The Nutrition Transition in High and Low-Income Countries: What are the Policy Lessons?

The world has seen a remarkable shift from a period when diets, activity patterns and body composition were characterized by the period termed the receding famine pattern to one dominated by nutrition-related non-communicable diseases (NR-NCDs). This presentation first examines the speed of these changes, summarizes dietary changes, and provides some sense of the way the burden of obesity is shifting from the rich to the poor not only in urban but also rural areas throughout the world. The focus is on the lower- and middle- income countries of Asia, Africa, the Middle East, and Latin America but some examples will come from the United States, Australia, and the UK. After showing that changes are occurring at great speed and at earlier stages of countries' economic and social development, the presentation shifts to some of the critical policy opportunities and some example of options. Few policy lessons exist at a macro level outside of selected countries such as South Korea and Finland. Examples of ways price policy and other options might work, using Chinese longitudinal case studies, are presented. The challenge is for the agricultural economics profession to focus on this major global issue-one which challenges some of the earlier paradigms of food policy an agricultural development.diet composition, price policy, economic growth, health effects, Food Consumption/Nutrition/Food Safety,

The Healthy Weight Commitment Foundation Pledge Calories Purchased by U.S. Households with Children, 2000–2012

ContextAn independent evaluation of the Healthy Weight Commitment Foundation (HWCF) marketplace pledge found that the participating companies met and exceeded their interim 2012 sales reduction pledge.Evidence acquisitionThis follow-up study conducted in 2013 used purchase data from 2000 to 2012 among U.S. households with children and compared trends in calorie purchases of HWCF, non-HWCF name brands, and private label (PL) products in the pre-pledge period (2000–2007) and the post-pledge period (2008–2012); controlled for potential effects of concurrent changes in demographic and economic factors, including the Great Recession and food prices; and assessed whether the HWCF marketplace pledge was associated with reductions in consumer packaged goods (CPG) calorie purchases by households with children.Evidence synthesisThere has been a significant per capita decline in average daily CPG caloric purchases between 2000 and 2012 among households with children from all brand categories. Based on pre-pledge trends, declines in CPG caloric purchases were already occurring. However, post-pledge reductions in calories purchased from HWCF brands were less than expected, and reductions in calories purchased from non-HWCF name brands and PLs were greater than expected after economic, sociodemographic, and secular factors were accounted for.ConclusionsIf the 16 HWCF companies had been able to maintain their pre-pledge trajectory, there should have been an additional 42 kcal/capita/day reduction in calories purchased from HWCF products in 2012 among households with children. A lack of change in total CPG calories purchased between 2011 and 2012 calls into question the sustainability of the decline and a need for continued monitoring

Understanding changes in diet, physical activity and weight among adults in China

China is facing a growing overweight problem in its adult population. This is a worrisome trend given its population size and the potential health care costs associated with nutrition-related non-communicable diseases. This trend has occurred together with changes in China's economic, social and physical environment. Hence, it is important to consider these factors in trying to understand what determined the changes in diet and physical activity, and thus the increases in weight. This dissertation first looks at how various dimensions of urbanization are associated with declines in physical activity. Second, it addresses how price and income changes might have contributed to dietary changes over time. Third, I apply a dynamic panel model to determine the degree to which physical activity and dietary choices affect weight change over time. I found that physical activity declines are strongly associated with greater availability of higher educational institutions, housing infrastructure, sanitation improvements and economic well-being of the community in which people function. These urbanization factors are associated with four-fifths and two-third of the decline in occupational physical activity for men and women, and 57% and 40% of the decline in total physical activity for men and women, respectively. Looking at food consumption, I found that changes in price elasticities are complex and are food-group and income-specific; income elasticities have fallen for most food-groups; rice has become an inferior good; and that the demand for pork was the most income responsive of these food-groups. I also found that dietary fat intake and declines in physical activities are positively related to weight gain among men, and that 30% of the weight gain was due to declines in physical activity, while 20% was due to higher fat intake. Given the rising overweight and obesity rates in China, these results suggest that policymakers should consider solutions targeting both physical activity and diets, as affected by the built and economic environment

The Nutrient Content of U.S. Household Food Purchases by Store Type

Little is known about where households shop for packaged foods, what foods and beverages they purchase, and the nutrient content of these purchases. The objectives are to describe volume trends and nutrient content (food groups and nutrient profiles) of household packaged foods purchases (PFP) by store-type

How should we evaluate sweetened beverage tax policies? A review of worldwide experience.

Funder: Bloomberg PhilanthropiesFunder: Bill and Melinda Gates FoundationFunder: Laura and John Arnold FoundationFunder: Consejo Nacional de Ciencia y TecnologíaFunder: Instituto Nacional de Salud PublicaOver 45 jurisdictions globally have implemented sweetened beverage taxes. Researchers and policymakers need to assess whether and how these taxes change beverage demand and supply, their intended and unanticipated health, economic and equity impacts. Lessons from such evaluations can maximise the policies' success and impact on non-communicable disease prevention globally. We discuss key theoretical, design and methodological considerations to help policymakers, funders and researchers commission and conduct rigorous evaluations of these policies and related disease prevention efforts. We encourage involving the perspectives of various stakeholders on what evaluations are needed given the specific context, what data and methods are appropriate, readily available or can be collected within time and budget constraints. A logic model /conceptual system map of anticipated implications across sectors and scales should help identify optimal study design, analytical techniques and measures. These models should be updated when synthesising findings across diverse methods and integrating findings across subpopulations using similar methods

Trends in racial/ethnic and income disparities in foods and beverages consumed and purchased from stores among US households with children, 2000–2013

Background: It is unclear whether racial/ethnic and income differences in foods and beverages obtained from stores contribute to disparities in caloric intake over time

Trends in added sugars from packaged beverages available and purchased by US households, 2007–2012

Background: The US Food and Drug Administration's updated nutrition labeling requirements will include added sugars starting in July 2018, but no measure currently exists to identify the added sugar content of products and what it represents among purchases. Beverages are one of the first targets for reducing added sugar consumption, and hence are the focus here. Objective: Our goal was to estimate trends in added sugars in nonalcoholic packaged beverage products available in the United States and to estimate amounts of added sugars obtained from these beverages given the purchases of US households overall and by subpopulations. Design: On the basis of nutrition label data from multiple sources, we used a stepwise approach to derive the added sugar content of 160,713 beverage products recorded as purchased by US households in 2007-2012 (345,193 observations from 110,539 unique households). We estimated the amounts of added sugars obtained from packaged beverages US households reported buying in 2007-2008, 2009-2010, and 2011-2012, overall and by subpopulations based on household composition, race/ethnicity, and income. The key outcomes are added sugars in terms of per capita grams per day and the percentage of calories from packaged beverages. Results: Packaged beverages alone account for per capita consumption of 12 g/d of added sugars purchased by US households in 2007-2012, representing 32-48% of calories from packaged beverages. Whereas the absolute amount of added sugars from beverages has not changed meaningfully over time, the relative contribution of added sugars to calories from beverages has increased. Non-Hispanic black households and low-income households obtain both higher absolute and relative amounts of added sugars from beverages than non-Hispanic white households and high-income households (all P < 0.01). Conclusions: These results provide measures of added sugars from packaged beverages at both the product level and the population level in the United States and can be used for comparisons after the revised nutrition labels are implemented and for future monitoring

Global growth of “big box” stores and the potential impact on human health and nutrition

Despite a large body of literature on the food environment, little is known about the role of supercenters in human nutrition and health. The objectives of this review are to examine what is currently known about the association between supercenters, nutrition, and obesity, to identify how supercenters may affect disparities in food access and nutritional quality of food purchases, and to document the rapid rise of supercenters as a source of food purchases in the United States. A case study of Wal-Mart, the largest food retailer in the United States, is presented that demonstrates the major and increasing role of supercenters as a source of packaged food purchases in the United States, particularly among low-income households, as well as the role of supercenters in supplying key nutrients. Taken together, this review and case study highlight the dominant role of supercenters in the US diet and the need to better understand how supercenters can be leveraged to improve the nutritional quality of what consumers buy and eat

Walmart and Other Food Retail Chains

Proliferation of food retail chains has created an environment in which a few food retailers account for the majority of U.S. packaged food purchases (PFPs). Despite the major potential for these food retail chains (FRCs) to impact what U.S. consumers buy and eat, little is known about the nutritional profile of PFPs from these retailers, particularly PFPs from Walmart, the U.S.’ largest grocer

Age, period and cohort effects on adult physical activity levels from 1991 to 2011 in China

Abstract Background To date no work has differentiated the effects of age, period, and cohort on physical activity (PA) among Chinese adults, while also considering biological, behavioral, economic, and environmental factors over time. Methods We used data from the China Health and Nutrition Survey (CHNS) between 1991 and 2011 (20 years). The outcomes of interest are metabolic equivalent of task (MET) hours per week from work and domestic activities. Age, individual characteristics, household size, asset ownership, urbanization were included as covariates. Analyses for adult (≥20y) males (n = 29,343) and females (n = 31,094) was conducted to explicitly assess differences in PA due to age vs period effects, and implicitly assess differences by cohorts due to the period-specific experiences across individuals of varying ages. Results The mean age of the sample rose from 41.31 to 50.8 years and PA decreased from 427.75 ± 264.35 MET hours per week (MET-hr/wk) in 1991 to 245.99 ± 206.65 MET-hr/wk in 2011, with much steeper declines for women compared to men. For both genders, we found non-linear decreases in PA with age over time. Controlling for age effects, negative period effects on PA were observed in each survey year, and were substantial from 1993 to 2000 for males and from 1993 to 2011 for females. The interaction between survey year and age (P < 0.05) were observed from 2004 to 2011. Higher community urbanicity, vehicle ownership, TV and computer ownership, overweight and obese, higher education served as negative predictors. Bicycle ownership, bigger household size, non-professional jobs, being married and having more children (for women) were positive predictors of PA (P < 0.05). Furthermore, at any given age, individuals who were younger at baseline had higher mean PA compared with individuals older at baseline. Conclusion This study followed a large cohort of adults over a significant portion of their lives. Strong age and secular trends were observed, resulting in an increasing number of participants who have or are likely to lower their PA levels. These trends suggest that tackling the rapid PA decline among its population is of high priority for China’s public health outlook as its population ages and continues to experience significant economic and environmental changes