Fortification, quality and policy: Cargill report identifies three key solutions to APAC malnutrition problem
The report, titled Food for Thought: Eating Better, was written with the support of research undertaken by the Economist Intelligence Unit (EIU), as part of Cargill-sponsored Asia Food Systems 2030 series.
In it, the authors point to lifestyle changes, growing inequality, and the media as the key drivers behind the nutritional changes in the region.
Lifestyle factors
The first trend noted in the report was the increase in average calorie consumption across Asia, which has increased and "converged with middle and higher income countries".
The trend is characterised by changes in dietary balance, with rising incomes throughout the region resulting in a significant increase in per-capita daily calorie intake, from 1,957 calories in the mid-1960s to 3,060 calories by 2015 in East Asia, and from 2,017 calories to 2,700 calories in South Asia.
The authors wrote: "Mirroring the nutritional transition experienced in other regions, consumption of cereals is falling and diets are transitioning from starchy, low-variety, low-fat and high-fibre foods to more processed foods with more fat, sugar, salt and refined carbohydrates, as well as increased consumption of fruit, vegetables, dairy and animal products among those with higher incomes."
This, they said, increased Asia's burden of non-communicable diseases like cancer, diabetes, obesity, heart disease and stroke — a burden especially prevalent in East Asia and the Western Pacific.
The next trend they identified was urbanisation and income growth, which has led to lifestyle changes that "adversely affect" nutrition.
Easy access to an abundance of high-fat, high-sugar convenience foods is common in urban areas, where more people now reside, leading to a high positive correlation between urban living and obesity.
In addition to being high in fat, salt and sugar, some street foods, especially in lower income countries, "carry the additional risk of microbial contamination, pesticide and chemical residues, and the presence of toxins".
Multi-dimensional inequality
Contrary to the commonly held belief that strong economic growth raises living standards across the board, fast-growing economies are among the world's worst in terms of nutrition.
South Asia is a prime example, with the prevalence of underweight adults remaining similar over the years at around 20.5%, despite steady economic growth: the region's per-capita income increased from $81 in the 1960s to $1,637 by 2016.
Gender inequality affecting nutrition is also common in some countries, with higher rates of malnutrition among girls than boys.
Furthermore, malnutrition is often multi-generational, as women in affected countries tend to be lowly educated also make poor nutritional choices for their children, hampering their mental and physical growth in the long-term.
The authors emphasised the need for government action, saying, "Countries that have successfully reduced malnutrition have done so through concerted government action and outreach, rather than relying solely on the trickle-down effects of economic growth."
Media and consumption
Beyond traditional advertising channels like print and TV, the 'food-sharing' trend on social media further encourages consumption, and even influences food choices and how they are perceived.
The report stated that in some Asian countries fast food was 'aspirational' for the growing middle class, despite being more often consumed by lower-income individuals in Western countries.
The authors added: "As social media increasingly becomes a key form of engagement between consumers and stakeholders in the food industry, opportunities for firms to advertise more effectively will arise.
"However, there will also be a corresponding need to monitor and regulate this space."
Triple solution for a double challenge
In order to overcome the 'twin challenges' of under-nutrition and over nutrition in Asia, the authors suggested three key courses of action, the first being food fortification.
With malnutrition rates — particularly among women and children — soaring throughout South Asia, repeated government efforts in India, Pakistan, Bangladesh and Sri Lanka have been made to provide fortified crops and staple foods to those who need it.
The implementation of such programmes has not been wholly successful so far, with issues such as logistics and questionable industry practices hampering progress.
As such, the report highlighted ready-to-use therapeutic foods (RUTF) for their convenience, long shelf-life and nutrient-dense content. Enriched with essential vitamins and minerals, RUTFs require no preparation, making them suitable for consumption in poor sanitary conditions.
The authors added that there were "opportunities for companies, NGOs and governments to advance food reformulation to tackle specific nutrient deficiencies".
At the other end of the spectrum, global F&B firms have been engaging in product innovation and reformulation to introduce low-fat and low-sugar versions of their products.
Secondly, the authors recommended a shift in focus to affordable yet high-quality food, as urban residents' access to nutritious food largely depends on income, location, and sourcing and cooking opportunities.
This has resulted in pockets of urban poor who are unable to access and / or afford nutritious, high-quality food.
To tackle the issue, the authors suggested improvements in sanitation, largely because recurring diarrhoea — a common issue where sanitation is lacking — contributes to child under-nutrition and stunting in urban slums.
In terms of dealing with obesity, they recommended a public initiative to reduce the amount of fatty, sugary foods sold at eateries, using Singapore's Healthy Hawker Programme as an example.
They further wrote: "Any regulations that improve the transparency of product labelling or restrict the advertising of non-core food products would also have an impact in cities, where food marketing is more pervasive.
"There are also opportunities to support urban farming, which is already popular in cities such as Singapore, Tokyo, Shanghai and Beijing."
Last but not least, the authors suggested widening the scope of health and nutrition policies which should vary from "prescription to advocacy".
Citing widespread support for and tangible results of public initiatives — including school food programmes and maternal education — they encouraged more child-centric interventions, such as "universal salt iodisation, disease management education for mothers, vitamin A 'megadoses', iron supplements and deworming".
On the other hand, the authors wrote that policies to combat obesity tended to be more complex, with a need for certain interventions to be customised for specific Asian markets in order to be effective.
Additionally, they noted that policies aimed at boosting the health of children in early life should be prescriptive, such as governments adopting best-practice codes to encourage exclusive breastfeeding, which has anti-obesity effects.
They concluded: "Interventions that restrict the availability of high-fat and high-sugar products in school environments, and promote exercise and nutritional awareness, are advised, as is investing in exercise infrastructure in schools.
