What the rising level of obesity says about the food system

It is the crudest expression of global dysfunction that the world produces enough food to feed us all, yet undernutrition and obesity coexist. 

In 2021, nearly half the global population is affected by malnutrition in one of its forms. And while it remains shocking to see a growing number of children stunted from undernourishment, the balance has shifted: more deaths result from overweight and obesity globally than underweight. Furthermore, people are now affected by multiple forms of malnutrition; for example, an individual can be simultaneously affected by obesity and deficient in essential micronutrients.

The international community needs to transform the type of food systems that have created this situation into ones that nourish, sustain and allow all people to thrive while living within our planetary boundaries.

As the number of people affected by obesity increases in nearly every country in the world, particularly in low- and middle-income countries, governments must work with actors across the food system to reverse this trend and redesign food systems to deliver human as well as planetary health.

Once considered a high-income country issue, obesity is a growing challenge for many lower income countries. The number of overweight children under five in Africa has increased by nearly a quarter since 2000, while almost half of children who were overweight or living with obesity in 2019 lived in Asia.

Obesity is a disease and also a risk factor for other conditions. Rising global obesity levels are bringing associated increases in non-communicable diseases, such as diabetes, heart disease and some cancers across the world.

But in order to tackle obesity, we must first understand its causes. An overreliance on refined carbohydrates and other energy-dense, highly processed foods that are often the most affordable and available option for poor consumers, is contributing to the rapid rise observed in lower income countries. Such energy-rich diets often lack other important nutrients, leading to the coexistence of obesity and malnutrition in the same individuals, that contribute to ill health.

However, the roots of obesity are complex and include genetics and biology, as well as diet and environmental factors. Food environments are influenced by the marketing of unhealthy products to children, as well as agricultural policies, climatic conditions, cultural and social factors such as women’s access to markets and policies that impact trade. 

The UN Food Systems Summit, which Dr. Agnes Kalibata is involved in helping to coordinate, provides a once-in-a-generation opportunity to understand these cross-cutting contributory factors and align solutions to the twin challenges of human and environmental health by paving the way to improve food systems in every aspect from production to consumption. The summit will take place later this year.

Crucially, the summit will provide an open forum for all players — consumers, people in society and health professionals — throughout the food system to share their ideas and insights. By engaging the broadest cross-section of society around key action areas, the summit will set out game-changing solutions for governments and other actors to consider in order to advance more inclusive, nourishing, sustainable and resilient food systems. 

The summit is designed to help progress towards the Sustainable Development Goals (SDGs) and highlight a number of efforts already underway. First, efforts to end malnutrition in all its forms must start before birth. The first 1,000 days are a defining period for healthy child development, with undernutrition at this time associated with an increased risk of obesity later in life.

Second, governments have a crucial role to play in improving nutrition in a child’s  early years by promoting breastfeeding as humanity’s first food system, and preventing the marketing of breast milk substitutes to vulnerable women.

Moreover, to breastfeed successfully, mothers must be healthy and well-nourished themselves, which remains a challenge in contexts where girls and women are the first to forego meals when times are hard. This is why it is important that the Food Systems Summit recognizes gender equality and women’s empowerment as one of four levers of change, which has the potential to make or break food systems transformation, along with human rights, innovation and finance.

Alongside solutions to improve nutrition and gender inequality, action on climate change is urgently required to ensure food systems are resilient and sustainable. Recent research shows how food systems underpin the triple threat, or syndemic, of obesity, undernutrition and climate change, generating approximately a third of greenhouse gas emissions (GHG).

To transform the food systems that define global health, the summit must deliver on “triple-duty actions” that address trade-offs and get the world back on track for achieving the SDGs.

The COVID-19 pandemic has only amplified the urgent need for the summit, shedding light on the links between health and food systems and how both can make people and the planet sick. 

In the wake of the pandemic, there is a renewed appetite for change. The World Obesity Federation’s new Atlas shows how the COVID-19 death rate is 10 times higher in countries where more than half of the population is overweight. It should be noted that one of us, John Wilding, serves as president of the World Obesity Federation. More than 2 million of the 2.5 million global deaths from COVID-19 were in countries with high levels of obesity.

Addressing obesity is thus not only important from a food and nutrition perspective, but also as a key strategy for building resilience and preventing future pandemics.

Dr. Agnes Kalibata is the special envoy of the UN Secretary-General for the 2021 Food Systems Summit. John Wilding is a professor at the University of Liverpool and the president of the World Obesity Federation.