11:30 – 1:00 PM PANEL II: Addressing the Double Burden

The double burden of obesity and chronic undernutrition, which arises from urbanization, demographic shifts, and changing dietary patterns, affects as many as two billion people around the globe. It also places particular demands on food and public health systems and will require a well-crafted response from local farmers and the global food industry. This panel will examine some of the important questions around these issues.

Moderator:
Raj Patel, Author of Stuffed and Starved

Panelists:
Tom Arnold, Concern
Barry Popkin, Carolina Population Center
Marie Ruel, International Food Policy Research Institute
Paulus Verschuren, Unilever
Walter Willett, Harvard University

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Raj Patel is opening the panel, by saying the reason we have a food crisis is not because of a shortage of food but because of poverty. He is introducing the panelists.

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Tom Arnold is giving a historical perspective of the double-burden. We face a lot of the same issues now, but in addition we have the issue of climate change. The food problem has become a political problem and a security problem.

Can we see this food crisis as an opportunity?

Some positives:

• Developing a broader and deeper consensus on the framework in which:

1. Agriculture and rural development needs higher level of prominence.
2. Understand that food security is not nutrition security.

• New forms of partnerships are emerging.

Some negatives:

• Money has not come through.
• It will be harder to solve this crisis under the financial crisis we are under. Needs to be more burden-sharing, in particular from oil companies.
  

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Barry Popkin is now giving the Average Annual Changes in Under- and Overweight Prevalence, in China and Vietnam in the 90s:

It's a complex issue of both undernourished and overweight people, at times in the same household.

What are the commonalaties?

• Breast-feeding certainly for undernutrition, possibly for overnutrition – complex set of issues that relate partially to the food industry side.
  
• Proper weaning food and proper growth pattern –increasingly is seen as important for adult health and certainly for stunting, undernutrition in Africa and South Asia. Question of healthy protein rich, supplements vs empty calories starchy staple gruels—no food industry role.
• Clean, sanitary water supply and environment – offsets need for caloric beverages.
• Adequate maternal nutritional status – South Asia major issue linked with low birth weight.
• Farming systems: need to get back to legumes, cheaper protein sources, coarse grains and reduce milling.

We have a dilmma. In India, increased bmi (body-mass index) is leading to diabetics or pre-diabetics.

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Marie Ruel is now giving a talk on Fostering Synergies between Agriculture, Health & Nutrition.

Global integration – across national borders – of production, processing, marketing, retailing and consumption of agricultural and food items has led to the double-burden.



We need to encourage collaboration between agriculture and health:

Will the Global Food and Fuel Price Crisis Reduce the Pace of the Nutrition Transition?

• Health problems presented by the nutrition transition will easily get forgotten.
• Assumption: return to more traditional diets.
  
• But who will reduce meat, dairy, fruit & vegetable consumption?
• What cheap foods will be available for the poor? Soft drinks (Mexico in the 90s), processed meat or snack foods.
  
• Given fuel prices, need for convenience: snack, ready-to-eat foods become even more attractive
  

What is the way forward:

• Orient national policy frameworks to promote synergies between agriculture and health
• Join efforts on problems: that require joint solutions and for which there are tangible solutions, amenable to change (E.g. fruit and vegetable schemes: bringing producers directly to poor consumers or public procurement (schools, hospitals)
• Need local solutions but with a global and national policy framework that creates incentives for better collaboration.
  

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Paulus Verschuren is addressing the double burden, stressing that we need to link business and the public sector to benefit both.

Corporate philanthropy is NOT a solution: 

• Cheque book approach is not sustainable/scalable.
• Malnutrition challenges are strategic business opportunities.
• Integrate economic and social issues in business agendas.

Partnerships are inevitable: 

• None of us is as smart as all of us ( Tex Gunning – former Unilever GVP SEA). Need to work together to find solutions that are sustainable and scalable.
  
• Bridge the gap what we do alone today and can do tomorrow together.
  
• Move from isolated projects to system change initiatives 

Double Burden deserves a single approach: 

• Bring better nutrition balance in product offerings.
  
• Develop coherent behavioural change programmes.
  
• Create local solutions that fit community needs and wants.

We need to bring under and overnutrition into one single approach. We need to experiment, learn and adapt.

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Walt Willett is now stressing diabetes as an indicator of the overall health system. There are four main dietary factors:

Soda and sugar-sweetened drinks contribute directly to obesity and also to diabetes by virtue of their high glycemic loads.

The Global Industrial Diet:

• Refined starch
• Sugar, especially beverages
• Trans fat
• Few vegetables

Add to this inactivity (television) and it becomes the perfect recipe for type 2 diabetes. It's a disease that can be easily treated with simple life-style choices, "The Global Quality Diet":

• Whole grains
• Low sugar (soda = tobacco)
• Nonhydrogenated vegetable oils
• Legumes, nuts, poultry, fish, dairy
• Some vegetables

And then add to this walking and biking and exercise.

The question is how do we get from the industrial diet to this global quality diet?

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QUESTIONS FOR THE PANEL:

Raj Patel is asking a question about political will and consensus. Why do we face the double-burden?

Tom Arnold: We can explain the burden of obesity and undernutrition individually, but the question is how to explain the connection? In both cases we need to put more emphasis on prevention. In regards to political will and food aid, we need to get away from the vested interests.

Barry Popkin: We're not talking about hunger and obesity co-existing, but the persistence and increase in obesity. We've had a globalization and modernization of food system. Mass media has had an impact. There's a lot of pieces around technologies and other areas that are hard to understand and we shouldn't point fingers at one thing (like soda) without understanding how all pieces fit together.

Paulus Verschuren: There is a gap in knowledge and offerings. Food industry has an important role to play in bridging this gap.

Walt Willet: Reiterates what others said about the multi-faceted nature of the double-burden. But in addition he brings up marketing forces. Marketing is ratcheting up and children becoming more and more vulnerable.

A Q&A then ensued. Derek Yach asks, what can we do to in marketing to kids and product labeling?

Paulus Verschuren: Need to divert marketing efforts to educational programs to change behavior in a positive way.

We are now breaking for lunch...