An Examination of Malnutrition and Obesity in Developing and Industrial Countries
Two food-related epidemics – obesity and malnutrition – are currently plaguing the world. In the 1970s, malnutrition (defined as having a BMI of 18.5 or less) was a major problem facing developing countries particularly in Africa and South Asia. In the present times, developing countries face simultaneous problems of malnutrition and obesity (defined as having a BMI of 30 or higher). Industrialized countries, such as most North American and European countries, in contrast have been facing an obesity epidemic since the 1970s but still must deal with malnutrition in certain sectors of the society. An examination of the prevalence of these food-related epidemics, their causes, as well as some of the policies that have been enacted in order to address these issues will reveal that obesity and malnutrition are not problems that must be addressed in different ways. Rather, the same techniques can be used to combat these epidemics that have severe global consequences.
According to data collected by the Food and Agriculture Organization of the United Nations, 820 million people in developing countries were undernourished in the years 2001 to 2003. An additional 2.5 million in transition countries (former member of the Soviet Union) and 9 million in industrial countries were undernourished in the same years (Pinstrup-Andersen, 2007, 98). Globally, 1.3 billion people were estimated to be overweight (BMI of 25 or higher), with obesity rates in developing countries now rivaling those in industrial countries (Popkin, 2007, p. 88).
With such high levels of malnutrition affecting the world, researchers have intensively studied the causes of this epidemic. Smith (2000) examined malnutrition in the developing world and identified three levels of causality of malnutrition (immediate, underlying, and basic). Immediate causes include dietary intake and health status. Underlying causes include food security (and availability), adequate care for mothers and children, and proper health environment. Basic causes consist of the amount of potential resources available to a country or community. This three-fold model maps onto Pinstrup-Andersen’s (2007) identification of two major subtypes of malnutrition, with Smith’s first two categories corresponding to chronic malnutrition (caused largely by poverty) and the third corresponding to transitory malnutrition (caused by natural or human-made disasters).
Similarly, the causes of obesity have been investigated. Drewnowski (2004) noted that the behavioral, physiological, and biological causes for obesity have already been extensively studied. His study was the first to address the influence of economics on the obesity epidemic. Since Drewnowski’s study, others have found particularly strong correlations between poverty and obesity, both in developing and industrial countries (Monteiro et al 2004, Popkin 2007). In examining obesity levels in developing countries, Popkin (2007) has identified the three primary contributors to the obesity epidemic that have led from economic considerations: growing presence of supermarkets, shift to energy-dense foods, and increased consumption of animal-source foods. As the reasons underlying malnutrition and obesity are numerous and varied, only issues related to the amount and types of available foods can be considered in this paper.
As global supplies of food are sufficient to meet the world’s population (Pinstrup-Andersen, 2007), the major problems facing developing countries in terms of malnutrition are insuring that the food is well-distributed and insuring that populations have access to balanced diets as one severe consequence of malnourishment is micronutrient deficiencies. Rose (1997) found that food insufficiency was significantly associated with low intakes of energy, protein, calcium, magnesium, and vitamins A, E, C, and B6. These micronutrient deficiencies can cause severe long-term health consequences. Black (2003) remarked that iodine deficiency leads to cretinism; iron deficiency causes iron deficiency anemia, early neonatal mortality, and maternal mortality; vitamin A deficiency causes blindness, death, and decreased resistance to measles and malaria); and zinc deficiency causes impaired growth in children, decreased resistance to infectious disease, and death. Therefore, a major concern that needs to be addressed in formulating policy to alleviate global levels of malnutrition is the ensuing micronutrient deficiencies.
It appears that efforts to provide food to developing countries have swung the pendulum from malnutrition to obesity due to the quality of available, affordable food. Drewnowski (2004) found that energy-dense foods represent the lowest cost option to consumers, as agricultural and technological developments have created an abundance of these foods which often have a more stable shelf life than fresh fruits and vegetables. Therefore, if money is short, people will choose energy-dense foods over healthier options. The importance of energy-density for BMI levels stems from the fact that “people consume a constant volume of food at a given meal such that the energy density of foods determines the amount of energy consumed” (Drewnowski, 2004, p. 7). Examples of energy-dense foods would include the potato chips, chocolate, and doughnuts so prevalent in industrial countries. Developing countries have seen a rise in the availability of cheap, energy-dense oils. Popkin (2007) noted that the consumption of these energy-dense vegetable oils (soybean, palm, and corn) has dramatically increased in developing countries, and is one of the primary causes of the obesity epidemic in these countries.
In addition to the problem of cheap, energy-dense foods flooding the market, practices related to agricultural subsidies have altered eating practices in developing countries. Pinstrup-Andersen (2007) noted that markets in developing countries need to increase their supplies of protein in order to provide the possibility of more balanced diets for the consumers. While this is no doubt the case for smaller, independently-owned markets that Pinstrup-Andersen examined, Popkin (2007) found the opposite to be true when looking at the types of food available in large supermarkets in developing countries. In these large supermarkets, animal-source foods (meat, eggs, and dairy products) are quite affordable, as funding has shifted to these industries since the world’s supply of grains and tubers has stabilized. Popkin (2007) asserted that the levels of animal-source food consumption in the developing world are not only contributing to the obesity epidemic but also rapidly increasing the consumption of saturated fat, which is known to increase the risk for heart disease.
In terms of fighting these epidemics, considerable progress has been made in decreasing levels of malnutrition in developing countries (though, as it has been shown, this has in some cases had the opposite effect of causing obesity epidemics in these same countries). Smith (2000) found that most of the efforts to increase food availability have been largely successful, but that there is a cut-off point at which this strategy ceases to have an impact on malnutrition levels. Once a daily-energy supply (DES) of approximately 3,120 kilocalories (average for the entire country) is reached, further increases in food availability are unlikely to effect malnutrition levels. At this point, attention must turn to the quality of the food that is available.
Several researchers have noted that transgenic crops could be instrumental in changing the situation in developing countries (Pinstrup-Andersen 2007, Raney & Pingali 2007). According to Raney and Pingali (2007), the benefits of transgenic crops include increased yields, lowered pesticide use, less dependence on weather factors, and potentially higher nutrient value. These benefits would go far to addressing both the transitory malnutrition that results from drought condition as well as the micronutrient deficiencies that often accompany malnutrition. Golden Rice, in particular, has been specifically designed to combat vitamin A deficiency (Raney & Pingali 2007).
Other efforts to combat micronutrient deficiencies include the introduction of iodized salts in iodine-deficient areas and providing dietary supplements (Black 2003). Black (2003) cautioned that treating micronutrient deficiency is not as simple as providing access to dietary supplements as micronutrients often interact with each other. For example, while vitamin A might aid in iron absorption, iron and zinc interfere with the absorption of each other.
One idea for fighting the global obesity epidemic would also have a large effect on levels of malnutrition and micronutrient deficiency. Popkin (2007) has advocated the revamping of agricultural subsidies in order to increase production of fruits and vegetables. He advised that the United States and other nations should re-allocate the billions of dollars currently given to agribusinesses growing grain for livestock use and redirect these funds to farmers who produce fruits and vegetables. This policy would increase the amount of produce, thereby decreasing the prices on the world market. As economic factors have been frequently cited as contributing to malnutrition and obesity, Popkin’s plan has considerable potential for reducing the prevalence of both diseases.
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