Triple threat of stunting, anemia, and obesity poses looming crisis, health experts warn

CANBERRA — A preview of what is to come in the “2018 Global Nutrition Report,” a multistakeholder report supported by the Food and Agriculture Organization, shows a growing number of people facing a triple burden of malnutrition — stunting, anemia, and obesity.

Findings presented at the Crawford Fund’s annual conference in Canberra on Aug. 14 showed that 41 countries are dealing with major nutritional challenges in all three categories. This is an increase of 41 percent from 2017, when 29 countries were found to face the triple burden.

The 2017 report already showed a looming health crisis, with countries in the Asia Pacific having the highest rate of both childhood stunting and obesity. Papua New Guinea, Myanmar, and Bhutan were among the countries where the triple burden is reaching a crisis point.

The findings presented by Jessica Fanzo, senior nutrition officer at FAO, showed the world was “not on a great course” to deliver the nutrition and health objectives of the Sustainable Development Goals by 2030.

“With the impact of climate change, undernutrition will grow,” she said. “There will be more children falling into the chronic undernourishment category in a business-as-usual situation, with Africa being the most affected. So, it will be a reversal of all the gains we have made.”

Importance of the Global Nutrition Report

Released annually, the Global Nutrition Report acts an accountability mechanism for the nutrition community, said Fanzo. Its data-driven content shows how countries are progressing with nutrition and health commitments.

“It’s important to have it [on] an annual basis just to remind people each year of where we are at,” Fanzo said.

But the report is not without its struggles.

“It is hard to get these figures annually,” she said. “And sometimes it is hard for us to find messaging each year — we’re still off-track, there’s still no progress being made. But I think sustaining that yearly reporting is important because we do get new figures from countries each year that adds to the information base.”

There is progress shown in the report — but at a slower rate than Fanzo would like.

“On the nutrition side stunting is coming down — but at a snail’s pace,” she said. “Some countries have done better than others but overall it is coming down too slow. It’s obesity that is a concern. It is going through the roof.”

Expert opinion on the challenge at hand

“Who is Jessica Fanzo?” asked Mario Herrero, chief research scientist at CSIRO, in his introduction for Fanzo at the Crawford Fund Conference.

“Jessica has taken a two-year leave of absence from her Bloomberg distinguished associate professorship in global food, agriculture, and ethics at Johns Hopkins. She also serves as the director of the Global Food Ethics and Policy Program at Hopkins, she is the co-chair of the Global Nutrition Report, and she’s been everywhere. You couldn’t get anyone better. Before joining Johns Hopkins she held positions at the UN World Food Programme, Biodiversity International, the Earth Institute, the Millennium Development Goals Center,” said Herrero.

Fanzo’s impressive resume shows her commitment, passion, and expertise in the area of global nutrition. But the current challenges of politics, environment, and economics has her frustrated, now Fanzo is calling for urgent action and disruptive change.

“Right now the United States is a big donor to nutritional internationally through USAID [United States Agency for International Development],” she said. “They are one of the largest … as time goes on and we [the U.S.] become more inward thinking — it is a big concern.”

Geopolitics, Fanzo believes, will be one of the biggest challenges in responding to nutrition needs.

“Especially when you think of the other drivers including climate change and trade, this is going to be problematic,” she said.

“With the United States withdrawing from COP, it would be one thing if we were a small emitter of greenhouse gasses but we are the largest. It’s unfortunate because the American public voted for the current president. In one sense we have to lay in our bed that we made, but it is when our policies impact other countries is what’s devastating.”

Working with the private sector is an additional challenge in responding to global nutrition needs, which Fanzo said was highlighted with the recent U.S. opposition to a World Health Assembly resolution to promote breastfeeding over formula — it put the interests of business over health.

“It’s classical unethical practices and shameful,” she said. “It means the nutrition community does not want to engage with private sector.”

“Working with industry in nutrition is a very contentious issue. It’s not just funding research — which is a whole other ethical issue — it’s whether you sit on a panel with industry, whether you go to a meeting with industry, whether you go to a conference sponsored by industry. It becomes a whole big contentious issue.

“And there are some that do not engage with industry at all — they feel they cannot be trusted. And then others say they have to work with industry because they control so much of the food system and we have to figure out how to work with them. So you’ll have extremes in the nutrition world,” she said.

In agriculture, Fanzo explained, working with industry is a natural fit because agriculture is considered a business. But nutrition, as a public health benefit, is harder for the private sector to assign value to. What makes an effective public-private relationship in the area of nutrition is still not properly understood — and is currently being researched by the Global Alliance for Improved Nutrition.

“We need more examples of what works,” Fanzo said.

Role of FAO in building nutrition momentum

FAO works with health and agriculture ministers of member countries to present the best evidence showing how nutrition and agriculture can be effective in working together, bridging the gap between the two.

“There is times when member states come together and that is an important time to present evidence — to present the Global Nutrition Report including how they are doing towards ending malnutrition,” Fanzo said. “It is an opportunity to work with member states and influence their decisions.”

But there are challenges in the operation of FAO. Fanzo explained that the structure of FAO includes a wealth of intellect sitting in Rome to report on data, in addition to regional and country offices.

“It is a centralized agency so you don’t have a lot of people on the ground like UNICEF or the World Food Programme,” Fanzo said. “FAO is a lot thinner on the ground and it’s a weakness. For me, where we need to strengthen our work is at the country offices.”

Need for disruption

At the Crawford Fund conference, Fanzo highlighted the urgency of action, with noncommunicable diseases already a development challenge, she called for urgent action and ideas for disruptive change to processes of government, research, and business.

“There needs to be disruptive change in the way the U.N. works, which is archaic at the moment,” she said. “They need to be more nimble and not so process-oriented to push the agenda.”

The private sector needs to be pushed into being accountable for “acting no-so-great.” And disruption in research should hold academics accountable for producing the best science.

“Everyone should be working towards thinking differently.”

The big disrupters, Fanzo believes, will be the younger generation — who need to think globally as well as locally.

“We need better global cooperation for sure across big issues that touch down at the individual level like trade and climate change. But then we need individual change: In high-income countries we consume too much meat, there is no reason for that. So, how do we get individuals to change and think about the implications of what they eat — that it matters for other people in the world. And to care about that.”

Fanzo is urging those with ideas for disruption to email her directly at jessica.fanzo@fao.org. She is willing to listen to any idea that could make a difference.

“We really need a social movement at the community level that will go higher, bigger, and better,” she said. “Something big needs to happen.”

Update, Aug. 23, 2018: This article has been updated to clarify that the Global Nutrition Report is a multi-stakeholder report.

For more coverage of NCDs, visit the Taking the Pulse series here.