Child Malnutrition in the 21st Century

By good chance, World Obesity Day (October 11th) has been launched just two weeks after the publication of the Global Nutrition Report, and at a time when the United Nations assembled to discuss sustainable world development targets for the next decade and beyond. This has brought media attention to the emerging patterns of children’s under-nutrition and children’s overweight and the nature of global food supplies – and not a moment too soon.

The good news is a decline in childhood under-nutrition: not as rapidly as hoped for, but the statistics are certainly travelling in the right direction. The bad news is that, while infant obesity levels appear stable over the last few years, several studies are showing a rise in overweight and obesity for school-age children. The statistics are travelling in the wrong direction, and most noticeably in the newly emerging economies of Latin America, the Middle East and Southern Asia.

Dietary surveys in developing countries around the world show the nutrition transition and its effects on population diets: for example, in Mexico, in 2012, the two largest contributors to children’s energy intake were milk (much of it sweetened milk drinks) and sugar-sweetened soda, for all children aged 1-19 years

Among school-age children in the Middle Eastern region, significant numbers are failing to eat a healthy breakfast: 32% of children in UAE aged just 6-7 years said they missed breakfast completely, rising to 50% among children aged 10-15y in Bahrain, and 74% of girls in Saudi Arabia aged 12-16y. Children who miss breakfast are more likely to seek snacks or sugary drinks on the way to school or during school breaks, and to have less healthy diets generally and at greater risk of obesity.

A survey among pre-school children in Jordan found more than 50% consumed carbonated sugary beverages, and 71% regularly consumed biscuits and cakes, and 76% confectionery. These children also consumed other sugar-sweetened soft drinks, a high quantity of desserts, and tea with sugar.

While concerns about child nutrition remain dominated by the language of under-nutrition and the adequacy of food supplies, these problems will only get worse. A focus on nutrient deficiency serves to justify the expansion of markets for processed food, especially food products with added fortification. But there is an urgent need to re-frame the discourse to take account of excess consumption of fats, salt, sugars and over-processed products, and for these products the message is now ‘eat less’. Such a message fits with improved health, with better environmental sustainability, less degrading agriculture, less atmospheric pollutants, reduced global warming – but it does not fit with continued market freedom.

The UN Committee on World Food Security recognises the importance of nutrition security but does not address some of the main threats to nutrition security. While the determinants of nutrition security include the determinants of food security (sustainable and adequate supplies, widespread availability, and affordable and accessible to all) nutrition security must also take account of the determinants of consumer behaviour and consumption patterns, including household distribution of foods, cultural practices, education and skills, information, product labelling, product promotion and persuasive marketing practices. These all determine what is actually eaten, and hence the health outcome.

Nutrition security depends critically on whether markets and marketing activities are promoting or impeding healthy dietary behaviour, and supporting or undermining optimum nutrition for each individual. Experience from the promotion of infant formula products suggests that, while marketing practices might have the potential to support nutrition security, in practice they make matters much, much worse.

As the Global Nutrition Report concludes, holding food companies to account for their actions, especially their impact on diets, will be a big step forward. It is an essential step to ensure that future generations of children can enjoy optimum health.