadequate dietary education, the persistence of older dietary habits and lack of child guidance away from  greed.

1. Failure to incorporate dietary knowledge and local food culture into general education, while it is not imparted to people at home when they are young.
2. Failure of people to make their food intake match their real energy needs due to indifference, desire for convenience or a greater belief in questionable dietary information put forth by persuasive advertising.
3. Lack of time to prepare balanced meals, or failure to budget for an adequate supply of wholesome food, which compels one to resort to cheap unwholesome items.
4. Adults’ fear to curb greed among children owing to their belief in psycologistic accounts of the phenomenon, which cannot be confirmed or disconfirmed, hence, unscientific.

Until this point, the causes I have outlined presume an availability of an adequate supply of affordable wholesome food.  It is under used owing to lack of appropriate dietary knowledge, lack of skill in domestic management, failure to prepare suitable food due to fatigue or desire for convenience, belief that curbing childhood greed is somehow injurious, and the conditioned or acquired belief in food advertising.

Distribution of these causes of turning people overweight or obese in less affluent countries, seems to increase as their economies grow. One can easily observe there a significant reduction in the intake of traditional dishes while that of industrial food increases. It mirrors the social development in the ‘North’ with respect to the decline in food culture, dietary knowledge, and an increase in the desire for culinary convenience.

Now, we can take a closer look at the second category into which the causes of inappropriate nutrition belong. It is not only a category, but also constitutes a cause, which in turn arises owing to the following:

Low income and comparatively high prices of wholesome food.

Limited availability of wholesome food owing to:

1. Neglect of agriculture.
2. Excessive use of arable land for cash crops, raw materials for industrial food production, or other purposes.
3. Loss of arable land due to desertification, soil erosion, drying up of rivers and streams, etc.
4. Migration of small farmers and farm workers to urban centra.
5. Reduction of the number of young people willing to engage in agricultural pursuits.
6. Inadequacies in infra-structure that hinder the transport of fresh produce to end-users.
7. Price-wars initiated by large chains that has driven out small independent retailers of fresh produce who provide a greater choice.
8. Food loss in storage, transport, and through its passage through ‘sophisticated’ food systems (see http://www.fao.org/fsnforum/cfs-hlpe/node/992).

It should be noted that D, E, G and H above have become growing problems even in the affluent countries. In many of them, individual retail chains have united themselves into ‘trade groups’ where what food items are sold and at what prices, are decided among themselves. This compels the farmers to produce what traders will buy, and moreover at the prices dictated to them. This legal monopoly victimises the actual food producer and the end-user so that middlemen may benefit.

Critical Elements of Policy and Strategy:

These then are some of the causes of inappropriate nutrition that may be mitigated by effective implementation of suitable policies and strategies. Let us pair the elements crucial for their success in the order those causes have appeared in this discussion.

1. Policy: Rendering national education holistic by incorporating dietary education into the school system; public education through suitable channels.

Strategies:

Revision of school curricula

Information campaigns, projects (eg. ‘My Healthy Family Project of the EU)

1. Policy: Promote the sale of fresh produce and real competition among the vendors of food.

Strategies:

1. Tax incentives and establishment loans to independent vendors of fresh produce.
2. Higher taxes on factory made food.
3. Practical help to the establishment of food cooperatives.
4. Suppression of hidden food monopolies.
5. Banning scientifically untenable claims from food advertising.

1. Policy: Take steps to render public attitude to food and its intake as rational as possible. (unfortunately, this important issue is much deprecated)

Strategies:

1. Supplement public education with ‘cooking breaks’ by introducing shorter working hours for those who cook their own meals. This would be similar to the training breaks at the work place, but would come at the end of the day.
2. Employer sponsored cookery classes.
3. Educational measures to accept greed as a consequence of inadequate personal training rather than a mental issue.

So far, we have talked about the elements whose incorporation into policy and strategy is crucial to their success when combating being overweight or obese in an environment where availability and affordability of wholesome food is not the most important issue. We will next take a look at the policy and strategy elements necessary to achieve our objective in areas where affordable wholesome food is scarce.

However, we must bear in mind that the problems the policies and strategies outlined above are intended to address, are becoming increasingly common in developing countries. Thus, their applicability is more or less world-wide when adapted to specific local needs. Likewise, the issues arising from our second category above, are increasing their relevance for the developed countries.

1. Policy: An employment policy embodying an economy of cooperation rather than competition seems to be the only way to make wholesome food available to most at affordable prices. However, the crucial need for this economic revision is either ignored or not understood in spite of its obviousness.

Strategies:

Public debate on the incommensurability between environmental sustainability and justice on one hand, and the current economic system on the other.

1. Policy: Active promotion of small farms, market and allotment gardens, rural agriculture, etc.

Strategies:

1. Financial and technical support to practising small farmers.
2. Schemes to attract youth to agriculture as discussed previously in this forum (means of achieving this were also included in that discussion).

1. Policy: Undertake the general measures needed to create an environment necessary and favourable to produce and procure wholesome food.

Strategies:

Putting in place and regular maintenance of the requisite infra-structure.

Exclusion of food items from speculation in commodity futures.

• Improved agriculture extension services, training and  research facilities.
• Honest and open public debate on the consequences of abolishing government subsidised food production, especially with respect to those on nutrition if one has to depend on industrial farming for food. Such a discussion might compel more and more people to understand the danger of regarding food production  as a mere commercial venture.
• Steps to simplify the unnecessary complexity of many a so-called food supply chain in order to minimize food loss and unfairness to  the farmers and end-users.
• Active steps to attain harmony and congruence among all policies, particularly among those of agriculture, health, education, justice and trade.

I mentioned harmony and congruence among policies at the end, to stress the fact that its lack has often made many an otherwise sound policy unimplementable. For instance, a trade policy that encourages import/domestic production of unhealthy industry food is not congruent with a health policy intended to reduce the incidence of being overweight or obese,, while an agriculture policy that promotes the production of wholesome food is in harmony and congruent with that health policy. I think that generations of reductive thought has made most of us fail to see the obvious, viz. the purpose of a policy is to direct some authority towards enabling a group of people to attain some end that is necessary for their total well-being.

Good health is obviously an essential component of individual well-being. So, if one policy promotes it while another exerts the opposite effect, irrationality emerges. What policy makers always ought to bear in mind is what impact a new policy will  have on others known to contribute to individual well-being. Achieving this objective manifests itself as a set of policies displaying harmony and congruence.

This does not happen on its own volition, and it requires a political will sufficient to undertake not only the required change in perspective, but also bringing in personnel skilled in inter-disciplinary policy correlation so that every unit of authority will pull in the same direction, i.e. well-being of the people, be it at the local, national or the global level.

Best wishes!

Lal Manavado.

[email protected]