The Lancet is a world-renowned journal of medical science and research. In its recent issue, it drew our attention to the twin problems existing in the arena of in health and nutrition. The low and middle income countries, judges the journal, seemingly stand in a dilemma driven by the existence of the twin crises of obesity and malnutrition. These countries are struggling hard to solve the problems simultaneously (The Lancet "The double burden of malnutrition", December 15, 2019).
As far as our knowledge goes, the report has been produced with the help of the World Health Organization (WHO) to reveal that about 2300 million (230 crores) adults and children of the world are prey to pernicious obesity; physical growth of 150 million children is reported to be retarded due to malnutrition. Out of 130 low- and middle-income countries considered, about one-third is observed to be severely subject to those types of illnesses. Because of the two problems emerging together, scientists ascribe them as 'double burden of malnutrition' (DBM) -- 20 per cent people in those countries being stunted, 30 per cent of children under four years of age facing retarded physical growth and 20 per cent of women wasted.
It is a matter of grave concern that, living under the same roof, mothers face obesity while their children face malnutrition, somewhat akin to 'haves' and 'have-nots', but both driven to early deaths. The far-reaching impacts of twin trouble on health system and productivity are possibly not far to seek. Apparently it generates a 'vicious circle of poverty' or 'poverty trap' of a kind where poor health condition - be it obesity or malnutrition - leads to lower income and lower income produces poverty. If mother suffers from acute malnutrition, then she gives birth to malnourished children who again assume malnourished motherhood to produce malnourished children. So the poverty trap is in evidence. Once a generation is malnourished, the future generation follows. However, the earlier divide between rich and poor countries in terms of obesity and malnutrition respectively seems to have withered away as both now face the same fate. According to the Lancet, physical growth of 150 million children is being retarded, overweight and obesity are spreading fast all over; out of each five deaths of adults, one owes to sub-standard and poor quality diets.
The reasons for the double burden of malnutrition are adduced to food habits, apathy to physical labour such as less walking and manual labour in the wake of growing modern technology, while rising consumption of salt, sugar and fat-laden cheap and tasty food intake.
The authors of the research reckon that, reducing malnutrition is a result of 'one-size fits all policy'. It calls for a change in food systems both in rich and poor countries. Only a change in the food system could pull the world out of the crises. They point to the reality that no more holds the idea that rich countries fall prey to obesity and poor countries to malnutrition. Present food habits are not healthy, safe and sustainable.
Three points to ponder upon: (a) both obesity and malnutrition are products of poor (unhealthy) diets and diet quality assumes entry point for improved health. And healthier diets stem from safe and secured food systems. A diet deficiency in macro and micronutrients impedes physical and cognitive development, contributes to ill health, low productivity and low wages. Thus production per se is not of capital importance as "quality diets comprise food that is safe and sufficient in terms of quality and quantity, providing individuals with essential nutrients in appropriate amounts"
Research on food systems in Bangladesh is very rare if not absent. The sporadic attempts by researchers centred around mostly demand and supply side spectrum of the system with scant attention to other determinants but concentrating only on production and consumption of different types of food crops and their correlates. A holistic approach to healthy diets that would stand out as deterrents to obesity and malnutrition - requires an in-depth and integrated analysis of the various drivers driving on the roads to healthy food system.
Bangladesh is one of the fastest growing economies of the world. Directly or indirectly, the economic transformation has been leading to a food system transformation - nay dietary transitions - fuelled by many factors such as urbanisation (39 per cent of population living in cities), change in life styles pari passu increase in per capita income, growth of unregulated fast food market, role of super markets in the supply chain, out of home meals, climate change affecting agricultural system, declining consumption of grains but increased consumption of non-grain foods such as meat, eggs, vegetables, fruits etc.
Therefore, with a view to reducing obesity and malnutrition in Bangladesh particularly, food system research should be at the top of research agenda. It should include, inter alia, production and consumption patterns, storage and transport facilities, processing activities and regulations concerning safety, consumers' preferences, market monitoring, knowledge and norms, food habits, cultural milieu, trends in prices of various types of commodities - all need to be on board to pour more nutrition-dense food on the plate.
In every stage of production, marketing, storage, processing, transportation, cooking and consumption, food value could be increased or wasted or nutrition density diminished with obvious consequences of obesity and malnutrition.
Abdul Bayes is a former Professor of Economics at Jahangirnagar University, and currently an adjunct Facuty of East West University. [email protected]
