This week I attended the UK Nutrition Society meetings in
London. The theme of the conference was on nutrition issues in metropolitan contexts
(i.e. urban spaces).
Most of the
conference was focused on high-income country issues. I went because it was a new audience for me
and for GAIN.
The presentations in my session were on (a) the nutrition
case for and against the consumption of artificially sweetened drinks (Professor
Peter Rogers), (b) demand creation for water consumption (Dr. Emma Derbyshire)
and (c) how public policy can shape food landscapes (Dr. Amelia Lake). I spoke about the challenges and solutions in urban areas in low and middle income countries.
The first presentation was interesting as it tried to
separate perceptions from evidence about the consumption of artificially
sweetened soft drinks. Based on the
evidence presented, do they reduce overall calorie intake? (yes,
although we don’t know enough about long term effects on weight managment) and do
they develop an increased demand for sweetened foods? (the evidence suggests no). What was somewhat reassuring
about the presentation was the use of systematic reviews and the citing of
Barry Popkin’s work
(the guru: see “The World
is Fat”). What was less reassuring was that some of the research was funded
by the soft drink industry (as declared by Prof. Rogers at the start of his
talk). The work would have presented much
more powerfully if it had been more independently funded.
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| The Drink Up (water) talking fountain in the US |
The second presentation focused on how to increase water
consumption. Most people are below the daily recommended levels. The session included a couple of
innovative demand creation campaigns for water and for activity (Drink Up -Drink Water in
the US and the JOGG
“free movement” campaign in the Netherlands)—the videos were fun and
engaging. We need more of this in
nutrition in the lower and middle-income countries. Of course the question is what impact do the
campaigns have, especially after they end.
 |
| The Jogg "movement" campaign in the Netherlands |
Our BADUTA
project with the Government of Indonesia, has a strong behaviour change
component, and the project is showing good signs of changing behaviour and
increasing diet diversity (I have seen the first draft of the independent
evaluation by the University of Sydney—I will share it when it becomes publicly
available).
The third presentation was all about “foodscapes” (i.e. how does
the built environment shape the availability and affordability of healthy and
unhealthy foods?). Work was highlighted from an EU funded research programme called “Transforming
the Foodscape: development and feasibility testing of interventions to
promote healthier take-away, pub or restaurant food”.
Interventions piloted in
the North East of England included (a) Take Away Masterclass (working with
staff from 18 takeaways--180 were invited--on how to improve the healthiness of
cooking practices), (b) reducing portion size in fish and chip shops (working
with wholesalers to create smaller portion options with half the calories of
regular portions—there has been significant demand from customers for smaller
portion options) and (c) a desk evaluation of the offerings of “healthier”
flagship sit down/take away restaurants such as NOSH Healthy Kitchen (work not
completed yet). All very interesting and
all very disconnected from similar work that is happening in Africa, Asia and Latin America--which is a major missed opportunity for all countries.
In the Q & A session, Dr. Alison Tedstone, the Director of Public
Health England—the nation’s lead government agency for ensuring the health
of the English population—asked me about my presentation: how do we avoid “tinkering
around the edges” and zero in on the really big levers that can change food
consumption? She highlighted the effect
the soft
drinks levy on food manufacturers is having: they are changing their
product formulation to avoid paying the levy, and more importantly the dialogue
has changed completely, from foot dragging on voluntary codes to having to deal
with the implications of legislation. My
answer was that every context is different and some preliminary work has to be
done to find that lever—work which factors in technical, political and capacity
considerations. In other words there are bound to be lots of promising options to effect
change, but we need to look hard in a given context to find the best.
Other questions in the panel discussion related to (a) what
is the role of researchers in lobbying for change based on balanced high
quality evidence? (my answer: senior researchers should be active in advocating
for change, as long as they are faithful to the evidence), (b) how do we
persuade research funders to be more inclusive in their acceptance of a range
of evaluation methods that are driven by the issue and context rather than a
familiarity with and preference for a particular method? (my answer: again, use
the evidence to show that other methods can work and engage with funders to
show them the wealth of credible evaluative tools that are available), and (c)
do we focus on demand or supply to change food environments? (my answer: both).
I enjoyed the conference session. It was good to see the experiences from the high income countries and to think about how they may read across to countries that are trying to
avoid their fate. But it was a bit disappointing to see so few
people present working on these issues in low and middle-income countries. The
continental boundaries are really very hard to cross, it seems.
The convergence in malnutrition problems between the high,
middle and low-income countries continues at rapid pace (GNR 2016). We better make sure the convergence in problem
solving can keep up. In the SDG era, all countries have malnutrition problems
and all need to share the solutions.
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