The document discusses how the food environment influences dietary transitions and obesity trends globally. It provides examples of how diets have changed in countries as they undergo economic development, shifting from plant-based to more calorie-dense, processed foods. Key factors shaping food choices are discussed, including prices, information, and access. The document reviews proposed policies to create healthier food environments and makes the case that influencing the food system could help guide dietary transitions in developing countries to healthier outcomes.

1. The Food Environment: How Does It
Influence the Dietary Transition?
Laurian Unnevehr
Senior Research Fellow, IFPRI
Presentation to the OECD Food Chain Network
October 26, 2012

2. Rising U.S. Childhood Obesity
% of children
25
20
15
1980
2000
10
2008
5
0
All 2-5 yrs 6-11 yrs 12-19 yrs

3. Global Burden
• 1.5 billion people overweight or obese
• WHO estimates deaths from overnutrition
exceed those from undernutrition
• Diet related disease has a global cost
estimated at $1.4 billion
Source: WHO, World Economic Forum and Harvard School of Public Health, 2011

4. The Dietary Transition
• Agriculture-based economy
– Starchy staples based diets
– Undernutrition, esp women and children
• Transforming economy
– Diet diversification improves diet quality
– Emergence of double burden
• Urbanized economy
– Diet includes too many calories, fats, sugars
– Non-communicable disease burden

5. Bangladesh: Food Group Shares of
Total Food Supply (kcal/capita/day)
24
52 53
130 Grains, Roots, and Tubers
5
38 85
Legumes and Nuts
87
Dairy Products
Flesh Foods
Eggs
Fruits and Vegetables
Sugars
2005
Oils and Fats
Miscellaneous
Data Source: FAO Food Balance Sheets, 2009
Tanzania: Food Group Shares of
Total Food Supply (kcal/capita/day)
Grains, Roots, and Tubers
63
168 Legumes and Nuts
93
Dairy Products
2 151
Flesh Foods
65
Eggs
69
1257 Fruits and Vegetables
268 Sugars
Oils and Fats
Miscellaneous

6. China: Food Group Shares of
Total Food Supply (kcal/capita/day)
90
468
Grains, Roots, and Tubers
63 Legumes and Nuts
Dairy Products
285 1596 Flesh Foods
Eggs
75
Fruits and Vegetables
Sugars
515 Oils and Fats
Miscellaneous
56 100
Data Source: FAO Food Balance Sheets, 2009

7. United States: Food Group Shares of
Total Food Supply (kcal/capita/day)
TWICE the recommended amount
Caloric Meat, Eggs, and
Sweeteners Nuts
Dairy
Added Fats and
Oils and Dairy
Fats Fruit
Vegetables
Flour and
Cereal Products
Less than HALF the
recommended
amount
Source: USDA/ERS

8. % Overweight Adults Follows Caloric Intake Per Capita
Across Countries
4000
Countries at the same level of income
3500
have different outcomes
Caloric Intake (Kcal/Person/Day)
Egypt
3000
Indonesia
2500
Nicaragua
2000
High Income
Zambia
Middle Income
1500 Low Income
0 10 20 30 40 50 60 70 80
% Adults Overweight (BMI ≥ 25)
Sources: FAO; WHO

9. Why are Consumer Choices
Constrained?
• Affordability
– Prices
– Income
• Knowledge
– Habits
– Limited information
• Access
– Nutrient dense foods
– Modernization of food system

10. Do we have an “Obeso-genic” Food Environment?
Illustration by Meredith Nelson

11. What are the Proposed Policies?
Major Reports Common Recommendations
• National Academies 2012 • Nutrition labels
• World Bank 2011 • Advertising controls
• OECD 2010 • Public information
• World Economic Forum • Regulation of school /
2011 workplace meals
• Tax unhealthy/ subsidize
healthy foods
Recent EATWELL review found most of these polices
are in widespread use in high income countries.

12. What Do We Know about the Factors
that Shape the Food Environment?
• Prices
• Information
• Access
How do these factors play out differently across
different kinds of food economies?

13. Prices Have Modest Impacts On Diets
Fruits and Vegetables Soda
10% price 16% less
drop 5% more 20% tax consumed
consumed
Very modest
effects on
calories
or weight.
Sources: Dong and Lin (2009); Andreyeva et al. (2010); Dharmasena and Capps (2012)

14. But They Do Shape Consumption
• Prices shape long run consumption
habits, preferences, health outcomes
– Higher prices for vegetables associated with more
diabetes in U.S. (Meyerhoefer and Leibtag, 2011)
– Lower food prices associated with higher rates of
obesity in OECD countries over the past 20 years
(Huffman et al., 2010)

15. Prices in Transforming Economies
• Greater response to price changes expected in
low income countries
– 2008 price increases reduced nutrient density of
diets (Ianotti et al. 2011)
• Emphasis on keeping staple prices low may
discourage diet diversification
– Pulses prices relatively high in India (Kadiyala
2011)

16. Information
• Nutrition education has resulted in greater
awareness, but little change in diets
• Behavioral approaches to “nudge” consumers
towards better food choices
• Product and menu labeling have brought
changes mainly through product
reformulation

17. Information Influences Supply
• Mandatory labeling
motivates food producers
to change product
formulation
• Benefits all consumers
whether they read the
label or not
• Trans fat label in 2006 led
to rapid substitutions in
major brands
• CDC reports reduction in
trans fat in blood in 2009
Sources: Golan and Unnevehr 2009; CDC 2012.

18. Information in Transforming
Economies
• Behavior change communication is key
element of many nutrition interventions
• When combined with value chain
interventions, can address constraints to
change
– Orange-flesh Sweet Potatoes in Mozambique
• Efforts to monitor, certify packaged food
attributes
– GAIN’s Access to Nutrition Index

19. OFSP in Mozambique and Uganda
(HarvestPlus)
 Intervention:
• Production:
(dissemination of
vines and farmers’
training)
• Demand creation
(nutrition education)
• Marketing and  Reached:
product development  14,000 hh (Mozambique)
 10,000 hh (Uganda)
 Doubled Vit A intake
Source: DeBrauw, Gilligan, et al. 2012

20. Access
• Socio-economically disadvantaged areas have
fewer food retail options for healthy food
• Access to unhealthy options leads to poor diet
and health outcomes for low income
women, teens in US (Currie 2010)
• Increased supermarket access in low income
countries associated with greater diet
diversity, both healthy and unhealthy (Toiba et
al. 2012)

21. Is a Healthy Dietary Transition
Possible?
• Dynamics of food system in transforming
economies provides scope for changing path
• Promising food environment policies:
• Targeted productivity and value chain development for
nutrient dense foods
• Market institutions that incentivize nutritional quality and
safety
• Monitor food access for vulnerable consumers as system
modernizes
• Learn from the many policy experiments underway in
OECD countries