Teresa Welsh :
Every country in the world experiences the burden of malnutrition and many nations now see a compounding of different forms including stunting, wasting, anemia, and obesity, according to the “2018 Global Nutrition Report.”
Child stunting, anemia in women of reproductive age, and overweight in women were examined in 141 countries that had consistent data on those malnutrition indicators. Findings show 88 percent (124 countries) have high levels of at least two different types of malnutrition, while 29 percent have high levels of all three.
“The global burden is unacceptably high. This is not new information in the sense that we have said this every year since 2014,” Corinna Hawkes, co-author of the report, told reporters on a conference call. “It’s not just that we’re seeing different forms of malnutrition, it’s that every country in the world is affected. So this is not just a problem that affects the poorest countries in the world. It affects everyone. When you start to pull together all those different forms of malnutrition, irrespective of wealth, every country has a problem.”
Triple threat of stunting, anemia, and obesity poses looming crisis, health experts warn. Jessica Fanzo, senior nutrition officer at the Food and Agriculture Organization, discusses with Devex the findings of the “2018 Global Nutrition Report” and the challenges ahead, calling for disruptive and urgent action.
Compounding burdens particularly impact children, with 15.95 million experiencing both wasting and stunting, and 8.23 million experiencing stunting and overweight, according to the report, written by an independent group of academics, researchers, and United Nations experts.
The report aims to draw attention to current gaps in nutrition progress and identify ways to close them. Eight key nutrition indicators are off track to meet targets, according to the report: adult high blood pressure, adult obesity, adult overweight, anemia, childhood stunting, childhood wasting, childhood overweight, and salt intake.
Stunting in children under 5 is declining globally, but while in Africa it dropped to 30.3 percent in 2017 from 38.3 percent in 2000, the actual number of stunted children is higher due to population growth on the continent. Percentages in Asia and Latin America have declined.
Protracted conflict situations around the world also hamper nutrition progress. Humanitarians responding in such contexts have to tailor their nutrition approach to support longer-term nutrition resilience, in recognition that people may live in civil war or other unrest situations for a number of years, the report said.
In addition, the numbers show that without significant reversal of current trends, the world cannot meet Sustainable Development Goal 2 of ending hunger by 2030, nor the World Health Organization global nutrition targets by 2025.
The report finds that no country is on track to meet all nine WHO targets, while just five countries are on track to meet four, the largest number for which any single country is on track. One hundred countries are not on track to meet any.
There is also a significant financing gap, even though donors met and have exceeded the 2013 Nutrition for Growth Summit goal two years ahead of schedule. But total donor assistance remains low, the report found, which prevents countries who have developed nutrition-specific policies and targets from being able to deliver them.
Diet matters
For the first time, the report highlighted the importance of diet in combating malnutrition. Governments have a particular role to play here, Hawkes said, pointing to examples such as Mexico’s imposition of a sugar tax to decrease consumption of soda, in a region where 59 percent of children drink soda every day.
Hawkes said children’s diets “are in a terrible state,” with less than one-fifth eating a minimally acceptable diet and over 51 percent not getting the recommended minimum number of meals.
“If we don’t focus on diet, we’re absolutely not going to get there,” said Hawkes, who also served as a co-chair of the Global Nutrition Report Independent Expert Group.
“Adults who don’t eat healthy elements of a diet are losing life years and contributing to diet being one of the leading causes of death and disability in the world today, with 18.8 percent of all deaths being caused by poor diet. So these diets are crucial from a noncommunicable disease perspective, from an obesity perspective, but they’re also crucial for anyone who has any risk of malnutrition.”
Little progress is being made on obesity and diabetes because those challenges are relatively new to the nutrition landscape and have therefore received less attention from governments, Hawkes said. Overweight, defined as someone with a body mass index equal or greater to 25, and obesity, someone with a BMI equal or greater to 30, have been increasing each year since 200. More women (15.1 percent) are obese than men (11.1 percent).
The compounding of traditional forms of malnutrition such as stunting and wasting with obesity and diabetes is one reason the report recommends a new approach must be taken if the comprehensive nutrition landscape is to be improved.
“We need to think about nutrition in a holistic way rather than these single different problems,” Hawkes said. “We need to break down silos and develop comprehensive programs to tackle all forms of malnutrition. For too long, countries, donors, community-based initiatives have focused on one form of malnutrition. We need to have actions which are actually designed to tackle the forms of malnutrition which are there in that community, and may be overlapping in individual households.”
The report found that although progress is not on track to meet targets, the world now has more data on nutrition than it has ever before, which can be utilized to address remaining challenges. This information, particularly geospatial data, must be expanded and taken advantage of to change course, Hawkes said, because each country is different and needs a specialized strategy.
“Why are things not better when we know so much more than before? That is a question that we often grapple with,” Hawkes said. “Data collection can cost money and it needs investment, but it also needs to be communicated to the right people so that decision-makers have that data to hand.”
(Teresa Welsh is a reporter with Devex based in Washington, D.C).
