José Graziano da Silva The worldwide surge in obesity rivals war and smoking in terms of the global economic burden it imposes. Obesity is no longer a concern solely of higher income, developed countries. The prevalence of obesity and overweight has risen in all regions, including in low-income countries. Today, nearly half of all countries are struggling with both under-nutrition and overweight/obesity. Indeed, under-nutrition and obesity often co-exist in the same communities -- even in the same household. Economic and social transformations, including higher incomes, in many poor and middle-income nations and the availability, at relatively attractive prices, of over processed foods have led to changes in lifestyles, including dietary habits and reduced physical activity across the globe. Not a single country -- not one – saw declining obesity between 2000 and 2013. WHO estimates 1.9 billion overweight people, of whom a third are obese. This involves social and economic costs that, piled on top of those resulting from malnutrition, society can ill afford to bear. The 2013 edition of FAO’s State of Food and Agriculture noted that the social burden due to overweight and obesity has doubled over the past two decades. According to the report, the cumulative cost of all non-communicable diseases, for which overweight and obesity are leading risk factors, were estimated to be about US$1.4 trillion in 2010. More recently, the McKinsey Global Institute estimated the global price tag of obesity – including the increasing the risk of heart disease, hypertension, strokes, diabetes, and some cancers affecting the overall quality of life – could run as high as $2 trillion a year, third only to smoking ($2.1 trillion) and armed conflicts ($2.1 trillion)! While the numbers are not comparable and the global estimates of the economic costs of obesity and overweight vary, they coincide in their scale. Now, think of what could be done to tackle malnutrition – hunger, under-nutrition, micronutrient deficiencies and obesity – if we threw that amount of money behind the effort. Increasing funding is necessary to scale up efforts, but it should be a part of a bigger effort to re-strategize our approach to tackling malnutrition in all of its forms, deepening our focus beyond the immediate causes to include the broader socio-cultural, economic and political dimensions of nutrition. This was a challenge that was taken up at the Second International Conference on Nutrition (ICN2) in Rome in November 2014. At ICN2, governments endorsed the Rome Declaration on Nutrition and the accompanying Framework for Action, committing themselves to address the broad spectrum of malnutrition -- including undernourishment, stunting, wasting, micronutrient deficiencies, obesity and related non-communicable diseases. Making progress on these pledges will require major shifts in the manner in which we address malnutrition. It entails shifting from treating the adverse effects of malnutrition to prevention by ensuring healthy balanced diets, to better address the root causes of malnutrition, and we’ll need to develop new policies, strategies and programs to help us do that. Here are some guiding ideas. First, let’s reform our food systems to ensure better nutrition for all. FAO’s State of Food and Agriculture 2013 showed how food systems influence the quantity, quality, diversity and nutritional content of foods, and determine the availability, affordability and acceptability of foods needed for good nutrition. Reforming our food systems to improve nutrition will require growing nutrient-rich foods and ensuring healthy processing to minimize the loss of nutrients. Second, we must make it easier for consumers to make food choices that promote healthy diets. This requires political commitment besides effective and coherent policies and strategies. It will require increased investment in nutrition promotion and education programs. It will require creating schools, work places and communities that make healthy diets easily accessible and encourage people to exercise more. It will require empowering consumers with information through formal and informal popular nutrition education and giving more information on the food being sold to them, including through appropriate labeling. Third, by creating a common vision and multisectoral approach involving governments, farming, health, retail and other relevant public and private sectors, as well as civil society. The multiple causes of malnutrition, including obesity, call for effective collaboration: no sector or entity can effectively address the problem on its own. Fourth, trade and investment agreements must be designed to influence food systems positively. By improving the availability of, and access to, food, efficient and effective trade can play a key role in achieving nutrition objectives. But such agreements should not “crowd out” the possibility of developing local agriculture. Thriving national and local agriculture systems not only reduce countries’ dependency on food imports but promote greater diversity in diets, can act as a buffer against price spikes in international markets, and generate jobs to help reduce rural poverty. ICN2 has set the stage for all actors to come on board to reverse the fast rising global obesity. Malnutrition, from under-nutrition to obesity, is preventable at a relatively low cost if we work well. Let us move quickly to reverse obesity trends and to make hunger and all forms of malnutrition history. The writer is the Director General, Food and Agriculture Organisation, FAO.
