Transcript Popkin-San Fran AAEA preconf july 23 2015x

Links between Transformation of the agrifood
system and transformation of diets and dietrelated health concerns in Latin America and Asia
Barry Popkin
W. R. Kenan, Jr. Distinguished University Professor
Department of Nutrition
Gillings School of Global Public Health
School of Medicine
Department of Economics
The University of North Carolina at Chapel Hill
THE
W
RLD IS FAT
Chinese Children’s Diets are
Changing Fast in the 2000’s
Outline: Why is this occurring?
• 3 sets of forces underlying:
--Agricultural system: history with its older nutrition goals,
impact within the context of modern health and
nutritional needs
--modern technology: biological mismatch
--agrifood system shifts in the past 25 years
• Physical activity decline: major cause, not a solution
• Latin American change: precursor of changes seen in Asia,
Africa. The Mexican case
• China’s diet transformation and role of current agrifood
system—impact on diet and risk of obesity
• Now double burden countries face agrifood system both
problems
“Over 2 billion people in the world are overweight”
I.Modern global food system:
postWWII
• Focus first on basic grains [corn, wheat,etc] and cash
crops and then animal source foods
• At that point feeling globally that animal protein was a
critical need to have a healthy diet. No sense of the role
of beans, fruit and vegetables
• Jointly worked to create a global system as see in the
next slide and shifted relative prices toward cheaper
grains, sugar, later oils, animal source foods globally.
“Over 2 billion people in the world are overweight”
Stages of Global Agricultural System’s Development
Scientific and technological change, economic change, urbanization, globalization
Pattern 1
1800’s mainly
Scientific
underpinning
s
Science and
institution building
Fossil energy
modern genetics,
fertilizer, beginning
Agricultural science
and experimental
work, & land grant/ag
universities
Farming remains the
major source food
supply; initiated
Industrial/large-scale
monoculture
Low fertility, low
life expectancy
Pattern 2
1900-1944
Expansion
technologies,
science
Expansion of science,
develop reaper, many
other technologies
Farming systems
developed,
underpinnings post
WWII revolution
added modernization
of agricultural
production inputs,
machinery
Pattern 3
Post WWII massive
investments
modern system
Create modern food
system focused on
staples, animal source
foods, cash crops
Trillions for major
infrastructure, system,
input and enhanced
seeds, technology
development
embraced
Europe, the US,
Japan, other higher
income countries
rapid mechanization,
development of new
food processing
technologies (e.g..
Extraction of edible
oils from oilseeds,),
investment in
transportation/
irrigation/
electrification/
modernization of
agriculture
“Over 2 billion people in the world are overweight”
Source: © (copyright) Barry M. Popkin, 2015
Pattern 5
Pattern 4
Pattern 6
The commercial sector
Transmission
Healthier food
system to the globe shifts major drivers of
supply
system
change
(present)
(1955-2008)
Create global farm
research-extension
system and education
mirroring that of the
west
Retailers,agro-input &
agriprocessing,
businesses, food
manufacturers begin
to dominate farm-level
decision-making
Price incentive,
taxation, system
investments
Investment training,
institutions,
infrastructure,
CGIARG
Direct farm linkages to
drive production
/marketing decisions
Major shift in incentive
system and economic
drivers
Price incentive
/taxation/ investments
in infrastructure and
training
The green revolution,
major irrigation/ credit/
farm extension/
agricultural institutions
mirroring the west,
further modernization
of food processing
Shift to production
linked to needs of food
manufacturers,
retailers, ignoring
climate/sustainability/
health concerns
Diet shifts linked with
reduced NCD’s,
reduced climate
footprint, total
sustainability, reduced
animal source foods
II. Mismatch: Biology which has evolved over the
millennia clashes with modern technology
Biology
Technology
Sweet preferences
cheap caloric sweeteners,
food processing benefits
Thirst and hunger/satiety
mechanisms not linked
Caloric beverage revolution
Fatty food preference
Edible oil revolution-high
yield oilseeds, cheap
removal of oils, modern
processed food/restaurant
sector
Desire to eliminate exertion
Technology in all phases of
movement/exertion
“Over 2 billion people in the world are overweight”
Mismatch (continued)
• Technology not only as noted above but marketing
forces unleashed globally by food industry and enabled
moreover by WTO
• Created behaviors: snacking, portion pricing, economies
of scale in selling bigger food/beverage sizes, etc
• WTO: pushed to speed up technology transfer and
forced countries to compete in ways rationalized many
food sectors and drove down many prices.
“Over 2 billion people in the world are overweight”
III.Modern agrifood system
• Retailer and food service sector growth exponential
• Penetration very deep—villages of Mexico.
• Modern technology has sped up enormously the speed
of transfer of any new successful food or beverage
globally. For example, consider coke vs Red Bull.
“Over 2 billion people in the world are overweight”
IV.Modern Technology: Energy Imbalance: Physical
Activity declines in LMIC’s represent a significant, large
component of increased energy imbalance.
• In countries with detailed longitudinal data on all components of
physical activity we find very large declines in METS and any other
measure of activity
• The MET concept represents a simple, practical, and easily
understood procedure for expressing the energy cost of physical
activities as a multiple of the resting metabolic rate. “MET” is
another name for metabolic equivalent; a measure of exercise
intensity based on oxygen consumption.
• Slow downward shift in high income countries starting from much
lower starting point relative to high METS starting point and very
steep decline in LMICs
• See review across a number of low-and high-income countries by
Ng and Popkin Obes Rev (2012) 13 (8):659-80 (next two slides)
“Over 2 billion people in the world are overweight”
US Adults Met-hours Per Week of All Physical Activity, and Hours/Week of Time in
Sedentary Behavior: Measured for 1965-2009 and Forecasted for 2010-2030
Active Leisure PA
Travel PA
Domestic PA
1965: 235
MET-hr/wk
45
Occupational PA
Sedentary Time (hrs/wk)
40
Average MET-hours per week
200
35
2009: 160
MET-hr/wk
by 2020: 142
MET-hr/wk
30
by 2030: 126
MET-hr/wk
150
25
20
100
15
10
50
5
0
0
1965
1970
1975
1980
1985
1990
1995 2000
Year
Source: Ng S.W. & Popkin B.M. Obesity Reviews (2012) 13 (8):659-80
2005
2010
2015
2020
2025
2030
Average hours per week being Sedentary
250
Chinese Adults Met-hours per Week of Physical Activity & Hours/Week of Time in
Sedentary Behavior: Measured for 1991-2009 and Forecasted for 2010-2030
Active Leisure PA
Travel PA
450
Sedentary Time (hrs/week)
25
350
20
300
15
2009: 213 METhr/week
250
by 2020: 200
MET-hr/week
by 2030: 188
MET-hr/week
10
200
5
150
100
0
1991
1994
1997
2000
2003
2006
2009 2012
Year
2015
Source: Ng S.W. & Popkin B.M. Obesity Reviews (2012) 13 (8):659-80
2018
2021
2024
2027
2030
Average hours per week bring sedentary
Occupational PA
400
Average MET-hours per week
30
Domestic PA
1991: 399
MET-hr/week
V. Latin America: the Mexican case
• One of the highest overweight and obesity levels
globally.
• Very rapid diabetes increase, occurring among younger
Mexicans than found in high income countries.
• Linked with rapid increases in kcal from caloric
beverages, snacking (over a first of kcal), and processed
food.
“Over 2 billion people in the world are overweight”
Todays processing and purposes: amazingly complex
Extent & Purpose of
Processing
Minimally processed
food
Definition
Single ingredient basic foods with no or very
slight modifications that do not change inherent
properties of the food
Moderately processed Extraction or purification of one specific
component of a single basic food using physical
ingredient
and chemical processes that change inherent
properties of the food
Moderately processed Physical and chemical processes applied to
for preservation or pre- minimally processed foods for the purpose of
preservation or pre-cooking that do not change
cooking
the basic nature of the food
Moderately processed Addition of moderately processed ingredients to
a minimally or moderately processed food,
for flavor
Moderately processed
grain products
Ultra-processed
ingredient
Ultra-processed food
Examples
Fresh, frozen, or dried plain fruits, vegetables, roots,
tubers, or legumes; unsalted nuts and seeds; fresh or
frozen unseasoned meats; eggs; plain milk; grains;
coffee beans; tea leaves; bottled water
Oil, sugar, flour, spices, 100% juice, butter
Canned fruit, vegetables, legumes, meat, poultry, or
seafood; plain yogurt; cheese; instant oatmeal; instant
rice; plain peanut butter
Frozen, dried, or canned fruit with sweeteners; salted
nuts and seeds; fresh or frozen meat or seafood with
combined for the purpose of enhancing flavor but seasoning; flavored milk; flavored yogurt; flavored
not changing the basic nature of the food
oatmeal; tuna canned in oil; sweetened juice
Combination of grains or flour with water, salt,
Taco shells/tortillas, bread, plain pasta, basic cereals
and/or yeast to convert grains into grain-based
(puffed rice, shredded wheat, plain flakes)
products
Multi-component mixture of combined
Margarine, mayonnaise, condiments, dips, salad
ingredients not resembling its basic components dressings, jam/jelly, sauces, gravy
but NOT consumed alone
Multi-component mixture of combined
SSBs, cookies, frozen entrees, pizza, canned soup,
ingredients not resembling its basic components processed meat, salty snacks, ice cream, dessert
13
and consumed alone
mixes, boxed or canned mixed dishes, candy
Of 1.2 million US barcoded foods and beverages with
unique ingredients, % calories purchased by
processing level
BEVERAGES
FOODS
250
1200
1000
200
800
46.9%
150
Per capita kcal/day
Per capita kcal/day
45.3%
45.3%
47.4%
100
8.2%
11.1%
9.1%
11.0%
11.7%
9.5%
50
35.4%
33.0%
33.5%
11.9%
8.6%
64.2%
2008
64.5%
62.5%
*
Processed
600
Moderately
processed
*
*
32.1%
2012
14.8%
16.6%
16.0%
16.7%
*
15.5%
13.4%
13.3%
13.4%
*
5.5%
5.6%
6.2%
7.4%
*
2004
2008
200
0
2004
64.4%
400
0
2000
highlyprocessed
2000
2012
Minimally
processed
Of 1.2 million US barcoded foods and beverages with
unique ingredients,% calories purchased by
convenience level
BEVERAGES
FOODS
250
1200
1000
200
Ready-to-eat
150
89.8%
91.3%
91.6%
100
91.7%
*
50
Per capita kcal/day
Per capita kcal/day
800
66.8%
65.4%
64.3%
64.2%
*
600
400
14.1% 15.7%
16.8% 16.5%
19.1% 19.0%
18.9% 19.3%
*
200
9.8%
0
2000
8.4%
8.1%
2004
2008
7.8%
*
2012
0
2000
2004
2008
2012
Ready-to-heat
or minimal
Preparation
Requires
cooking
and/or
preparation
Packaged and Processed food
consumed in Mexico, 2012
• In Ensanut 2012 we asked each person with 24hour recall if the food was consumed not raw, came
from a packaged item, had the word industrial in the
title or the nutrient data came from the nutrition
labeling on the package. All were considered
packaged and processed.
Popkin (2014) Food Policy,47:91-96
“close to 2 billion people overweight”
Packaged and Processed Food is high across all areas of Mexico,
Ensanut 2012
Not Processed
Processed
100%
% of kcal by source
80%
57%
55%
58%
43%
45%
42%
Urban
Rural
Total
66%
60%
40%
20%
34%
0%
MexicoCity
Source: The Mexican National Nutrition Survey, 2012
Popkin (2014) Food Policy,47:91-96
The six food groups account for half of all kcal in Mexico
from packaged and processed foods and beverages*
Dairy-soy beverages
6.8%
Tortillas
14.1%
Grain-based desserts/sweet breads
10.5%
Salty snacks
2.1%
Meat/poultry/fish/eggs
3.1%
Sugar-sweetened beverages
3.8%
*Proportion of total kcal from packages and processed foods and beverages
from National Nutrition Survey, 2012 for ages 2 and older
Popkin (2014) Food Policy,47:91-96.
“Over 2 billion people in the world are overweight”
VI.China Health and Nutrition Survey
• China Health and Nutrition Survey: Like Mexico, asked
for each food consumed if it was packaged and
processed in some way.
• Controlled for selectivity but used only CHNS2011 so
cross-sectional. Zhou et al, (2015) Food Policy 55: 92100
•
•
“Over 2 billion people in the world are overweight”
Purchase of Consumer Package Foods and Beverages are
Increasing Rapidly! In China, in 2011 we asked in 3 Days of
Daily 24-hr Recall about the Source of Each Food Item.
Home
Restaurant
Processed
100%
27%
29%
% of kcal by source
80%
33%
35%
30%
8%
13%
60%
12%
13%
19%
40%
65%
58%
58%
54%
46%
20%
0%
Rural
Small city
Big city
Source: The China Health and Nutrition Survey, 2011
Popkin (2014) Food Policy,47:91-96
Big cities: 5-20 million; mega cities: > 20 million-Shanghai, Beijing, Chongqing
“Over 2 billion people in the world are overweight”
Mega-city
Total
Factors Associated with the relationships between Purchasing
Packaged Processed Foods in China and kcal/day,
CHNS 2011
(Additional 1000 kcal/day of Purchases of Processed Food)
175
154
150
127
kcal/day
125
100
97
75
50
25
0
Male
Urbanization: Middle Tertile
Urbanization: High Tertile
Consumption of Processed Foods
Zhou et al, (2015) Food Policy 55: 92-100
“Over 2 billion people in the world are overweight”
The Effect of an Additional 1000 kcal Increase in Predicted Daily
Processed Food Consumption on the Risk of Being Overweight
and the BMI Level, CHNS2011
• Linked with a significant increase in BMI(for 1000 kcal
processed food) by 1.32 unit only in those aged 2-18,
not adults or elderly. Also linked with significant
increase in the risk of overweight and obesity by 39%.
• Instruments were: distances from household to various
markets (fresh markets, convenience stores,
supermarkets). Processed food purchases (kcal) was
endogenous for kids only. We performed endogeneity tests to
determine if the endogenous regressors are in fact endogenous (Durbin
score and Wu-Hausman) and overidentifying restriction tests to
determine if the instruments are valid (Sargan score and Basmann).
Zhou et al, (2015) Food Policy 55: 92-100
“Over 2 billion people in the world are overweight”
Food Service Expenditure per Capita (In Real US$)
among Lower Income Countries
450
real US$ per capita
400
Vietnam
350
Malaysia
300
China
(excluding HK)
Thailand
250
Indonesia
200
South Africa
150
Egypt
100
Philippines
50
India
0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Year
Source: Ng and Dunford Obes Revi(2013). Euro monitor Global Market Information Database.
Opportunities with the modern food
sector
• A major scientific question: can we create healthy
processed and packaged foods that will be less
obesogenic. They can sell healthy or unhealthy food and
make a profit
• Many scholars feel we must go back to eating real foods
but minimal evidence. With our high levels of inactivity
we can gain weight and waist circumference with any
type of food
• So the critical issue is: with the existing food system and
considering its very rapid growth what can we do?
“Over 2 billion people in the world are overweight”
Can we reform the retail food sector?
• So how do we use regulations and other incentives,
taxes, information options to ensure healthy
reformulation and healthy food purchases?
• Challenges: marketing of unhealthy foods and
beverages (billions of Yuan). Globally countries are
working to control, focus on healthy food marketing
• Shifting relative costs: taxation mainly of unhealthy foods
and beverages (Mexico)
• Globally countries are working to create simpler front-ofthe package labels
• Requirement of selected fruits and vegetables with set
proportion of space in smaller stores
“Over 2 billion people in the world are overweight”
Food labeling: future directions
• Nutrition facts panels are necessary. But for very few do
they affect behavior and lead to healthy choices
• Front of the package profiling: positive focus on labeling
only healthy foods (e.g. low sodium, low added sugar,
minimal unhealthy saturated fats, more whole grains,
fruit and vegetables, pulses/legumes) that follow WHO
and global nutrition knowledge. Or a negative logo that
highlights excessive sodium, unhealthy fats, added
sugar(e.g Chile).
• To date, the positive logo only has been linked with
product reformulation, some impact on purchasing.
“Over 2 billion people in the world are overweight”
Away-from-home food service
sector
• Fast food and stalls: few efforts but minimal outside of
Singapore’s creation of hawker centers where can
educate, control behavior of stalls
• Portion size controls, pricing only beginning to
understand how to get calorie labeling of fast food chains
or restaurants with more than six in the chain to do this.
“Over 2 billion people in the world are overweight”
Low and middle income countries
• Many are beginning to be world leaders in this arena but
more related so far to sugar-sweetened beverage and
junk food taxes (Mexico 10% SSB,8% junk food;
Chile,8% SSB; Barbados, many others coming soon)
• Many countries pushing marketing controls and positive
or negative Front-of-the-package logos(Chile most
inclusive with lagged initiation)
• Great promise but rigorous evaluations are needed such
as we are doing with Mexico as programs and policies
emerge. Taxes work very successfully in middle
income Mexico but low level, modest impact
• To date no success stories of turning back the rapid
increases in both BMI and waist circumference
“Over 2 billion people in the world are overweight”