When malnutrition is a double burden

THE World Health Organization (WHO) malnutrition overview[i] shows that, for every underweight adult around the world, four more adults are overweight and at risk of diet-related disease such as type 2 diabetes, cardiovascular disease and cancer. More than a third of them are obese.

Such statistics confirm what we now know to be true: that rising incomes, urbanisation, and round-the-clock access to convenience foods are not, in themselves, the road to better health. Those who are over-nourished can suffer nutritional deficiencies just as readily as those who go hungry. Within Southeast Asia, even the most robust of national food cultures face challenges to address this concern.

In the city, round the clock access to convenience foods is one reason consumers are not getting sufficient nutrients. (Photo: Dawn Balaban / Dreamstime.com)

Despite the significant differences in local dietary habits, all countries in the region – like many others around the world – face the double burden of malnutrition. Although, as a 2017 study[ii] commissioned by the Asia Roundtable on Food Innovation for Improved Nutrition points out, rates of obesity and overweight vary between men and women, ethnic groups and rural and urban dwellers.

Who’s responsible? 

WHO pinpoints increasingly sedentary urban lifestyles as one of today’s emerging nutritional challenges along with an influx of low-cost, high-energy foods – a knock-on effect of globalisation.

So, who’s responsible for it all? Is it the marketeers behind aggressive food and beverage advertising campaigns, as some suggest? Most importantly, can the problem of over and under nutrition be solved?

For Cyndy Au, regional director for regulatory affairs and product stewardship at DuPont Nutrition & Biosciences in Asia Pacific, these are questions that usually come up in media interviews. And, when they do, she refers to the many policies on the subject – launched by WHO, the United Nations, and by the governments of Singapore, Malaysia and Thailand, for example – all of which highlight the need for a multi-stakeholder approach. Governments, Academe, healthcare professionals, food manufacturers and ingredient suppliers each have a role.

“Obesity is multi-factorial. It is not ‘my issue’ or ‘your issue’. The key word in solving it is trust between the stakeholders, so they all acknowledge the efforts of others to make a change,” Au says.

“Having said that, food and beverage companies do have an obligation to respond to government and healthcare professionals’ calls for healthier food options, for example by producing foods that are reduced in salt, fat or sugar or have a higher content of essential nutrients.”

Cyndy Au, regional director for regulatory affairs and product stewardship, DuPont Nutrition & Biosciences in Asia Pacific (Photo: DuPont)

Raising awareness

Public awareness campaigns on health and nutrition are equally important in bringing about change. Au stresses that such campaigns should be aimed at the general public, and in parallel, to educate food outlets. Data have shown that most people in urban cities in Southeast Asia consume freshly cooked foods at these outlets or at hawkers for main meals. In many parts of Southeast Asia, she explains, it is these outlets, and not packaged foods that make up the biggest part of consumer diets.

“Street food outlets contribute a huge proportion of the daily energy and nutrient intake. It would make sense to focus on these vendors to encourage the use of healthier oils and less salt and sugar in their food preparation.”

A healthy influence

While food and ingredient manufacturers have no direct responsibility for street food outlets, they can have an influence on consumer habits by participating in local consumer education initiatives and working with policymakers and health professionals to set new national standards for healthier foods and beverages.

Au names the International Young Food and Nutrition Leadership Program (iYouLead) organised by the Federation of Asian Nutrition Societies as one possibility. As she says: “Having great food and nutrition knowledge is not enough. Current and future leaders must be able to communicate the benefits clearly to nudge the public to change their behavior.”

DuPont is one of the founder members of the iYouLead network and, among other activities, has participated in public food education programmes in collaboration with the national food and nutrition societies in Malaysia, Indonesia, and Vietnam.     

It is positive initiatives like these that, Au believes, are likely to have a bigger impact than the introduction of punitive measures, such as taxes on sugar. Why not, for example, introduce tax incentives for food manufacturers that produce healthier, more nutritious products or for workplaces that encourage their staff to choose a healthier diet and take regular exercise?

National initiatives

Singapore is one of the countries that has long made tackling the double burden of obesity and undernutrition a priority. In 1992, the Ministry of Education introduced its Trim and Fit program[iii] to target child obesity through education about nutrition and physical exercise. Consumers are also guided by the ‘Healthier Choice’ symbol to packaged foods that are a more nutritious alternative to other products in the same category. Other initiatives include the Healthier Dining Programme, which has improved access to healthier dishes in restaurants, and the National Steps Challenge, which encourages more physical activity among the general public[iv].

Since 2012, food manufacturers have supported the Singapore government’s health agenda by using the Guideline Daily Amount label to show nutritional content on product packaging. National and international companies have further undertaken a voluntary pledge to ensure responsible advertising and marketing to children.

Another proactive example is Malaysia, which has the highest obesity rate in Southeast Asia. The Malaysian government launched a nine-year nutrition action plan in 2016[v]. Following the example set by Singapore, this includes implementation of the Healthier Choice logo and Guideline Daily Amount labels along with a sugar tax on beverages, introduced in July 2019.

According to research by IGD in association with Food Industry Asia, consumer health awareness is relatively high in Singapore, Malaysia, India and Thailand[vi]. However, consumers also believe eating healthier foods is more expensive – a barrier which manufacturers can overcome by developing more nutritious mainstream products that the average consumer can afford.

Reformulate and innovate

There are many possibilities within reach. Ingredient companies like DuPont, who place science, innovation and insights at the forefront, have developed nutritional solutions for the food industry.

Today, clinically proven probiotic cultures are available to help consumers manage their weight and improve their digestive health – the latter being an excellent starting point for improved wellbeing overall. Plant-based proteins such as soy have proven effective in supporting healthy weight loss and building muscle mass in combination with regular exercise. And then there are dietary fibres that contribute to longer-lasting fullness after a meal, resulting in lower calorie consumption during the course of a day.

With sugar taxes now in force in Malaysia, Thailand and other markets around the world, ingredient suppliers have developed technology to enable sugar reduction in a wide number of food applications without compromising taste.

“We see a growing number of food manufacturers in Southeast Asia working on reformulation and innovation projects to reduce salt, sugar and fat and add positive nutrients to their products. Sales are growing. But the biggest potential to overcome the overnutrition challenge is when innovation is accompanied by national initiatives to encourage healthier lifestyles,” says Au.

Out of the silos

Since the founding of the Asia Roundtable on Food Innovation for Improved Nutrition[vii] in 2015, partnerships and innovation have been key words in the roundtable vision. The goal is to bring together experts from governments, academia, industry and civil society to stimulate multi-stakeholder dialogue and strategies for driving food innovation and a positive change in consumer behavior. Based on the current initiatives in Southeast Asian countries, new product development by food manufacturers and the availability of documented ingredient technology, all the enablers of change appear to be there.

But, Au says, there is still much more work to be done – by partners in collaboration. “In partnership, the region can accelerate and make significant progress in addressing over and undernutrition. This and more investment in intervention programs are essential to make a true difference,” she concluded.