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Food and mood: how do diet and nutrition affect mental wellbeing?

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• Food and mood: how do diet and nutrition affect mental wellbeing? - November 09, 2020
• Joseph Firth , research fellow 1 2 ,
• James E Gangwisch , assistant professor 3 4 ,
• Alessandra Borsini , researcher 5 ,
• Robyn E Wootton , researcher 6 7 8 ,
• Emeran A Mayer , professor 9 10
• 1 Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Oxford Road, University of Manchester, Manchester M13 9PL, UK
• 2 NICM Health Research Institute, Western Sydney University, Westmead, Australia
• 3 Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, USA
• 4 New York State Psychiatric Institute, New York, NY, USA
• 5 Section of Stress, Psychiatry and Immunology Laboratory, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, King’s College London, London, UK
• 6 School of Psychological Science, University of Bristol, Bristol, UK
• 7 MRC Integrative Epidemiology Unit, Oakfield House, Bristol, UK
• 8 NIHR Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
• 9 G Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA Vatche and Tamar Manoukian Division of Digestive Diseases, UCLA, Los Angeles, CA, USA
• 10 UCLA Microbiome Center, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
• Correspondence to: J Firth joseph.firth{at}manchester.ac.uk

Poor nutrition may be a causal factor in the experience of low mood, and improving diet may help to protect not only the physical health but also the mental health of the population, say Joseph Firth and colleagues

Key messages

Healthy eating patterns, such as the Mediterranean diet, are associated with better mental health than “unhealthy” eating patterns, such as the Western diet

The effects of certain foods or dietary patterns on glycaemia, immune activation, and the gut microbiome may play a role in the relationships between food and mood

More research is needed to understand the mechanisms that link food and mental wellbeing and determine how and when nutrition can be used to improve mental health

Depression and anxiety are the most common mental health conditions worldwide, making them a leading cause of disability. 1 Even beyond diagnosed conditions, subclinical symptoms of depression and anxiety affect the wellbeing and functioning of a large proportion of the population. 2 Therefore, new approaches to managing both clinically diagnosed and subclinical depression and anxiety are needed.

In recent years, the relationships between nutrition and mental health have gained considerable interest. Indeed, epidemiological research has observed that adherence to healthy or Mediterranean dietary patterns—high consumption of fruits, vegetables, nuts, and legumes; moderate consumption of poultry, eggs, and dairy products; and only occasional consumption of red meat—is associated with a reduced risk of depression. 3 However, the nature of these relations is complicated by the clear potential for reverse causality between diet and mental health ( fig 1 ). For example, alterations in food choices or preferences in response to our temporary psychological state—such as “comfort foods” in times of low mood, or changes in appetite from stress—are common human experiences. In addition, relationships between nutrition and longstanding mental illness are compounded by barriers to maintaining a healthy diet. These barriers disproportionality affect people with mental illness and include the financial and environmental determinants of health, and even the appetite inducing effects of psychiatric medications. 4

Hypothesised relationship between diet, physical health, and mental health. The dashed line is the focus of this article.

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While acknowledging the complex, multidirectional nature of the relationships between diet and mental health ( fig 1 ), in this article we focus on the ways in which certain foods and dietary patterns could affect mental health.

Mood and carbohydrates

Consumption of highly refined carbohydrates can increase the risk of obesity and diabetes. 5 Glycaemic index is a relative ranking of carbohydrate in foods according to the speed at which they are digested, absorbed, metabolised, and ultimately affect blood glucose and insulin levels. As well as the physical health risks, diets with a high glycaemic index and load (eg, diets containing high amounts of refined carbohydrates and sugars) may also have a detrimental effect on psychological wellbeing; data from longitudinal research show an association between progressively higher dietary glycaemic index and the incidence of depressive symptoms. 6 Clinical studies have also shown potential causal effects of refined carbohydrates on mood; experimental exposure to diets with a high glycaemic load in controlled settings increases depressive symptoms in healthy volunteers, with a moderately large effect. 7

Although mood itself can affect our food choices, plausible mechanisms exist by which high consumption of processed carbohydrates could increase the risk of depression and anxiety—for example, through repeated and rapid increases and decreases in blood glucose. Measures of glycaemic index and glycaemic load can be used to estimate glycaemia and insulin demand in healthy individuals after eating. 8 Thus, high dietary glycaemic load, and the resultant compensatory responses, could lower plasma glucose to concentrations that trigger the secretion of autonomic counter-regulatory hormones such as cortisol, adrenaline, growth hormone, and glucagon. 5 9 The potential effects of this response on mood have been examined in experimental human research of stepped reductions in plasma glucose concentrations conducted under laboratory conditions through glucose perfusion. These findings showed that such counter-regulatory hormones may cause changes in anxiety, irritability, and hunger. 10 In addition, observational research has found that recurrent hypoglycaemia (low blood sugar) is associated with mood disorders. 9

The hypothesis that repeated and rapid increases and decreases in blood glucose explain how consumption of refined carbohydrate could affect psychological state appears to be a good fit given the relatively fast effect of diets with a high glycaemic index or load on depressive symptoms observed in human studies. 7 However, other processes may explain the observed relationships. For instance, diets with a high glycaemic index are a risk factor for diabetes, 5 which is often a comorbid condition with depression. 4 11 While the main models of disease pathophysiology in diabetes and mental illness are separate, common abnormalities in insulin resistance, brain volume, and neurocognitive performance in both conditions support the hypothesis that these conditions have overlapping pathophysiology. 12 Furthermore, the inflammatory response to foods with a high glycaemic index 13 raises the possibility that diets with a high glycaemic index are associated with symptoms of depression through the broader connections between mental health and immune activation.

Diet, immune activation, and depression

Studies have found that sustained adherence to Mediterranean dietary patterns can reduce markers of inflammation in humans. 14 On the other hand, high calorie meals rich in saturated fat appear to stimulate immune activation. 13 15 Indeed, the inflammatory effects of a diet high in calories and saturated fat have been proposed as one mechanism through which the Western diet may have detrimental effects on brain health, including cognitive decline, hippocampal dysfunction, and damage to the blood-brain barrier. 15 Since various mental health conditions, including mood disorders, have been linked to heightened inflammation, 16 this mechanism also presents a pathway through which poor diet could increase the risk of depression. This hypothesis is supported by observational studies which have shown that people with depression score significantly higher on measures of “dietary inflammation,” 3 17 characterised by a greater consumption of foods that are associated with inflammation (eg, trans fats and refined carbohydrates) and lower intakes of nutritional foods, which are thought to have anti-inflammatory properties (eg, omega-3 fats). However, the causal roles of dietary inflammation in mental health have not yet been established.

Nonetheless, randomised controlled trials of anti-inflammatory agents (eg, cytokine inhibitors and non-steroidal anti-inflammatory drugs) have found that these agents can significantly reduce depressive symptoms. 18 Specific nutritional components (eg, polyphenols and polyunsaturated fats) and general dietary patterns (eg, consumption of a Mediterranean diet) may also have anti-inflammatory effects, 14 19 20 which raises the possibility that certain foods could relieve or prevent depressive symptoms associated with heightened inflammatory status. 21 A recent study provides preliminary support for this possibility. 20 The study shows that medications that stimulate inflammation typically induce depressive states in people treated, and that giving omega-3 fatty acids, which have anti-inflammatory properties, before the medication seems to prevent the onset of cytokine induced depression. 20

However, the complexity of the hypothesised three way relation between diet, inflammation, and depression is compounded by several important modifiers. For example, recent clinical research has observed that stressors experienced the previous day, or a personal history of major depressive disorders, may cancel out the beneficial effects of healthy food choices on inflammation and mood. 22 Furthermore, as heightened inflammation occurs in only some clinically depressed individuals, anti-inflammatory interventions may only benefit certain people characterised by an “inflammatory phenotype,” or those with comorbid inflammatory conditions. 18 Further interventional research is needed to establish if improvements in immune regulation, induced by diet, can reduce depressive symptoms in those affected by inflammatory conditions.

Brain, gut microbiome, and mood

A more recent explanation for the way in which our food may affect our mental wellbeing is the effect of dietary patterns on the gut microbiome—a broad term that refers to the trillions of microbial organisms, including bacteria, viruses, and archaea, living in the human gut. The gut microbiome interacts with the brain in bidirectional ways using neural, inflammatory, and hormonal signalling pathways. 23 The role of altered interactions between the brain and gut microbiome on mental health has been proposed on the basis of the following evidence: emotion-like behaviour in rodents changes with changes in the gut microbiome, 24 major depressive disorder in humans is associated with alterations of the gut microbiome, 25 and transfer of faecal gut microbiota from humans with depression into rodents appears to induce animal behaviours that are hypothesised to indicate depression-like states. 25 26 Such findings suggest a role of altered neuroactive microbial metabolites in depressive symptoms.

In addition to genetic factors and exposure to antibiotics, diet is a potentially modifiable determinant of the diversity, relative abundance, and functionality of the gut microbiome throughout life. For instance, the neurocognitive effects of the Western diet, and the possible mediating role of low grade systemic immune activation (as discussed above) may result from a compromised mucus layer with or without increased epithelial permeability. Such a decrease in the function of the gut barrier is sometimes referred to as a “leaky gut” and has been linked to an “unhealthy” gut microbiome resulting from a diet low in fibre and high in saturated fats, refined sugars, and artificial sweeteners. 15 23 27 Conversely, the consumption of a diet high in fibres, polyphenols, and unsaturated fatty acids (as found in a Mediterranean diet) can promote gut microbial taxa which can metabolise these food sources into anti-inflammatory metabolites, 15 28 such as short chain fatty acids, while lowering the production of secondary bile acids and p-cresol. Moreover, a recent study found that the ingestion of probiotics by healthy individuals, which theoretically target the gut microbiome, can alter the brain’s response to a task that requires emotional attention 29 and may even reduce symptoms of depression. 30 When viewed together, these studies provide promising evidence supporting a role of the gut microbiome in modulating processes that regulate emotion in the human brain. However, no causal relationship between specific microbes, or their metabolites, and complex human emotions has been established so far. Furthermore, whether changes to the gut microbiome induced by diet can affect depressive symptoms or clinical depressive disorders, and the time in which this could feasibly occur, remains to be shown.

Priorities and next steps

In moving forward within this active field of research, it is firstly important not to lose sight of the wood for the trees—that is, become too focused on the details and not pay attention to the bigger questions. Whereas discovering the anti-inflammatory properties of a single nutrient or uncovering the subtleties of interactions between the gut and the brain may shed new light on how food may influence mood, it is important not to neglect the existing knowledge on other ways diet may affect mental health. For example, the later consequences of a poor diet include obesity and diabetes, which have already been shown to be associated with poorer mental health. 11 31 32 33 A full discussion of the effect of these comorbidities is beyond the scope of our article (see fig 1 ), but it is important to acknowledge that developing public health initiatives that effectively tackle the established risk factors of physical and mental comorbidities is a priority for improving population health.

Further work is needed to improve our understanding of the complex pathways through which diet and nutrition can influence the brain. Such knowledge could lead to investigations of targeted, even personalised, interventions to improve mood, anxiety, or other symptoms through nutritional approaches. However, these possibilities are speculative at the moment, and more interventional research is needed to establish if, how, and when dietary interventions can be used to prevent mental illness or reduce symptoms in those living with such conditions. Of note, a recent large clinical trial found no significant benefits of a behavioural intervention promoting a Mediterranean diet for adults with subclinical depressive symptoms. 34 On the other hand, several recent smaller trials in individuals with current depression observed moderately large improvements from interventions based on the Mediterranean diet. 35 36 37 Such results, however, must be considered within the context of the effect of people’s expectations, particularly given that individuals’ beliefs about the quality of their food or diet may also have a marked effect on their sense of overall health and wellbeing. 38 Nonetheless, even aside from psychological effects, consideration of dietary factors within mental healthcare may help improve physical health outcomes, given the higher rates of cardiometabolic diseases observed in people with mental illness. 33

At the same time, it is important to be remember that the causes of mental illness are many and varied, and they will often present and persist independently of nutrition and diet. Thus, the increased understanding of potential connections between food and mental wellbeing should never be used to support automatic assumptions, or stigmatisation, about an individual’s dietary choices and their mental health. Indeed, such stigmatisation could be itself be a casual pathway to increasing the risk of poorer mental health. Nonetheless, a promising message for public health and clinical settings is emerging from the ongoing research. This message supports the idea that creating environments and developing measures that promote healthy, nutritious diets, while decreasing the consumption of highly processed and refined “junk” foods may provide benefits even beyond the well known effects on physical health, including improved psychological wellbeing.

Contributors and sources: JF has expertise in the interaction between physical and mental health, particularly the role of lifestyle and behavioural health factors in mental health promotion. JEG’s area of expertise is the study of the relationship between sleep duration, nutrition, psychiatric disorders, and cardiometabolic diseases. AB leads research investigating the molecular mechanisms underlying the effect of stress and inflammation on human hippocampal neurogenesis, and how nutritional components and their metabolites can prevent changes induced by those conditions. REW has expertise in genetic epidemiology approaches to examining casual relations between health behaviours and mental illness. EAM has expertise in brain and gut interactions and microbiome interactions. All authors contributed to, read, and approved the paper, and all the information was sourced from articles published in peer reviewed research journals. JF is the guarantor.

Competing interests: We have read and understood BMJ policy on declaration of interests and declare the following: JF is supported by a University of Manchester Presidential Fellowship and a UK Research and Innovation Future Leaders Fellowship and has received support from a NICM-Blackmores Institute Fellowship. JEG served on the medical advisory board on insomnia in the cardiovascular patient population for the drug company Eisai. AB has received research funding from Johnson & Johnson for research on depression and inflammation, the UK Medical Research Council, the European Commission Horizon 2020, the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, and King’s College London. REW receives funding from the National Institute for Health Research Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol. EAM has served on the external advisory boards of Danone, Viome, Amare, Axial Biotherapeutics, Pendulum, Ubiome, Bloom Science, Mahana Therapeutics, and APC Microbiome Ireland, and he receives royalties from Harper & Collins for his book The Mind Gut Connection. He is supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases, and the US Department of Defense. The views expressed are those of the authors and not necessarily those of the organisations above.

Provenance and peer review: Commissioned; externally peer reviewed.

This article is part of series commissioned by The BMJ. Open access fees are paid by Swiss Re, which had no input into the commissioning or peer review of the articles. T he BMJ thanks the series advisers, Nita Forouhi, Dariush Mozaffarian, and Anna Lartey for valuable advice and guiding selection of topics in the series.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ .

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Food Inequality: How Poor Nutrition Affects Health, Wealth, & Opportunity (And What We Can Do About It!)

When millions of people suffer from malnutrition, either due to insufficient calories or a lack of access to affordable, wholesome food, their health, wealth, resilience, and even their mental clarity are impacted. If we want to create a just and sustainable world, we must tackle the twin issues of food inequality and food insecurity.

We all need food to live. At Food Revolution Network, we are dedicated to healthy, ethical and sustainable food for all.

But unfortunately, that isn’t the world we live in right now.

Not everyone has access to a grocery store to buy what they need to support their health. Not everyone has the knowledge, time, or energy to prepare healthy food. And not everyone has the money to afford healthy food.

And just as poverty and income insecurity can lead to poor nutrition, the same dynamic exists in reverse. Poor nutrition undermines health, and then poor health can also contribute to poverty. Poor nutrition not only leads to chronic disease and emotional distress. It also robs people of opportunities to move out of poverty and improve the prospects of future generations.

In this article, I’ll look at how social factors influence access to nutrition, how poor nutrition can keep people stuck in a cycle of poverty and disease, and what we can do about it.

Access to Food for All

Let’s try a thought experiment: imagine that oxygen wasn’t freely available in the atmosphere. That someone had figured out a way to extract it from the air, put it in canisters, and sell it.

And in order to breathe and stay alive, we had to pay to refill our canisters before they ran out.

What are the first words that come to mind when you consider that dystopian sci-fi scenario?

Far-fetched? Outrageous? Unacceptable?

Well, that’s exactly how we should feel about our current food system.

The way I see it, access to whole, healthy foods should be a basic human right. In tribal societies, which represent more than 99% of human history , food was all around for the taking (with some effort). To get roots or berries, you had to walk, keep your eyes peeled, and dig or pick. To eat an animal, you had to hunt or trap.

I’m not romanticizing the lives of hunter-gatherers (or of gatherer-hunters, as more and more researchers are starting to call them, recognizing that many such tribes got far more of their calories from gathering than from hunting ). Our ancestors often had to deal with food insecurity due to drought, pestilence, or even seasonal shortages. Life was often hard and dangerous, and life expectancies were far shorter, on average, than those in modern civilizations.

But the central feature I want to point out is that food access was universally shared. No chief or ruling class put the food “under lock and key.” Look around you; wherever you live, no other species has invented a system to deny access to free food. Squirrels don’t lock up oak trees and force other squirrels to pay for acorns. Hummingbirds squabble over flowers and feeders but don’t systematically deny entire classes of birds access to nectar. Sharks and whales swim through oceanic restaurants in which no bill is ever presented. Only humans have invented a social and economic system in which people may literally starve to death if they do not have access to enough money. 

The Cycle of Poverty & Food Inequality

In industrialized countries, poverty doesn’t always look like starvation. It can look like intermittent hunger. It can even look like excess. High rates of obesity occur when food access consists of calorically dense, nutritionally poor junk foods. As “gangsta gardener”  Ron Finley put it in his TED talk, in his South Central Los Angeles neighborhood, the drive-thru, fast food restaurants kill more people than the drive-by shootings.

The problem is not that we don’t have enough food in the world to feed everyone well. As Francis Moore Lappé points out , “The real cause of hunger is the powerlessness of the poor to gain access to the resources they need to feed themselves.”

This is a huge problem. Lack of access to healthy food, economic disenfranchisement, insufficient nutritional education , and unequal distribution of tools for preparing healthy meals, have created a gaping divide in the world. Those with the ability to procure and prepare nutritious food are healthier, less stressed, and better prepared to take advantage of opportunities for advancement.

But those without that ability are too often embedded in a vicious cycle, in which low-income individuals do not get the nutrition they need to fuel their own efforts to improve their lives. Thus poverty and inequality are perpetuated.

The gap isn’t random, either. Often poverty and food inequality are directly linked to race, gender, disability, and other demographic factors. Inequality of access to healthy food both arises from and reinforces class divides, racial inequality, and intergenerational cycles of poverty.

One example: folks with less money tend to spend a higher percentage of their money on food, than those with more. And statistically, the lower your income , the more likely you are to depend on cheaper, less nutritious food.

The Government Subsidy Problem

This isn’t because unhealthy, processed food is naturally cheaper than healthy, whole foods. It’s because, in many wealthier countries like the US, tens of billions of dollars of taxpayer money subsidize the mass production of gargantuan amounts of crops like corn, soy, and wheat.

These highly subsidized crops have two primary uses in the modern diet: as animal feed in factory farms, which brings down the price of industrial meat, and as ingredients in highly processed and nutrient-poor junk foods. This brings down the price of food-like products that provide cheap and tasty calories but are nutritionally horrendous.

Food subsidies are the primary reason why, over the last four decades , the price of processed foods and industrial meat has gone down 20-30%, while the price of fruits and vegetables has increased 40%.

When we subsidize junk food, we essentially force the economically poor to eat foods that are nutritional disasters. This makes it much harder for people who are born into families that are struggling financially to ever rise above poverty, and virtually ensures that cycles of intergenerational poverty will persist. And when a vastly disproportionate share of those who struggle financially are people of color, we’ve created one of the conditions that, in effect, perpetuate racial health inequality.

It may seem obvious, but the less healthfully you eat, the less likely you are to be healthy — and the more likely you are to suffer from debilitating illness, be unable to work, and fall into medical care-induced bankruptcy . And it’s hard to quantify the mental and emotional stress that comes from not knowing how or if you’re going to be able to feed yourself and your loved ones today.

Food Insecurity

There’s an epidemic of food insecurity today, even in the richest countries on earth. For example, 40% of US households below the poverty line are food insecure. In 2012, that number was a little less than 11 million households. By 2019, it had jumped to almost 14 million . The pandemic and lockdowns then proceeded to make a very bad situation much worse .

Food insecurity is largely tied to low income, of course, but there are other factors that can contribute. Income volatility, housing discrimination , changes in employment, and rising food prices are all associated with not having a reliable supply of food.

In neighborhoods known as “ food deserts ,” a host of interlocking conditions exist that perpetuate poverty, inequality, and food insecurity. For example, in many low-income urban and rural areas, it’s nearly impossible to find healthy food within walking distance. When supermarkets and healthy grocery stores aren’t present, inhabitants must make do with convenience stores, liquor stores, and gas station fare, or spend time and money traveling on public transit to get to supermarkets in other neighborhoods. And if they don’t have cars to carry their groceries home, they’re limited in the number of items they can purchase at one time, necessitating more frequent trips.

In this way, if the poorest and most vulnerable members of our society want healthy food, they must sacrifice time and money they could otherwise spend building up opportunities through work, education, or child care.

SNAP and Other Nutrition Programs

You might be thinking, “Hey, food insecurity is terrible, but that’s why most developed countries, at least, have food aid programs like food stamps. Don’t they solve the problem?”

They help, for sure, but don’t solve the problem.

It’s true that food aid programs are an essential lifeline for hundreds of millions of people. And in the US, the Supplemental Nutrition Assistance Program (SNAP) does exist to fill in the income gap when families and individuals can’t afford enough food. But the way it’s set up and administered severely dampens its effectiveness. The Center on Budget and Policy Priorities has determined that half of all SNAP recipients are still food insecure, despite receiving the aid.

How is this possible?

First, the amount of SNAP benefits are hardly enough to feed a person or family. Although “ the largest permanent increase to benefits ” was announced in the summer of 2021, the average SNAP benefit will still come to about $1.75 per person per meal — enough to purchase a box of highly processed mac and cheese, but not enough to add many veggies.

Second, many people who receive SNAP benefits work long hours, often at multiple jobs, often with difficult and long commutes between them. This means they do not have time to prepare healthy food from scratch. So they tend to do the rational thing: use the government benefit to purchase convenience foods.

Third, SNAP benefits are uniform throughout the US and don’t reflect local conditions. Since food is more expensive in big cities and other more costly areas, SNAP benefits don’t provide as much support, in net effect, to recipients living in those areas.

Also, people receiving SNAP may have limited access to markets and stores that accept SNAP. And those stores may not include healthy options. For example, SNAP recipients in Burlington County, North Carolina, have few options other than spending their credit at stores like Dollar General, Dave’s Mini Mart, along with Walgreens and Rite-Aid pharmacies. There they can get staples like white bread, peanut butter, and canned tuna, but will have a hard time finding fresh fruits and vegetables — and even inexpensive items like dried legumes.

Food banks can step in and fill the gap, but many of these don’t offer fresh produce either. Unlike a retail store with a robust inventory and distribution system, food banks can be very hit-or-miss when it comes to variety and quality. If you rely on a food bank, you’re pretty much at the mercy of whatever they have available and how many other people you have to share it with.

The Increasing Issue of Malnutrition

Food inequality leads to not only food insecurity, but also to disease, disability, and premature death. Indeed, when we look at the numbers, we see that a diet of poor quality food is more prevalent worldwide than starvation. Nearly two billion people worldwide are now overweight or obese, close to three times as many as are underfed and undernourished ( 690 million ).

Unlike starvation, which tends to occur in societies that lack basic resources, the malnutrition that stems from eating mostly high-calorie, low-nutrient foods is endemic in the modern “Western” world. Junk foods and fast foods, calorie-dense with little nutritional value, make up the majority of calories consumed in these societies. Kids in the US, for example, today get two-thirds of their total calories from ultra-processed foods. The skyrocketing rates of obesity and food-related illnesses testify to the prevalence of this dietary pattern.

While such malnutrition is not necessarily tied directly to poverty — wealthy people can live on fast food and junk food diets as well — it invariably leads to poorer health outcomes for those without disposable income. The cruel irony is that the malnourished who are monetarily poor typically lack the resources to buffer the health effects of their diets.

The Health Gap

While the rich and monetarily poor can both suffer from unhealthy diets, people of color and people in historically marginalized groups tend to face additional burdens of chronic disease from poor nutrition. This is largely because social and environmental factors linked to poverty often make things worse.

Diet-related disease is more common among people of color. For example, cancer, type 2 diabetes, asthma, and heart disease are up to twice as prevalent in Black, Hispanic, and Native American populations as in white ones. A representative sample of US adults aged 55 or older found that food-insecure women were more likely than average to experience lung disease and diabetes. And simply being a member of a minority group increased the odds, statistically, of being food insecure and having diabetes.

The unfortunate truth is, the very people who can least afford to get sick are getting sick the most. 

Food Inequality’s Impact on Children

Tragically, those who bear the worst brunt of food inequality, food insecurity, and malnutrition are children. They have easy access to junk food in schools, both from hallway vending machines and cafeterias. Unhealthy school lunches can lead to not just health and weight problems but to learning difficulties as well. It’s hard to feed children well on $1.30 per meal, so schools rely on prepackaged meals made with the lowest quality and most subsidized ingredients (factory farmed cow’s milk, white flour, sugar, etc.)

If a consortium of evil scientists were convened to design a diet intended to undermine learning and child development, they might feel mighty satisfied with the current system.

Outside of school, kids are still vulnerable. Fast food, junk food, and processed food manufacturers have learned that they can increase sales and profits by marketing directly to children through toys, characters, bright colors, and so on. Eric Schlosser reported in his 2001 book Fast Food Nation that 96% of American schoolchildren could recognize Ronald McDonald, putting him second in the fictional character Olympics. Only Santa Claus had higher brand recognition.

And for some reason, Ronald McDonald is portrayed as thinner than old Kris Kringle, who at least gets some exercise as VP of logistics at his polar toy factory. (Although, to be fair, the reindeer do the heavy lifting.)

Juvenile Delinquency

Poor diets can also raise rates of juvenile delinquency . The good news there, of course, is that feeding kids can dramatically reduce antisocial behaior, like my dad, Food Revolution Network President, John Robbins, has pointed out :

“A series of studies in the 1980s removed chemical additives and reduced sugar in the diets of juvenile delinquents. Overall, 8,076 young people in 12 juvenile correctional facilities were involved. The result? Deviant behavior fell 47%.

In Virginia, 276 juvenile delinquents at a detention facility housing particularly hardened adolescents were put on the diet for two years. During that time, the incidence of theft dropped 77%, insubordination dropped 55%, and hyperactivity dropped 65%. In Los Angeles County probation detention halls, 1,382 youths were put on the diet. Again, the results were excellent. There was a 44% reduction in problem behavior and suicide attempts.  

These and other studies have found that when troubled youngsters are put on a healthy diet based on nutrient-dense foods like whole grains, vegetables, and fruits, and avoid sugar and artificial colors, flavors, and preservatives, the results are predictably outstanding.”

The Wealth Gap

A popular 1927 song proclaimed that “The Best Things in Life Are Free,” pointing to examples such as the moon, the stars, the flowers in spring, the robins that sing, and love.

The much more cynical Ogden Nash retorted, in his 1938 poem “The Terrible People”: “Certainly there are lots of things in life that money won’t buy, but it’s very funny — have you ever tried to buy them without money?”

After all, it’s hard to enjoy a nighttime stroll under the moon and stars, or a morning walk in a flower-covered meadow while birds serenade, when you’re worried about covering next month’s rent to avoid eviction, or giving your kids something more nutritious than Cheetos and Mountain Dew for dinner.

We’ve seen that the “wealth gap” contributes heavily to the “health gap” between the affluent and the impoverished. What’s particularly insidious is that this is a self-reinforcing, vicious cycle. Poor nutrition leads to health problems that further erode wealth and diminish the opportunities to rise out of poverty.

Race plays a big role here; African Americans are 260% more likely than whites to incur medical debt. Even after adjusting for the differences in health status, income, and insurance coverage, almost 60% of the gap is still attributable to race .

The Cycle of Poor Health & Poverty

The vicious cycle between poor health and poverty is an unwanted gift that keeps on giving. Medical debt degrades health and nutrition, both financially and in terms of stress. Those laboring under the burden of debt have higher blood pressure, worse self-reported health status, poorer mental health, and shorter life expectancy than those with less debt. And without access to healthier foods, chronic illnesses continue to progress, causing even more economic hardship.

As if that wasn’t bad enough, the curses of food inequality and insecurity often get passed down from generation to generation. Just as children of the wealthy inherit stocks, bonds, real estate, and connections, so do children of the economically poor tend to inherit poverty, health problems, and other social harms from their parents and grandparents.

One of the core principles of the “American Dream” is upward mobility — the belief that if you work hard, follow the rules, and do the right thing, you can achieve wealth and rise above your original station. The reality of intergenerational poverty undermines that aspiration for far too many people. And unequal access to healthy food is a huge contributor to this problem.

It reminds me of a 1961 Herblock newspaper cartoon showing a wealthy businessman berating a poor woman huddled on a stoop in a slum neighborhood: “If you had any initiative, you’d go out and inherit a department store.”

What We Must Do About Food Inequality

I share all this not to depress you, but to inspire you to take action. There are things each of us can do to contribute to a just and sustainable solution.

We must continue to raise awareness about the impact of food on health, wealth, and opportunity — especially in low-income communities — and advocate for a sustainable food system that provides healthy and affordable food for all.

When our society is willing to face the shameful reality of chronic malnutrition, we can mobilize the political will to tackle the problem. Think of how we come together to aid those in a disaster zone. How donations pour in to those devastated by a hurricane, or catastrophic flooding. When we see people as part of “our community,” we naturally reach out to help, and seek to dismantle barriers to well-being. We need to make the consequences of our broken food system as visible as the effects of a natural disaster. And we need to remember to, as Bruce Springsteen sings, “ take care of our own .”

Taxing Junk Food

One powerful and effective legislative solution is to change the tax code and subsidies programs to reflect the true societal costs of particular foods. For example, we could reduce government subsidies of commodities crops, such as corn, soy, and wheat. And we could support laws that discourage the selling, marketing, and consumption of harmful foods and beverages. High taxes on soda , for example, have proven to reduce demand in the cities where the law is in place.

Berkeley, California’s tax on sugar-sweetened beverages reduced soda consumption by 21% and increased water consumption by 63% in low-income neighborhoods, according to a 2021 study reported in the American Journal of Public Health . And the funds raised by the taxes can be used to further reduce the inequality of outcomes between rich and poor.

Bring Down the Price of Healthy Food

In addition to making soda and junk food more expensive and harder to access, we can be doing the opposite to healthy food: making it cheaper and more accessible. SNAP incentive programs can encourage the purchase of fresh fruits and vegetables by increasing the value of SNAP credits when applied toward these foods.

One wonderful example is the DoubleUp Bucks program promoted by Wholesome Wave . Participants in this program, which is now available in 25 US states ( check here to see which ones), get their SNAP credits doubled when spent on fresh produce. Participants can buy a dollar’s worth of broccoli for 50 cents, making it a financially wise as well as health-supporting choice. Despite the upcoming rule changes to SNAP, which will increase the total SNAP budget, such incentive programs will likely continue.

Protect Kids from Junk Food Marketing

Another common sense step is to ban the marketing of junk food to children . Kids don’t have the experience needed to evaluate the claims in junk food ads, and these ads often fuel conflict between kids — who may be unfairly influenced by the ads — and their parents and other caregivers.

That cereal with a full tablespoon of sugar in each cup is not “grrreat.” That soda full of sugar, phosphoric acid, caffeine, colorings, and chemical flavorings is not “the real thing.” The fast food meal that features a movie superhero toy will not make anyone “happy” for long. Let’s pass laws to protect children from sugar-coated lies that lead to unhealthy habits and outcomes.

Support Nutrition Education

We can also support the expansion of nutrition education programs, such as those presented by Food Revolution Network, to local community leaders, activists, and advocates.

Another strategy is to focus on teaching nutrition to young children. Kids who learn to try new foods and how to prepare healthy dishes, are far more likely to eat healthier into adulthood. And children who attend schools that have gardening programs have a whole new outlook on food once they’ve tasted a cherry tomato they’ve grown themselves.

Build Community Gardens

Community gardens are a powerful tool to bring nutrition, nutrition education, and even employment to underserved communities. There are several ways to support such efforts, either locally or online, which you can find out about here .

Support Produce Prescriptions

Finally, anyone in the medical field can start advocating for produce prescription programs. A doctor can write a prescription, not just for a medication, but for fresh fruits and vegetables (which, rather than treating symptoms, often address root causes of disease). The prescription allows the patient to receive the produce either at a drastically reduced cost (like an insurance copay) or for free. One example is Wholesome Wave’s National Produce Prescription Consortium .

Organizations Working Towards Food Equality & Opportunity

A number of organizations are tackling the issues of food inequality and insecurity head-on. Here are a few you may want to check out, and possibly support.

1. Wholesome Wave

Wholesome Wave’s mission is to fight nutrition insecurity. Since 2007, they’ve been partnering with community-based organizations to provide enough food, and the right food, for our most vulnerable citizens — regardless of race, ethnicity, age, gender, or income. (Food Revolution Network is grateful to be a major supporter of Wholesome Wave.)

2. Chef Ann Foundation

The Chef Ann Foundation teaches and empowers schools and school districts to cook fresh, whole-food meals to students from scratch. Through professional development and implementation grants, the foundation works through the considerable barriers to organizational change and helps schools transform their lunch programs from relying on cheap, institutional junk food into produce-heavy affairs.

3. Food Research and Action Center

The Food Research and Action Center, or FRAC, engages in research, advocacy, and legislative solutions to food inequality and insecurity. They also offer resources on their website for local activists, including communication toolkits and in-depth reports.

4. Seeds of Native Health

Seeds of Native Health seeks to eradicate food impoverishment among US Native American populations and improve the health of Indigenous peoples. Noting that 81% of Native American adults are overweight or obese, and their rates of diabetes are double the national average, the organization supports grassroots practitioners, researchers, and advocates aiming to restore traditional, healthful diets within Indigenous communities.

5. Prosperity Now

Prosperity Now seeks to close the racial wealth divide. Noting that for a disproportionate number of Americans of color, financial ruin is just “one crisis away,” the organization promotes strategies, programs, and laws that enable low-income and minority communities to start building wealth that they can pass on to future generations.

6. Center for Healthy Food Access

The Center for Healthy Food Access works on many fronts to contribute to a healthy food future for all. From lobbying to strengthen SNAP and other food assistance programs to improving the food and water quality in schools to working with hospitals and other healthcare systems to deploy healthy diets in the fight against chronic disease in underserved populations, they seek to provide everyone with access to healthy food and access to information to make healthy decisions.

Healthy, Ethical, & Sustainable Food for All

Most of us want to live in lands of opportunity, where hard work is rewarded, and people from any background can rise up and improve their lives and their community. As we’ve seen, however, food inequality and poor nutrition can prevent individuals and communities from enjoying the health, wealth, and opportunity that should be the birthright of every human. As a society, we fail unless we can offer access to healthy whole foods to all our people.

Dr. Martin Luther King famously said, “The arc of the moral universe is long, but it bends toward justice.” The truth is, it doesn’t bend all by itself. With increased awareness and advocacy, we’re starting to see positive efforts and real progress on these issues. And there’s so much more for us to do.

At Food Revolution Network, our mission is “healthy, ethical, and sustainable food for all.” Perhaps if we stand up and speak out, we can contribute to building a healthier and a brighter future for all of us — regardless of our race, economic status, or other demographic factors.

Tell us in the comments:

• How does food inequality and food insecurity show up where you live?
• What organizations fighting food inequality inspire you?
• What steps can you take to help reduce food inequality in and around your community?

Feature image: iStock.com/MarsBars

• Increasing Health & Opportunity for All: An Interview with Terry Mason, MD
• America’s Two Deadly Viruses: How COVID-19 and Racism Converge – And What We Need to do About Health Inequality
• Food Insecurity Is A Problem for Almost 30 Million Americans — But See What individuals and Organizations Are Doing and What You Can Do to Take Action

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CEO, Food Revolution Network

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Malnutrition

• Malnutrition, in all its forms, includes undernutrition (wasting, stunting, underweight), inadequate vitamins or minerals, overweight, obesity, and resulting diet-related noncommunicable diseases.
• In 2022, 2.5 billion adults were overweight, including 890 million who were living with obesity, while 390 million were underweight.
• Globally in 2022, 149 million children under 5 were estimated to be stunted (too short for age), 45 million were estimated to be wasted (too thin for height), and 37 million were overweight or living with obesity.
• Nearly half of deaths among children under 5 years of age are linked to undernutrition. These mostly occur in low- and middle-income countries. The developmental, economic, social and medical impacts of the global burden of malnutrition are serious and lasting, for individuals and their families, for communities and for countries.
• The developmental, economic, social and medical impacts of the global burden of malnutrition are serious and lasting, for individuals and their families, for communities and for countries.

Malnutrition refers to deficiencies, excesses, or imbalances in a person’s intake of energy and/or nutrients. The term malnutrition addresses 3 broad groups of conditions:

• undernutrition, which includes wasting (low weight-for-height), stunting (low height-for-age) and underweight (low weight-for-age);
• micronutrient-related malnutrition, which includes micronutrient deficiencies (a lack of important vitamins and minerals) or micronutrient excess; and
• overweight, obesity and diet-related noncommunicable diseases (such as heart disease, stroke, diabetes and some cancers).

Various forms of malnutrition

Undernutrition.

There are 4 broad sub-forms of undernutrition: wasting, stunting, underweight, and deficiencies in vitamins and minerals. Undernutrition makes children in particular much more vulnerable to disease and death.

Low weight-for-height is known as wasting. It usually indicates recent and severe weight loss because a person has not had enough food to eat and/or they have had an infectious disease, such as diarrhoea, which has caused them to lose weight. A young child who is moderately or severely wasted has an increased risk of death, but treatment is possible.

Low height-for-age is known as stunting. It is the result of chronic or recurrent undernutrition, usually associated with poor socioeconomic conditions, poor maternal health and nutrition, frequent illness, and/or inappropriate infant and young child feeding and care in early life. Stunting holds children back from reaching their physical and cognitive potential.

Children with low weight-for-age are known as underweight. A child who is underweight may be stunted, wasted or both.

Micronutrient-related malnutrition

Inadequacies in intake of vitamins and minerals often referred to as micronutrients, can also be grouped together. Micronutrients enable the body to produce enzymes, hormones and other substances that are essential for proper growth and development.

Iodine, vitamin A, and iron are the most important in global public health terms; their deficiency represents a major threat to the health and development of populations worldwide, particularly children and pregnant women in low-income countries.

Overweight and obesity

Overweight and obesity is when a person is too heavy for his or her height. Abnormal or excessive fat accumulation can impair health.

Body mass index (BMI) is an index of weight-for-height commonly used to classify overweight and obesity. It is defined as a person’s weight in kilograms divided by the square of his/her height in meters (kg/m²). In adults, overweight is defined as a BMI of 25 or more, whereas obesity is a BMI of 30 or more. Among children and adolescents, BMI thresholds for overweight and obesity vary by age.

Overweight and obesity result from an imbalance between energy consumed (too much) and energy expended (too little). Globally, people are consuming foods and drinks that are more energy-dense (high in sugars and fats) and engaging in less physical activity.

Diet-related noncommunicable diseases

Diet-related noncommunicable diseases (NCDs) include cardiovascular diseases (such as heart attacks and stroke, and often linked with high blood pressure), certain cancers, and diabetes. Unhealthy diets and poor nutrition are among the top risk factors for these diseases globally.

Scope of the problem

In 2022, approximately 390 million adults aged 18 years and older worldwide were underweight, while 2.5 billion were overweight, including 890 million who were living with obesity. Among children and adolescents aged 5-19 years, 390 million were overweight, including 160 million who were living with obesity. Another 190 million were living with thinness (BMI-for-age more than two standard deviations below the reference median).

In 2022, an estimated 149 million children under the age of 5 years were suffering from stunting, while 37 million were living with overweight or obesity.

Nearly half of deaths among children under 5 years of age are linked to undernutrition. These mostly occur in low- and middle-income countries.

Who is at risk?

Every country in the world is affected by one or more forms of malnutrition. Combating malnutrition in all its forms is one of the greatest global health challenges.

Women, infants, children, and adolescents are at particular risk of malnutrition. Optimizing nutrition early in life –including the 1000 days from conception to a child’s second birthday – ensures the best possible start in life, with long-term benefits.

Poverty amplifies the risk of, and risks from, malnutrition. People who are poor are more likely to be affected by different forms of malnutrition. Also, malnutrition increases health care costs, reduces productivity, and slows economic growth, which can perpetuate a cycle of poverty and ill-health.

The United Nations Decade of Action on Nutrition

On 1 April 2016, the United Nations (UN) General Assembly proclaimed 2016–2025 the United Nations Decade of Action on Nutrition. The Decade is an unprecedented opportunity for addressing all forms of malnutrition. It sets a concrete timeline for implementation of the commitments made at the Second International Conference on Nutrition (ICN2) to meet a set of global nutrition targets and diet-related NCD targets by 2025, as well as relevant targets in the Agenda for Sustainable Development by 2030 – in particular, Sustainable Development Goal (SDG) 2 (end hunger, achieve food security and improved nutrition and promote sustainable agriculture) and SDG 3 (ensure healthy lives and promote wellbeing for all at all ages).

Led by WHO and the Food and Agriculture Organization of the United Nations (FAO), the UN Decade of Action on Nutrition calls for policy action across 6 key areas:

• creating sustainable, resilient food systems for healthy diets;
• providing social protection and nutrition-related education for all;
• aligning health systems to nutrition needs, and providing universal coverage of essential nutrition interventions;
• ensuring that trade and investment policies improve nutrition;
• building safe and supportive environments for nutrition at all ages; and
• strengthening and promoting nutrition governance and accountability, everywhere.

WHO response

WHO aims for a world free of all forms of malnutrition, where all people achieve health and wellbeing. According to the 2016–2025 nutrition strategy, WHO works with Member States and partners towards universal access to effective nutrition interventions and to healthy diets from sustainable and resilient food systems. WHO uses its convening power to help set, align and advocate for priorities and policies that move nutrition forward globally; develops evidence-informed guidance based on robust scientific and ethical frameworks; supports the adoption of guidance and implementation of effective nutrition actions; and monitors and evaluates policy and programme implementation and nutrition outcomes.

This work is framed by the Comprehensive implementation plan on maternal, infant, and young child nutrition , adopted by Member States through a World Health Assembly resolution in 2012. Actions to end malnutrition are also vital for achieving the diet-related targets of the Global action plan for the prevention and control of noncommunicable diseases 2013–2020 , the Global strategy for women’s, children’s, and adolescent’s health 2016–2030 , and the 2030 Agenda for sustainable development .

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• Double burden of malnutrition
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• Global action plan for the prevention and control of NCDs 2013-2020
• Global nutrition targets for 2025
• Second International Conference on Nutrition (ICN2)
• UN Decade of Action on Nutrition 2016-2025

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Americans poor diet drives $50 billion a year in health care costs

An #NHLBI-funded study put a price tag on American's bad eating habits: $50 billion a year in health care costs, attributable to cardiometabolic diseases such as heart disease, stroke and type 2 diabetes. The research, reported in the journal PLoS Medicine , sought to zero in on the national health care costs of unhealthy diet habits, which are known to account for up to 45% of all cardiometabolic deaths.

The researchers examined the impact of 10 food groups - fruits, vegetables, nuts/seeds, whole grains, unprocessed red meats, processed meats, sugar-sweetened beverages, polyunsaturated fats, seafood omega-3 fats and sodium - and found that almost 20% of heart disease, stroke and diabetes costs are due to poor diet.

Three dietary factors contributed most to these costs: consumption of processed meats, low consumption of nuts/seeds, and low consumption of seafoods containing omega-3 fats.

Media Coverage

• Health Care Costs Of Unhealthy American Diet? At Least $50B A Year, Study Estimates
• Unhealthy Eating Habits Cost U.S. $50 Billion a Year: Study
• Suboptimal Diet May Drive $50 Billion in Cardiometabolic Costs
• Better diets could save billions in U.S. health care costs
• Unhealthy eating costs $50B a year in health care costs
• Poor Diet Contributes Substantially to Cardiometabolic Disease Costs
• Healthy Diet Could Save $50B in Health Care Costs
• Cardiometabolic disease costs associated with suboptimal diet in the United States: A cost analysis based on a microsimulation model

12.4 Annotated Student Sample: "Healthy Diets from Sustainable Sources Can Save the Earth" by Lily Tran

Learning outcomes.

By the end of this section, you will be able to:

• Analyze how writers use evidence in research writing.
• Analyze the ways a writer incorporates sources into research writing, while retaining their own voice.
• Explain the use of headings as organizational tools in research writing.
• Analyze how writers use evidence to address counterarguments when writing a research essay.

Introduction

In this argumentative research essay for a first-year composition class, student Lily Tran creates a solid, focused argument and supports it with researched evidence. Throughout the essay, she uses this evidence to support cause-and-effect and problem-solution reasoning, make strong appeals, and develop her ethos on the topic.

Living by Their Own Words

Food as change.

public domain text For the human race to have a sustainable future, massive changes in the way food is produced, processed, and distributed are necessary on a global scale. end public domain text

annotated text Purpose. Lily Tran refers to what she sees as the general purpose for writing this paper: the problem of current global practices in food production, processing, and distribution. By presenting the “problem,” she immediately prepares readers for her proposed solution. end annotated text

public domain text The required changes will affect nearly all aspects of life, including not only world hunger but also health and welfare, land use and habitats, water quality and availability, energy use and production, greenhouse gas emissions and climate change, economics, and even cultural and social values. These changes may not be popular, but they are imperative. The human race must turn to sustainable food systems that provide healthy diets with minimal environmental impact—and starting now. end public domain text

annotated text Thesis. Leading up to this clear, declarative thesis statement are key points on which Tran will expand later. In doing this, she presents some foundational evidence that connects the problem to the proposed solution. end annotated text

THE COMING FOOD CRISIS

public domain text The world population has been rising exponentially in modern history. From 1 billion in 1804, it doubled to approximately 2 billion by 1927, then doubled again to approximately 4 billion in 1974. By 2019, it had nearly doubled again, rising to 7.7 billion (“World Population by Year”). It has been projected to reach nearly 10 billion by 2050 (Berners-Lee et al.). At the same time, the average life span also has been increasing. These situations have led to severe stress on the environment, particularly in the demands for food. It has been estimated, for example, that by 2050, milk production will increase 58 percent and meat production 73 percent (Chai et al.). end public domain text

annotated text Evidence. In this first supporting paragraph, Tran uses numerical evidence from several sources. This numerical data as evidence helps establish the projection of population growth. By beginning with such evidence, Tran underscores the severity of the situation. end annotated text

public domain text Theoretically, the planet can produce enough food for everyone, but human activities have endangered this capability through unsustainable practices. Currently, agriculture produces 10–23 percent of global greenhouse gas emissions. Greenhouse gases—the most common being carbon dioxide, methane, nitrous oxide, and water vapor— trap heat in the atmosphere, reradiate it, and send it back to Earth again. Heat trapped in the atmosphere is a problem because it causes unnatural global warming as well as air pollution, extreme weather conditions, and respiratory diseases. end public domain text

annotated text Audience. With her audience in mind, Tran briefly explains the problem of greenhouse gases and global warming. end annotated text

public domain text It has been estimated that global greenhouse gas emissions will increase by as much as 150 percent by 2030 (Chai et al.). Transportation also has a negative effect on the environment when foods are shipped around the world. As Joseph Poore of the University of Oxford commented, “It’s essential to be mindful about everything we consume: air-transported fruit and veg can create more greenhouse gas emissions per kilogram than poultry meat, for example” (qtd. in Gray). end public domain text

annotated text Transition. By beginning this paragraph with her own transition of ideas, Tran establishes control over the organization and development of ideas. Thus, she retains her sources as supports and does not allow them to dominate her essay. end annotated text

public domain text Current practices have affected the nutritional value of foods. Concentrated animal-feeding operations, intended to increase production, have had the side effect of decreasing nutritional content in animal protein and increasing saturated fat. One study found that an intensively raised chicken in 2017 contained only one-sixth of the amount of omega-3 fatty acid, an essential nutrient, that was in a chicken in 1970. Today the majority of calories in chicken come from fat rather than protein (World Wildlife Fund). end public domain text

annotated text Example. By focusing on an example (chicken), Tran uses specific research data to develop the nuance of the argument. end annotated text

public domain text Current policies such as government subsidies that divert food to biofuels are counterproductive to the goal of achieving adequate global nutrition. Some trade policies allow “dumping” of below-cost, subsidized foods on developing countries that should instead be enabled to protect their farmers and meet their own nutritional needs (Sierra Club). Too often, agriculture’s objectives are geared toward maximizing quantities produced per acre rather than optimizing output of critical nutritional needs and protection of the environment. end public domain text

AREAS OF CONCERN

Hunger and nutrition.

annotated text Headings and Subheadings. Throughout the essay, Tran has created headings and subheadings to help organize her argument and clarify it for readers. end annotated text

public domain text More than 820 million people around the world do not have enough to eat. At the same time, about a third of all grains and almost two-thirds of all soybeans, maize, and barley crops are fed to animals (Barnard). According to the World Health Organization, 462 million adults are underweight, 47 million children under 5 years of age are underweight for their height, 14.3 million are severely underweight for their height, and 144 million are stunted (“Malnutrition”). About 45 percent of mortality among children under 5 is linked to undernutrition. These deaths occur mainly in low- and middle-income countries where, in stark contrast, the rate of childhood obesity is rising. Globally, 1.9 billion adults and 38.3 million children are overweight or obese (“Obesity”). Undernutrition and obesity can be found in the same household, largely a result of eating energy-dense foods that are high in fat and sugars. The global impact of malnutrition, which includes both undernutrition and obesity, has lasting developmental, economic, social, and medical consequences. end public domain text

public domain text In 2019, Berners-Lee et al. published the results of their quantitative analysis of global and regional food supply. They determined that significant changes are needed on four fronts: end public domain text

Food production must be sufficient, in quantity and quality, to feed the global population without unacceptable environmental impacts. Food distribution must be sufficiently efficient so that a diverse range of foods containing adequate nutrition is available to all, again without unacceptable environmental impacts. Socio-economic conditions must be sufficiently equitable so that all consumers can access the quantity and range of foods needed for a healthy diet. Consumers need to be able to make informed and rational choices so that they consume a healthy and environmentally sustainable diet (10).

annotated text Block Quote. The writer has chosen to present important evidence as a direct quotation, using the correct format for direct quotations longer than four lines. See Section Editing Focus: Integrating Sources and Quotations for more information about block quotes. end annotated text

public domain text Among their findings, they singled out, in particular, the practice of using human-edible crops to produce meat, dairy, and fish for the human table. Currently 34 percent of human-edible crops are fed to animals, a practice that reduces calorie and protein supplies. They state in their report, “If society continues on a ‘business-as-usual’ dietary trajectory, a 119% increase in edible crops grown will be required by 2050” (1). Future food production and distribution must be transformed into systems that are nutritionally adequate, environmentally sound, and economically affordable. end public domain text

Land and Water Use

public domain text Agriculture occupies 40 percent of Earth’s ice-free land mass (Barnard). While the net area used for producing food has been fairly constant since the mid-20th century, the locations have shifted significantly. Temperate regions of North America, Europe, and Russia have lost agricultural land to other uses, while in the tropics, agricultural land has expanded, mainly as a result of clearing forests and burning biomass (Willett et al.). Seventy percent of the rainforest that has been cut down is being used to graze livestock (Münter). Agricultural use of water is of critical concern both quantitatively and qualitatively. Agriculture accounts for about 70 percent of freshwater use, making it “the world’s largest water-consuming sector” (Barnard). Meat, dairy, and egg production causes water pollution, as liquid wastes flow into rivers and to the ocean (World Wildlife Fund and Knorr Foods). According to the Hertwich et al., “the impacts related to these activities are unlikely to be reduced, but rather enhanced, in a business-as-usual scenario for the future” (13). end public domain text

annotated text Statistical Data. To develop her points related to land and water use, Tran presents specific statistical data throughout this section. Notice that she has chosen only the needed words of these key points to ensure that she controls the development of the supporting point and does not overuse borrowed source material. end annotated text

annotated text Defining Terms. Aware of her audience, Tran defines monocropping , a term that may be unfamiliar. end annotated text

public domain text Earth’s resources and ability to absorb pollution are limited, and many current agricultural practices undermine these capacities. Among these unsustainable practices are monocropping [growing a single crop year after year on the same land], concentrated animal-feeding operations, and overdependence on manufactured pesticides and fertilizers (Hamilton). Such practices deplete the soil, dramatically increase energy use, reduce pollinator populations, and lead to the collapse of resource supplies. One study found that producing one gram of beef for human consumption requires 42 times more land, 2 times more water, and 4 times more nitrogen than staple crops. It also creates 3 times more greenhouse gas emissions (Chai et al.). The EAT– Lancet Commission calls for “halting expansion of new agricultural land at the expense of natural ecosystems . . . strict protections on intact ecosystems, suspending concessions for logging in protected areas, or conversion of remaining intact ecosystems, particularly peatlands and forest areas” (Willett et al. 481). The Commission also calls for land-use zoning, regulations prohibiting land clearing, and incentives for protecting natural areas, including forests. end public domain text

annotated text Synthesis. The paragraphs above and below this comment show how Tran has synthesized content from several sources to help establish and reinforce key supports of her essay . end annotated text

Greenhouse Gas and Climate Change

public domain text Climate change is heavily affected by two factors: greenhouse gas emissions and carbon sequestration. In nature, the two remain in balance; for example, most animals exhale carbon dioxide, and most plants capture carbon dioxide. Carbon is also captured, or sequestered, by soil and water, especially oceans, in what are called “sinks.” Human activities have skewed this balance over the past two centuries. The shift in land use, which exploits land, water, and fossil energy, has caused increased greenhouse-gas emissions, which in turn accelerate climate change. end public domain text

public domain text Global food systems are threatened by climate change because farmers depend on relatively stable climate systems to plan for production and harvest. Yet food production is responsible for up to 30 percent of greenhouse gas emissions (Barnard). While soil can be a highly effective means of carbon sequestration, agricultural soils have lost much of their effectiveness from overgrazing, erosion, overuse of chemical fertilizer, and excess tilling. Hamilton reports that the world’s cultivated and grazed soils have lost 50 to 70 percent of their ability to accumulate and store carbon. As a result, “billions of tons of carbon have been released into the atmosphere.” end public domain text

annotated text Direct Quotation and Paraphrase. While Tran has paraphrased some content of this source borrowing, because of the specificity and impact of the number— “billions of tons of carbon”—she has chosen to use the author’s original words. As she has done elsewhere in the essay, she has indicated these as directly borrowed words by placing them within quotation marks. See Section 12.5 for more about paraphrasing. end annotated text

public domain text While carbon sequestration has been falling, greenhouse gas emissions have been increasing as a result of the production, transport, processing, storage, waste disposal, and other life stages of food production. Agriculture alone is responsible for fully 10 to 12 percent of global emissions, and that figure is estimated to rise by up to 150 percent of current levels by 2030 (Chai et al.). Münter reports that “more greenhouse gas emissions are produced by growing livestock for meat than all the planes, trains, ships, cars, trucks, and all forms of fossil fuel-based transportation combined” (5). Additional greenhouse gases, methane and nitrous oxide, are produced by the decomposition of organic wastes. Methane has 25 times and nitrous oxide has nearly 300 times the global warming potential of carbon dioxide (Curnow). Agricultural and food production systems must be reformed to shift agriculture from greenhouse gas source to sink. end public domain text

Social and Cultural Values

public domain text As the Sierra Club has pointed out, agriculture is inherently cultural: all systems of food production have “the capacity to generate . . . economic benefits and ecological capital” as well as “a sense of meaning and connection to natural resources.” Yet this connection is more evident in some cultures and less so in others. Wealthy countries built on a consumer culture emphasize excess consumption. One result of this attitude is that in 2014, Americans discarded the equivalent of $165 billion worth of food. Much of this waste ended up rotting in landfills, comprised the single largest component of U.S. municipal solid waste, and contributed a substantial portion of U.S. methane emissions (Sierra Club). In low- and middle-income countries, food waste tends to occur in early production stages because of poor scheduling of harvests, improper handling of produce, or lack of market access (Willett et al.). The recent “America First” philosophy has encouraged prioritizing the economic welfare of one nation to the detriment of global welfare and sustainability. end public domain text

annotated text Synthesis and Response to Claims. Here, as in subsequent sections, while still relying heavily on facts and content from borrowed sources, Tran provides her synthesized understanding of the information by responding to key points. end annotated text

public domain text In response to claims that a vegetarian diet is a necessary component of sustainable food production and consumption, Lusk and Norwood determined the importance of meat in a consumer’s diet. Their study indicated that meat is the most valuable food category to consumers, and “humans derive great pleasure from consuming beef, pork, and poultry” (120). Currently only 4 percent of Americans are vegetarians, and it would be difficult to convince consumers to change their eating habits. Purdy adds “there’s the issue of philosophy. A lot of vegans aren’t in the business of avoiding animal products for the sake of land sustainability. Many would prefer to just leave animal husbandry out of food altogether.” end public domain text

public domain text At the same time, consumers expect ready availability of the foods they desire, regardless of health implications or sustainability of sources. Unhealthy and unsustainable foods are heavily marketed. Out-of-season produce is imported year-round, increasing carbon emissions from air transportation. Highly processed and packaged convenience foods are nutritionally inferior and waste both energy and packaging materials. Serving sizes are larger than necessary, contributing to overconsumption and obesity. Snack food vending machines are ubiquitous in schools and public buildings. What is needed is a widespread attitude shift toward reducing waste, choosing local fruits and vegetables that are in season, and paying attention to how foods are grown and transported. end public domain text

annotated text Thesis Restated. Restating her thesis, Tran ends this section by advocating for a change in attitude to bring about sustainability. end annotated text

DISSENTING OPINIONS

annotated text Counterclaims . Tran uses equally strong research to present the counterargument. Presenting both sides by addressing objections is important in constructing a clear, well-reasoned argument. Writers should use as much rigor in finding research-based evidence to counter the opposition as they do to develop their argument. end annotated text

public domain text Transformation of the food production system faces resistance for a number of reasons, most of which dispute the need for plant-based diets. Historically, meat has been considered integral to athletes’ diets and thus has caused many consumers to believe meat is necessary for a healthy diet. Lynch et al. examined the impact of plant-based diets on human physical health, environmental sustainability, and exercise performance capacity. The results show “it is unlikely that plant-based diets provide advantages, but do not suffer from disadvantages, compared to omnivorous diets for strength, anaerobic, or aerobic exercise performance” (1). end public domain text

public domain text A second objection addresses the claim that land use for animal-based food production contributes to pollution and greenhouse gas emissions and is inefficient in terms of nutrient delivery. Berners-Lee et al. point out that animal nutrition from grass, pasture, and silage comes partially from land that cannot be used for other purposes, such as producing food directly edible by humans or for other ecosystem services such as biofuel production. Consequently, nutritional losses from such land use do not fully translate into losses of human-available nutrients (3). end public domain text

annotated text Paraphrase. Tran has paraphrased the information as support. Though she still cites the source, she has changed the words to her own, most likely to condense a larger amount of original text or to make it more accessible. end annotated text

public domain text While this objection may be correct, it does not address the fact that natural carbon sinks are being destroyed to increase agricultural land and, therefore, increase greenhouse gas emissions into the atmosphere. end public domain text

public domain text Another significant dissenting opinion is that transforming food production will place hardships on farmers and others employed in the food industry. Farmers and ranchers make a major investment in their own operations. At the same time, they support jobs in related industries, as consumers of farm machinery, customers at local businesses, and suppliers for other industries such as food processing (Schulz). Sparks reports that “livestock farmers are being unfairly ‘demonized’ by vegans and environmental advocates” and argues that while farming includes both costs and benefits, the costs receive much more attention than the benefits. end public domain text

FUTURE GENERATIONS

public domain text The EAT– Lancet Commission calls for a transformation in the global food system, implementing different core processes and feedback. This transformation will not happen unless there is “widespread, multi-sector, multilevel action to change what food is eaten, how it is produced, and its effects on the environment and health, while providing healthy diets for the global population” (Willett et al. 476). System changes will require global efforts coordinated across all levels and will require governments, the private sector, and civil society to share a common vision and goals. Scientific modeling indicates 10 billion people could indeed be fed a healthy and sustainable diet. end public domain text

annotated text Conclusion. While still using research-based sources as evidence in the concluding section, Tran finishes with her own words, restating her thesis. end annotated text

public domain text For the human race to have a sustainable future, massive changes in the way food is produced, processed, and distributed are necessary on a global scale. The required changes will affect nearly all aspects of life, including not only world hunger but also health and welfare, land use and habitats, water quality and availability, energy use and production, greenhouse gas emissions and climate change, economics, and even cultural and social values. These changes may not be popular, but they are imperative. They are also achievable. The human race must turn to sustainable food systems that provide healthy diets with minimal environmental impact, starting now. end public domain text

annotated text Sources. Note two important aspects of the sources chosen: 1) They represent a range of perspectives, and 2) They are all quite current. When exploring a contemporary topic, it is important to avoid research that is out of date. end annotated text

Works Cited

Barnard, Neal. “How Eating More Plants Can Save Lives and the Planet.” Physicians Committee for Responsible Medicine , 24 Jan. 2019, www.pcrm.org/news/blog/how-eating-more-plants-can-save-lives-and-planet. Accessed 6 Dec. 2020.

Berners-Lee, M., et al. “Current Global Food Production Is Sufficient to Meet Human Nutritional Needs in 2050 Provided There Is Radical Societal Adaptation.” Elementa: Science of the Anthropocene , vol. 6, no. 52, 2018, doi:10.1525/elementa.310. Accessed 7 Dec. 2020.

Chai, Bingli Clark, et al. “Which Diet Has the Least Environmental Impact on Our Planet? A Systematic Review of Vegan, Vegetarian and Omnivorous Diets.” Sustainability , vol. 11, no. 15, 2019, doi: underline 10.3390/su11154110 end underline . Accessed 6 Dec. 2020.

Curnow, Mandy. “Managing Manure to Reduce Greenhouse Gas Emissions.” Government of Western Australia, Department of Primary Industries and Regional Development, 2 Nov. 2020, www.agric.wa.gov.au/climate-change/managing-manure-reduce-greenhouse-gas-emissions. Accessed 9 Dec. 2020.

Gray, Richard. “Why the Vegan Diet Is Not Always Green.” BBC , 13 Feb. 2020, www.bbc.com/future/article/20200211-why-the-vegan-diet-is-not-always-green. Accessed 6 Dec. 2020.

Hamilton, Bruce. “Food and Our Climate.” Sierra Club, 2014, www.sierraclub.org/compass/2014/10/food-and-our-climate. Accessed 6 Dec. 2020.

Hertwich. Edgar G., et al. Assessing the Environmental Impacts of Consumption and Production. United Nations Environment Programme, 2010, www.resourcepanel.org/reports/assessing-environmental-impacts-consumption-and-production.

Lusk, Jayson L., and F. Bailey Norwood. “Some Economic Benefits and Costs of Vegetarianism.” Agricultural and Resource Economics Review , vol. 38, no. 2, 2009, pp. 109-24, doi: 10.1017/S1068280500003142. Accessed 6 Dec. 2020.

Lynch Heidi, et al. “Plant-Based Diets: Considerations for Environmental Impact, Protein Quality, and Exercise Performance.” Nutrients, vol. 10, no. 12, 2018, doi:10.3390/nu10121841. Accessed 6 Dec. 2020.

Münter, Leilani. “Why a Plant-Based Diet Will Save the World.” Health and the Environment. Disruptive Women in Health Care & the United States Environmental Protection Agency, 2012, archive.epa.gov/womenandgirls/web/pdf/1016healththeenvironmentebook.pdf.

Purdy, Chase. “Being Vegan Isn’t as Good for Humanity as You Think.” Quartz , 4 Aug. 2016, qz.com/749443/being-vegan-isnt-as-environmentally-friendly-as-you-think/. Accessed 7 Dec. 2020.

Schulz, Lee. “Would a Sudden Loss of the Meat and Dairy Industry, and All the Ripple Effects, Destroy the Economy?” Iowa State U Department of Economics, www.econ.iastate.edu/node/691. Accessed 6 Dec. 2020.

Sierra Club. “Agriculture and Food.” Sierra Club, 28 Feb. 2015, www.sierraclub.org/policy/agriculture/food. Accessed 6 Dec. 2020.

Sparks, Hannah. “Veganism Won’t Save the World from Environmental Ruin, Researchers Warn.” New York Post , 29 Nov. 2019, nypost.com/2019/11/29/veganism-wont-save-the-world-from-environmental-ruin-researchers-warn/. Accessed 6 Dec. 2020.

Willett, Walter, et al. “Food in the Anthropocene: The EAT– Lancet Commission on Healthy Diets from Sustainable Food Systems.” The Lancet, vol. 393, no. 10170, 2019. doi:10.1016/S0140-6736(18)31788-4. Accessed 6 Dec. 2020.

World Health Organization. “Malnutrition.” World Health Organization, 1 Apr. 2020, www.who.int/news-room/fact-sheets/detail/malnutrition. Accessed 8 Dec. 2020.

World Health Organization. “Obesity and Overweight.” World Health Organization, 1 Apr. 2020, www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. Accessed 8 Dec. 2020.

World Wildlife Fund. Appetite for Destruction: Summary Report. World Wildlife Fund, 2017, www.wwf.org.uk/sites/default/files/2017-10/WWF_AppetiteForDestruction_Summary_Report_SignOff.pdf.

World Wildlife Fund and Knorr Foods. Future Fifty Foods. World Wildlife Fund, 2019, www.wwf.org.uk/sites/default/files/2019-02/Knorr_Future_50_Report_FINAL_Online.pdf.

“World Population by Year.” Worldometer , www.worldometers.info/world-population/world-population-by-year/. Accessed 8 Dec. 2020.

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March 14, 2017

How dietary factors influence disease risk

At a glance.

• Researchers found that eating too much or too little of certain foods and nutrients can raise the risk of dying of heart disease, stroke, and type 2 diabetes.
• These results suggest ways to change eating habits that may help improve health.

Having too much sugar, salt, or fat in your diet can raise your risk for certain diseases. Healthy eating can lower your risk for heart disease, stroke, diabetes, and other health conditions. A healthy eating plan emphasizes vegetables, fruits, whole grains, and fat-free or low-fat dairy products; includes lean meats, poultry, fish, beans, eggs, and nuts; and limits saturated and trans fats, sodium, and added sugars.

The major cardiometabolic diseases—heart disease, stroke, and type 2 diabetes—pose substantial health and economic burdens on society. To better understand how different dietary components affect the risk of dying from these diseases, a research team led by Dr. Dariush Mozaffarian of Tufts University analyzed data from CDC’s National Health and Nutrition Examination Survey (NHANES) and national disease-specific mortality data. The study was supported in part by NIH’s National Heart, Lung, and Blood Institute (NHLBI). Results appeared on March 7, 2017, in the Journal of the American Medical Association .

The researchers investigated the relationships of 10 different foods and nutrients with deaths related to heart disease, stroke, and type 2 diabetes. They also compared data on participants’ age, sex, ethnicity, and education. They found that nearly half of all the deaths in the United States in 2012 that were caused by cardiometabolic diseases were associated with suboptimal eating habits. Of 702,308 adult deaths due to heart disease, stroke, and type 2 diabetes, 318,656 (45%) were associated with inadequate consumption of certain foods and nutrients widely considered vital for healthy living, and overconsumption of other foods that are not.

The highest percentage of cardiometabolic disease-related death (9.5%) was related to excess consumption of sodium. Not eating enough nuts and seeds (8.5%), seafood omega-3 fats (7.8%), vegetables (7.6%), fruits (7.5%), whole grains (5.9%), or polyunsaturated fats (2.3%) also increased risk of death compared with people who had an optimal intake of these foods/nutrients. Eating too much processed meat (8.2%), sugar-sweetened beverages (7.4%), and unprocessed red meat (0.4%) also raised the risk of heart disease, stroke, and type 2 diabetes-related deaths.

The study showed that the proportion of deaths associated with suboptimal diet varied across demographic groups. For instance, the proportion was higher among men than women; among blacks and Hispanics compared to whites; and among those with lower education levels.

“This study establishes the number of cardiometabolic deaths that can be linked to Americans’ eating habits, and the number is large,” explains Dr. David Goff, director of the NHLBI Division of Cardiovascular Sciences. “Second, it shows how recent reductions in those deaths relate to improvements in diet, and this relationship is strong. There is much work to be done in preventing heart disease, but we also know that better dietary habits can improve our health quickly, and we can act on that knowledge by making and building on small changes that add up over time.”

These findings are based on averages across the population and aren’t specific to any one person’s individual risk. Many other factors contribute to personal disease risk, including genetic factors and levels of physical activity. Individuals should consult with a health care professional about their particular dietary needs.

—Tianna Hicklin, Ph.D.

Related Links

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• Diet Beverages and Body Weight
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• Healthy Diet May Fend Off Type 2 Diabetes After Gestational Diabetes
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References:  Association Between Dietary Factors and Mortality From Heart Disease, Stroke, and Type 2 Diabetes in the United States. Micha R, Peñalvo JL, Cudhea F, Imamura F, Rehm CD, Mozaffarian D. JAMA . 2017 Mar 7;317(9):912-924. doi: 10.1001/jama.2017.0947. PMID: 28267855.

Funding:  NIH’s National Heart, Lung, and Blood Institute (NHLBI) and Bunge Fellowship in Global Nutrition.

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Importance of Healthy Nutrition Essay

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To stay alive, the human body requires proper nutrients. These nutrients are absorbed from the food we eat. The absorbed food will help the cells in the human body stay alive and function optimally.

Nutrition is important to all human beings. One cannot survive without proper nutrition. However, nutrition is more important in certain stages of life than others (Wardlaw & Smith 2011). Nutrition is very important during childhood.

The reason for this is that children require more energy than adults. The macronutrients and micronutrients that the body needs are absorbed according to the body size. The smaller the body size the more nutrients the body will need. Children also have a higher growth rate.

Proper nutrition is also important to the elderly. This is due to the slow growth of their body cells. Proper nutrition is required to maintain normal cell growth and improve the rate of cell growth (Insel 2011). They also need proper nutrition to maintain good mental health, immunological health and cardiovascular health.

The lifestyle of most people will affect them in future. The food we eat today will affect our health in future. The consumption of healthy foods minimizes the chance of contracting certain diseases (Wardlaw & Smith 2011). These diseases include; cancer, arthritis and stroke. Obesity is also among the diseases that can be avoided if we eat healthy.

Recent research has shown that more people are at risk of suffering from these diseases due to lack of proper nutrition. Their lifestyles have forced them to consume fatty foods commonly referred to as junk food. Eating healthy food will help boost the body’s immune system while reducing the risk of trauma. The ability of the body to grow and operate optimally depends on the food we eat.

Recent findings have revealed that obesity is the most common health condition affecting young adults. The number of overweight children has been growing day by day. The reason behind this is poor nutrition. Change in lifestyle has also been found to be the main cause of this problem (Insel 2011). Most parents are now fully employed. This leaves them with no option but to take their children to fast food joints to have meals. Fast food joints are expanding daily and relocating to more strategic places.

The government has an important role to play in order to control this menace. They need to come up with various legislations that will help put a stop to this worrying trend. A good example would be banning all fast food joints within a certain radius from educational institutions (Wardlaw & Smith 2011). This will make it harder for children to access these joints.

The government should also encourage awareness campaigns that will help in the fight against obesity. These campaigns will focus more on sensitizing parents and children on the need for proper nutrition. The effects of poor nutrition should also be addressed during these campaigns. With time, this will raise the awareness levels and help in the fight against obesity (Insel 2011).

The recent statistics leaves the government with no choice. The productive population of the society is slowly dying from health related diseases (Wardlaw & Smith 2011). These are the future leaders, employees and workers that will help grow the economy when the current leaders have retired. It is also the responsibility of the government to make sure that all citizens are healthy and protected from all health issues that would endanger their lives.

Insel, P. M. (2011). Nutrition . Sudbury, Mass.: Jones and Bartlett Publishers.

Wardlaw, G. M., & Smith, A. M. (2011). Contemporary nutrition . New York, NY: McGraw-Hill.

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The Effects of Poor Nutrition on Your Health

Poor nutrition habits can be a behavioral health issue, because nutrition and diet affect how you feel, look, think and act. A bad diet results in lower core strength, slower problem solving ability and muscle response time, and less alertness. Poor nutrition creates many other negative health effects as well.

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According to a National Center of Health Statistics 2003 survey, about 65.2 percent of American adults have overweight or obesity as a result of poor nutrition. Obesity is defined as having a body mass index (BMI) of 25 or more. Having overweight puts people at risk for developing a host of disorders and conditions, some of them life-threatening.

Hypertension

The National Institutes of Health reports that hypertension is one of the possible outcomes of poor nutrition. Hypertension, also known as high blood pressure, is called the silent killer, because it frequently remains undetected and thus untreated until damage to the body has been done. Eating too much ultra-processed food, fried food, salt, sugar, dairy products, caffeine and refined food can cause hypertension.

High Cholesterol and Heart Disease

Poor nutrition can lead to high cholesterol, which is a primary contributor to heart disease. High fat diets are common in the United States and Canada. The National Institutes of Health reports that more than 500,000 people in the United States die each year due to heart disease, which can be caused by a high fat diet. High cholesterol foods contain a large amount of saturated fat. Examples include ice cream, eggs, cheese, butter and beef. Instead of high fat foods, choose lean proteins such as chicken, turkey, fish and seafood and avoid processed foods.

Diabetes also can be linked to poor nutrition. Some forms of the disease can result from consuming a sugar- and fat-laden diet, leading to weight gain. According to the National Institute of Health, about 8 percent of the American population has diabetes.

A stroke that is caused by plaque that builds up in a blood vessel, then breaks free as a clot that travels to your brain and creates a blockage can be linked to poor nutrition. Strokes damage the brain and impair functioning, sometimes leading to death. Foods high in salt, fat and cholesterol increase your risk for stroke.

According to the National Institutes of Health, poor nutrition can lead to gout. With gout, uric acid buildup results in the formation of crystals in your joints. The painful swelling associated with gout can lead to permanent joint damage. A diet that is high in fat or cholesterol can cause gout. Some seafood--sardines, mussels, oysters and scallops--as well as red meat, poultry, pork, butter, whole milk, ice cream and cheese can increase the amount of uric acid in your body, causing gout.

According to the National Institutes of Health, several types of cancer, including bladder, colon and breast cancers, may be partially caused by poor dietary habits. Limit your intake of foods that contains refined sugars, nitrates and hydrogenated oils, including hot dogs, processed meats, bacon, doughnuts and french fries.

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Unhealthy Dietary Habits and Obesity: The Major Risk Factors Beyond Non-Communicable Diseases in the Eastern Mediterranean Region

Ayoub al-jawaldeh.

1 World Health Organization (WHO), Regional Office for the Eastern Mediterranean (EMRO), Cairo, Egypt

Marwa M. S. Abbass

2 Oral Biology Department, Faculty of Dentistry, Cairo University, Cairo, Egypt

There are 22 countries in the Eastern Mediterranean Region (EMR) expanding from Morocco in the west to Pakistan and Afghanistan in the east, containing a population of 725,721 million in 2020. In the previous 30 years, the illness burden in the EMR has transmitted from communicable diseases to non-communicable diseases such as diabetes, cardiovascular diseases, and cancer. In 2019, cardiovascular mortality in the EMR was mostly attributed to ischemic heart disease, the first reason for mortality in 19 countries in the region. Stroke was the second reason for death in nine countries followed by diabetes, which was ranked as the second reason for death in two countries. The prominent nutrition-related NCDs risk factors in EMR include obesity, hypertension, high fasting plasma glucose, and upregulated unhealthy diet consumption. Most of the EMR population are unaware of their NCDs risk factor status. These risk factors, even if treated, are often poorly controlled, therefore, inhibiting their existence by changing the lifestyle to proper dietary habits and sufficient physical activity is mandatory. In this review, the epidemiology and nutrition-related risk factors of NCDs in the EMR will be discussed and illustrated, aiming to scale up action and support decision-makers in implementing cost effective strategies to address obesity and NCDs prevention and management in the region.

Introduction

The Eastern Mediterranean Region (EMR) encompasses 22 countries including [Afghanistan, Bahrain, Djibouti, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Palestine, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, United Arab Emirates (UAE), and Yemen], with a population of ~725,720 million ( 1 ).

In the past three decades, similar to other developing regions in the world, the EMR has undergone a transmission in the disease burden from primarily communicable disorders, such as lower respiratory infections, to non-communicable diseases (NCDs). NCDs include cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases. In 2012, the rate of death from NCDs in the EMR (654 per 100,000 persons) was higher than the global rate (539 per 100,000 persons) and is expected to peak by 2030. In 2015, nearly 58.4% of total deaths in the EMR were due to NCDs, with the chief cause being CVDs (27.4% of total deaths) ( 2 , 3 ).

NCDs are the essential global cause of death and are responsible for over 70% of deaths worldwide ( 3 ). NCDs were responsible for 41 million of the 57 million fatalities worldwide, 15 million of which were premature (30–70 years). The burden is the greatest among low- and middle-income countries, where 78% of global NCDs fatalities and 85% of premature deaths took place ( 4 ). Moreover, globally, NCDs were responsible for 1.62 billion DALYs in 2019, with an increase from 43.2% in 1990 to 63.8% in 2019 ( 5 ). In 2019, the number of fatalities in EMR due to CVDs was 1,464,672 million, 431,312 thousand individuals died from cancer, and 186,841 thousand died from diabetes ( 6 ).

The NCDs share the key four modifiable behavioral risk factors including tobacco usage, unhealthy diet, physical inactivity, and excessive use of alcohol, these factors, in turn, lead to nutritional- physiological related risk factors including overweight/obesity, raised blood pressure, high fasting blood glucose, and high blood cholesterol. The relationship between NCDs and the risk factors involved in their incidence is intermingled and the risk factors are also associated with each other ( Figure 1 ). It is noteworthy that the behavioral risk factors linked with NCDs are closely related to the demographic and socioeconomic status (SES) in the region ( 7 ).

The interdisciplinary relationship between unhealthy diet consumption, obesity, and other NCDs risk factors.

Despite NCDs being a critical health obstacle in all EMR countries, tackling NCDs and their key risk factors requires an imperative understanding of the current status and progress at the country and region level. This review discusses nutrition-related NCDs burden and the associated risk factors in the EMR. The current challenges and areas requiring further attention will be also highlighted.

Methodology

In this paper, the prevalence of NCDs and the associated nutrition-related risk factors in the WHO-EMR are discussed and illustrated. Data for the prevalence of CVDs, diabetes, and cancer as well as different risk factors including overweight/obesity, raised blood pressure, high fasting blood glucose, and high blood cholesterol in the WHO –EMR are summarized. Age-standardized estimates were obtained from the NCDs Risk Collaboration, which in turn, are based on data provided to WHO and the NCDs Risk Factor Collaboration or obtained through a literature review ( 8 ). For those estimates, adjustments had been made to standardize risk factor definition, age groups, reporting year, and representativeness of the population. Age-standardized prevalence estimates were calculated to adjust for differences in age/sex structure between populations and to enable comparisons between countries ( 8 ). The definition of being overweight or having obesity was used for people with a BMI of 25 kg/m 2 or higher and a BMI of 30 kg/m 2 or higher, respectively.

Data regarding the number of deaths and probability of death attributed to CVDs, diabetes, and cancer among adults in EMR were obtained from the global health observatory ( 9 ). Raised fasting blood glucose, raised blood pressure, and diabetes prevalence in EMR was also obtained from the global health observatory ( 6 ). Cancer trends in EMR data including the number of cancer cases, cancer rates/100,000 (Age-standardized) as well as cumulative cancer risk were obtained from the Global Cancer Observatory ( 9 ). Data regarding the food consumption in EMR were collected from the FAO food balance sheets ( 10 ). Concerning estimated sodium intakes (g/day) for persons aged 20 and over data were attained from the systematic analysis of 24 h urinary sodium excretion and dietary surveys worldwide ( 11 ). Data relating to the mean salt intake for adults (g/day) were obtained from the non-communicable diseases country profiles ( 4 ). Saturated fat (% energy), Omega-6 PUFA (% energy), Trans fat (% energy), Dietary cholesterol (mg/d), Seafood omega-3 fat (mg/d), and Plant omega-3 fat (mg/d) data were obtained from the systematic analysis nutrition surveys including 266 countries ( 11 ). Data relating to sugar-sweetened beverage consumption in EMR were harvested from a systematic assessment of beverage intake in 187 countries ( 12 ).

The data from the Global Burden of Disease Study 2019 presented in this review included the rank of the nutrition related risk factors that caused deaths in EMR countries in 2019 as well as the percentage change in these risk factors between 2009 and 2019 ( 13 ).

The policies relating to actions to reduce NCDs in EMR, as well as the policies associated with healthy diets in the countries of the WHO-EMR, are tabulated. Data have been extracted from various sources. These include the WHO's global ( 6 ) and regional health observatories ( 14 ), data collected for the second WHO Global Nutrition Policy Review 2016–2017 ( 15 ), the WHO Global Database on the Implementation of Nutrition Action (GINA) ( 16 ), communication about country-level action from WHO country offices and national government nutrition focal points, and other relevant academic papers ( 17 – 20 ). Specifically, data were collected on the policy areas related to a healthy diet that features in the new regional nutrition strategy ( 21 ).

Data are presented in narrative or tabular form. To group countries according to the income level, the World Bank classification was used to identify the income level of each country ( 22 ). The low-income group includes Afghanistan, Somalia, Sudan, Syria, and Yemen. The lower middle-income group includes Djibouti, Egypt, Morocco, Pakistan, Tunisia, and the occupied Palestinian Territory. The upper middle-income group includes: Iran, Iraq, Jordan, Lebanon, and Libya. The high-income level includes: Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and United Arab Emirates (UAE).

Nutrition Related Non-Communicable Diseases

Cardiovascular diseases.

Worldwide, in 2019, cardiovascular diseases were responsible for 393 million DALYs and 18.6 million deaths in both sexes ( 23 ). In EMR, the high number of NCDs deaths was attributed to CVDs (1,464,672 million) in 2019. Pakistan recorded the highest number (449,905) followed by Egypt (252,650), Iran (157,018) then Morocco (126,562) ( 6 ) ( Table 1 ).

Number of deaths and probability of death attributed to CVDs, diabetes, and cancer among adults in EMR ( 6 ).

Diabetes, smoking, high blood pressure, high BMI, stress, high cholesterol levels, poor nutrition, and insufficient physical exercise are all considered risk factors responsible for the incidence of CVDs ( 24 ). According to Franklin and Wong, hypertension is the main cause of cardiovascular disease, which worsens with age and may be the world's leading cause of mortality ( 25 ).

A cross-sectional study conducted among the local population of 53 cities in Punjab, Pakistan, reported that CVDs impacted 17.5% of the population, with females having a higher incidence rate than males and start occurring at a younger age. An inactive lifestyle, low level of activity and family history of disease could be disease risk factors ( 26 ). CVDs are also responsible for 40% and 37% of deaths in Egypt and Saudi Arabia, respectively. A comparative cross-sectional study involved students from two medical of both sexes from Saudi Arabia and Egypt revealed a relatively high prevalence of a sedentary life style, obesity, and abdominal obesity. Saudi students revealed a significantly higher prevalence of obesity while male Egyptian students recorded a significantly higher prevalence of hypertension. Both populations were at an elevated risk of acquiring fatal cardiovascular disease within 10 years (23.9% of Saudi students and 16.7% of Egyptian students) ( 27 ). In Iran despite the slight recession in the number of smokers, total cholesterol, and blood pressure, adverse trends in physical activity, unhealthy diet, obesity, and fasting plasma glucose must be addressed immediately at a public health level in order to battle the advancement of CVDs ( 28 ).

According to the Global Burden of Disease Study 2019, ischemic heart disease is the most common reason for death in EMR and it is the first reason for death in 19 countries in EMR (Afghanistan, Bahrain, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Palestine, Qatar, Saudi Arabia, Sudan, Syrian Arab Republic, Tunisia, United Arab Emirates, and Yemen) ( 13 ). Globally, on concomitant ischemic heart disease was the leading cause of death in people aged between 30 and 70 years in 146 (83%) countries for men and 98 (55.7%) for women. For men, the risk reached as high as 20% and for women as high as 13% in some countries. Other regions that suffer from this high risk of dying from ischemic heart disease were eastern Europe, central Asia, and south Asia ( 29 ). The highest increase in the ischemic heart disease percentage between 2009 and 2019, in the EMR, was reported in UAE (130.6%) followed by Jordan (86.3%) then Djibouti (67.9 %) and Egypt (62.9 %). Stroke is the second reason for death in nine countries (Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Palestine, Syrian Arab Republic, and Tunisia). The highest increase in stroke percentage between 2009 and 2019, was reported in UAE (105.2%) followed by Jordan (78.5%) then Djibouti (52.7%) ( 13 ).

Diabetes Mellitus

In 2019, diabetes mellitus caused 70.9 million (2.8%) of total global DALYs ( 30 ). 9.3 percent (463 million people) was the conservative estimate for the prevalence of diabetes in 2019 which is expected to rise by 2030 to 10.2% (578 million) and by 2045 to 10.9% (700 million). The prevalence is higher in urban (10.8%) than rural (7.2%) areas, and in high-income (10.4%) than low-income countries (4.0%). Nearly, half of people (51%) living with diabetes are not aware of that they are diabetics. Impaired glucose tolerance affected 7.5% of the world's population (374 million) in 2019, rising to 8.0% (454 million) by 2030 and 8.6% (548 million) by 2045 ( 31 ). Notably, in 2019 the prevalence of diabetes was the highest in the EMR (11.96%) compared with all other regions. Sudan, Qatar, Iran, Bahrain, Somalia, and Djibouti revealed the highest percentage of Diabetes among individuals aged 20–80 years (22.1, 19.9, 17.2, 16.3, 15.8, and 15.6%, respectively) ( 32 ) ( Table 2 ; Figure 2 ).

Obesity, raised fasting blood glucose, raised blood pressure, diabetes prevalence, and cancer trends in EMR ( 6 ).

Diabetes prevalence among adults in different regions ( 6 ).

In EMR, the total number of fatalities due to diabetes was 186,841 thousand in 2019. Pakistan recorded the highest number (80,976) followed by Egypt (26,844), Iran (157,018) then Morocco (17,947) ( 6 ) ( Table 1 ). According to the 2019 Global Burden of Disease Study, diabetes is the second cause of death in two countries (Bahrain and Jordan) and the third reason for death in three countries (Iraq, Palestine, and Qatar) in the region. The highest increase in diabetes percentage between 2009 and 2019 in EMR was reported in UAE (124.2%) followed by Palestine (89.1%) then Bahrain (88.1%), Iran (80.8%), and Jourdan (69.7%) ( 13 ).

The mortality rate due to diabetes in Bahrain was 14% in 2016. A cross sectional study reported that type 2 diabetes exerts a significant pressure on Bahrain's healthcare system—primarily due to costly diabetes-related complications. Thereby, reducing the risk factors for diabetes is mandatory to minimize disabling and expensive complications ( 33 ). Additionally, multivariate analysis for a wide community-based survey in Pakistan using glycated hemoglobin revealed a significant link between type 2 diabetes and old age. Increase in body mass index, central obesity, positive family history, and having hypertension with type 2 diabetes were inversely related to education ( 34 ).

Egypt has been identified by the International Diabetes Federation as the ninth leading country in the world for the number of type 2 diabetes patients. The frequency of type 2 diabetes has nearly tripled in the last two decades in Egypt. This dramatic increase could be due to an increase in the typical risk factors for type 2 diabetes, such as obesity and physical inactivity, as well as a shift in dietary habits, or to other risk factors specific to Egypt. Increased exposure to environmental risk factors such as pesticides and a higher prevalence of chronic hepatitis C are two examples ( 35 ).

In a population-level mathematical model among Qatari, the baseline scenario revealed that type 2 diabetes prevalence would be upregulated from 16.7% in 2016 to 24.0% in 2050. By lowering obesity prevalence by 10–50%, type 2 diabetes prevalence would reduced by 7.8–33.7%, while by reducing physical inactivity prevalence by 10–50%, type 2 diabetes prevalence would reduced by 0.5–6.9% by 2050 ( 36 ).

Globally in 2019, total cancers recorded 23.6 million incident cases, 10.0 million deaths, and 250 million DALYs. Total cancers were the second-ruling reason for death and DALYs in 2019 worldwide ( 13 ). Globally in 2020, an estimated 19.3 million new cancer cases (18.1 million excluding non-melanoma skin cancer) and almost 10.0 million cancer deaths (9.9 million excluding non-melanoma skin cancer) occurred ( 37 ). According to long-term projections, the EMR countries will suffer from a disturbing rise in the number of cancer patients reaching a 1.8 fold by 2030 ( 38 ). The highest number of cancer cases in EMR in 2020 has been recorded in Pakistan (170,668) thousand individuals followed by Egypt (129,577), then Iran (127,548) ( 9 ) ( Table 2 ). Bahrain, Qatar, Iran, and Lebanon reported a 16% mortality rate due to cancers, Kuwait reported 15% while Egypt reported 13% ( 4 ).

Bahrain, which is among the high income gulf countries, suffers from a rising burden of cancer ( 39 , 40 ). Breast, colorectal, and lung cancers, followed by non-Hodgkin lymphoma and leukemia, are the five most frequently diagnosed cancers in Bahrain ( 41 ). Obesity, smoking, a sedentary lifestyle, and a high-fat/low-fiber diet are among the significant risk factors for colorectal cancer in Bahrain. Nearly one-third of the population of Bahrain is overweight or obese ( 42 , 43 ).

A systematic review investigating the epidemiological aspects of gastric cancer in Iran based on articles published during the years 1970–2020 showed that poor levels of economic position and food insecurity raised the probabilities of stomach cancer by 2.42- and 2.57-times, respectively. Moreover, there was a link between dairy products, processed red meat, fruit juice, legumes, smoked and salty fish, salt, strong as well as hot tea consumption with the risk of stomach cancer. There was also an inverse link between fresh fruit, citrus, and garlic consumption and stomach cancer ( 44 ).

The global age-standardized rate as reported by the American Institute for Cancer Research, 2018 for all cancers (including non-melanoma skin cancer) for both genders was 197.9 per 100,000 in 2018. Men revealed a higher rate (218.6 per 100,000) than women (182.6 per 100,000) ( 45 ). Most of the EMR countries revealed a relatively high rate of cancer incidence as nine countries in the region have cancer rates of more than (200 per 100,000). The highest cancer rates as revealed in 2020 have been reported in Egypt (258 per 100,000) followed by Lebanon (252.5 per 100,000) then Jordan (251.8 per 100,000) then Iran (245.2 per100,000) followed by Syria (241.5 per 100,000), and then Morocco (238.8 per 100,000) ( 9 ) ( Table 2 ).

In EMR, the total number of fatalities due to cancer (431,312) in 2019. Pakistan recorded the highest number (124,328) followed by Egypt (85,226), Iran (61,063), then Morocco (33,845) ( 6 ) ( Table 1 ). By 2050, a three-fold increase in cancer incidence relative to 2013 was estimated to occur in Egypt ( 46 ). The highest increase in cancer percentage between 2009 and 2019 in EMR was reported in the UAE (241.7% increase in pancreatic cancer) followed by Jordan and Qatar (103.7 and 95.2%, respectively increase in lung cancer) ( 13 ).

Risk Factors Burden

A dramatic increase in NCDs-related risk factors has been reported in the EMR in the past 10 years ( 13 ). The risk factors of NCDs comprise metabolic-physiological-related conditions (including obesity, high blood pressure, high fasting plasma glucose, high blood cholesterol) as well as behavioral-related activities (including smoking, low physical activity, unhealthy diet consumption, excessive use of alcohol). An analytic review published in 2019 reported that individuals who followed healthy lifestyle practices including regular physical activity, sound nutrition, weight management, and non-smoking revealed a significant downregulation of CVDs risk by >80% and diabetes by >90% ( 47 ). Additionally, another study outlined that around 40% of cancer cases could be prevented by reducing exposure to cancer risk factors including diet, nutrition, and physical activity ( 45 ).

Dietary Risks or Unhealthy Diet Consumption

Dietary risk is defined as eating a diet low in whole grains, nuts, seeds, fruit, vegetables, fibers, legumes, omega-3 fatty acids, PUFA, milk, and calcium as well as a diet high in sodium, trans fats, red or processed meat, and sugar-sweetened beverages (SSB). Globally in 2019, dietary risks were responsible for 188 million DALYs and 7.94 million deaths among adults aged 25 and older. It was the fifth-ruling risk factor for attributable DALYs ( 48 ). Dietary risk is the third risk factor in Syria and the fourth risk factor in 6 countries in the EMR (Afghanistan, Morocco, Oman, Pakistan, KSA, and Yemen) responsible for the most deaths and disabilities. The highest increase in dietary risk percentage between 2009 and 2019 in EMR was reported in UAE (136.9%), followed by Jordan (84.7%) then Qatar (66.8%) ( 13 ), as shown in Table 5 .

Fruits and Vegetables

An adequate daily intake of fruits and vegetables is associated with reduced risks of CVDs ( 49 ), stroke ( 50 ), type 2 diabetes ( 51 ), and certain types of cancer ( 52 , 53 ), which are the major causes of mortality and morbidity in the EMR. The 2002 Joint FAO/WHO Expert Consultation on Diet, Nutrition and the Prevention of Chronic Diseases recommends a minimum of 400 g per day of fruits and vegetables, an equivalent of ≥5 servings of fruits and vegetables per day, excluding starchy roots ( 54 ).

In 2013, the rate of fruits and vegetables intake among individuals living in the EMR was 280 g per day, which is lower than WHO recommendation for the prevention of NCDs. Furthermore, it has been reported that the mean daily intake of fruits in the Middle East and North Africa region was <130 g per day, and the mean intake of vegetables was less than 200 g per day ( 2 ). According to the food balance sheets 2019, the mean fruits and vegetables intake among EMR countries is 32 kg/capita/year ( 10 ), see Table 3 . It is noteworthy, that data concerning fruits and vegetables intake in EMR are limited.

Food consumption in EMR (2019) ( 10 ).

Most individuals living in the EMR have an insufficient intake of fruits and vegetables. It has been established that only 7.3% of individuals from Saudi Arabia aged 15–64 years were consuming the WHO-recommended five servings of fruits and vegetables per day and only 2.6% met the CDC guidelines for daily consumption of fruits and vegetables ( 55 ). In a more recent cross-sectional study conducted on 1,437 individuals, aged ≥ 18 years, 88% of the subjects recorded low intake of fruits and vegetables with a significant increase in fast food consumption ( 56 ). The relationship between food consumption patterns and expenditure was investigated in village Kabal in rural areas of Pakistan, using a sample size of 100 households. The study outlined that an adult consumes nearly 74.68 g of meat, 166.34 g of milk, 372.51 g of flour, 70.29 g of rice, 28.31 g of pulses, 177.12 g of vegetables, 66.39 g of fruits, 6.76 g of black tea, 53.60 g of fats, and 73.21 g of sugar daily ( 57 ). Furthermore, an assessment of fruits and vegetables consumption among 473 medical students in Egypt outlined that 8.2% of students knew the recommended five daily servings for fruits and vegetables, and 23.26% consumed the five daily servings. Healthy food items were tried by only 35.7% of students ( 58 ).

Fat Consumption

Fat consists of trans-fatty acids (TFAs), saturated fatty acids (SFA), and unsaturated fatty acids ( 59 ). Saturated fatty acids can be found in animal products like milk, butter, cheese, as well as most plant oils, particularly palm and coconut oil, which are high in SFA. Lauric acid, myristic acid, and palmitic acid (PA) are all major sources of SFA, and they all raise low-density lipoprotein cholesterol (LDL-c) ( 60 ). Increased inflammation, oxidative stress, and decreased nitric oxide and insulin signaling is some of the impacts of PA, which is found in palm oil ( 61 , 62 ). The American Heart Association recommends a healthy dietary pattern that achieves 5–6% of calories from saturated fat (about 13 g of saturated fat per day). In EMR, three countries have exceeded 13% of energy from saturated fats, Djibouti (15.2% of energy) followed by Yemen (13.9% of energy), and KSA (13.5% of energy) ( 63 ) (see Table 4 ). In Saudi Arabia, a significant positive association was found between the intake of fats, protein, and calories and the risk of breast cancer. Adjusted odds ratios for the highest quartile of intake versus the lowest were 1.88 for cholesterol, 2.12 for polyunsaturated fat, 2.25 for animal protein, 2.43 for saturated fat, and 2.69 for total energy from dietary intake ( 64 ).

Salt, fat, and sugar-sweetened beverage consumption in EMR ( 4 , 11 , 12 , 63 ).

A diet high in trans-fatty acids is defined as any intake (in percentage daily energy) of trans fat from all sources, primarily partially hydrogenated vegetable oils and ruminant products. TFAs are typically found in processed food, fast food, snack food, fried food, pies, cookies, margarine, and spreads ( 59 ). In 2019, a diet high in TFAs was responsible for 14.2 million DALYs and 645,000 deaths. It was the seventh-ruling dietary risk factor for attributable DALYs ( 65 ).

The consumption of TFAs increases the risk of death from any cause by 34% and coronary heart disease by 28% ( 66 ). An increase in coronary heart disease mortality estimated by 12% occurs as a result of every 1% increase in daily energy obtained from TFAs ( 67 ). Industrial TFAs intake has also been related to an increased risk for other NCDs and associated conditions such as ovarian cancer ( 68 ), infertility, endometriosis, Alzheimer's disease, diabetes, and obesity ( 59 , 69 ). Higher consumption of hydrogenated vegetable oils was associated with an increased risk of myocardial infarction in a cohort study conducted among an Iranian population ( 70 ).

Despite WHO recommendations that total trans fat intake should not exceed 1% of total energy intake, which translates to >2.2 g/day for a 2,000-calorie diet ( 71 ), in 2010, four countries in the region have exceeded this level (Iran, Bahrain, Pakistan, and Egypt) ( 63 ) ( Table 4 ). Laboratory analysis was conducted for profiling TFAs, saturated, and unsaturated fatty acids in the products that are mostly consumed in the major governorates in Egypt. On average, 34% of the products exceeded the TFAs limit (more than 2 g TFA/100 g of fat). The study revealed that around one third of products in the Egyptian market have a high TFAs content ( 72 ). Iran has achieved a marked improvement in the reduction of TFAs as early studies recorded 12.3 g as a mean intake in 2007, while in 2013 this has been reduced to 1.42 and 1.5 g in 2018 ( 73 – 76 ).

The 2019 American College of Cardiology/American Heart Association Guideline on the Primary Prevention of Cardiovascular Disease concluded that a diet containing reduced amounts of cholesterol and sodium could be beneficial to decrease atherosclerotic CVDs risk ( 77 ). Every increase in dietary cholesterol by 100 mg/day predicted an increase in LDL-c from 1.90 to 4.58 mg/dl depending on the model ( 78 ). The 2015 National Lipid Association Recommendations for Patient-Centered Management of Dyslipidemia, recommend limiting dietary cholesterol to <200 mg/d to lower LDL-c and non–high-density lipoprotein cholesterol (HDL-c) concentrations, however, insufficient evidence among populations doesn't exist ( 79 ). Within EMR, all of the countries are beyond the previous recommended level, particularly Egypt where the recorded dietary cholesterol level was 402 mg/day, followed by Iraq 288 mg/day, then Lebanon 287 mg/day, then KSA and Tunisia 286 mg/day ( 63 ) ( Table 4 ).

High Sugar Diet

The term “sugars” includes intrinsic sugars, from intact fruit and vegetables; milk, as well as free sugars, which are added to foods and beverages, and sugars naturally present in honey, syrups, fruit juices, and fruit juice concentrates ( 80 ).

There is uprising worry regarding the free sugars' intake, particularly in the form of SSB that increases the overall energy consumption and may reduce healthy food items' intake. This leads to unhealthy dietary habits, subsequent weight gain, and increased risk of NCDs ( 54 , 81 – 83 ). Another concern is the association between intake of free sugars and dental caries ( 54 , 84 – 86 ). Dental diseases are the most prevalent NCDs globally ( 87 , 88 ).

The established dietary goal for free sugars' intake is <10% of total energy but ideally less than 5% of total energy intake. This 10% ratio is equivalent to 50 g for a person of healthy body weight consuming about 2,000 calories per day ( 54 ).

Juice and SSB Consumption

A diet high in SSB is defined as any intake (in grams per day) of beverages with ≥50 kcal per 226.8 g serving, including sodas, carbonated beverages, energy drinks, and fruit drinks, but excluding 100% fruit and vegetable juices. In 2019, a diet high in sugar-sweetened beverages was responsible for 6.31 million DALYs and 242 000 deaths. It was the 13th-leading dietary risk factor for DALYs ( 89 ).

The average consumption of raw sugar in EMR is 80 g per day, while the recommended amount of sugar is equivalent to 50 g. The highest mean consumption of SSB among EMR countries has been recorded in Djibouti 0.78 serving/day followed by Lebanon 0.72, then Jordan 0.64, then Sudan 0.62, then Syria 0.52, and Bahrain 0.51. The highest juice intake in EMR has been recorded in KSA 0.34 serving/day followed by Iran 0.31, then UAE 0.25 and Bahrain 0.24 ( 12 ) (as outlined in Table 4 ).

A review of the literature reveals that SSBs contribute partly to the obesity epidemic, as reported by epidemiologic studies, which emphasized the link between SSB consumption and long-term weight gain, type 2 diabetes mellitus, and CVDs risk. It is hypothesized that SSB contribute to weight gain due to their high added sugar content, low satiety, and potential partial compensation for total energy leading to increased energy intake ( 90 , 91 ). In addition, because of their large consumed quantities besides their high contents of rapidly absorbable carbohydrates such as different forms of sugar and high-fructose corn syrup, SSB could be responsible for increased type 2 diabetes mellitus and CVDs incidence. Independent of obesity, SSB could serve as a contributor to a high dietary glycemic load leading to inflammation, insulin resistance, and impaired ß-cell function ( 92 ). Fructose from any sugar or high-fructose corn syrup may also increase blood pressure, and enhance the cumulative effects of visceral adiposity, dyslipidemia, and ectopic fat precipitation due to upregulated hepatic de novo lipogenesis ( 93 ).

Salt/Sodium Intake

Salt consumption within the WHO-recommended level for adults is <5 g per person per day (2 g per day of sodium). Excessive salt consumption is linked to adverse health outcomes, such as the increased risk of hypertension (raised blood pressure), which in turn leads to stroke and heart disease ( 94 ). The current salt intake in the Region averages more than 10 g per person per day, which is double the recommended level set by WHO. In 2010, within EMR countries the highest mean salt intake has been recorded in Bahrain (14 g/day) followed by Libya, Morocco, Qatar, Syria, and Tunisia (11 g/day) ( 11 ) (see Table 4 ). Conversely, according to more recently collected data based on urinary excretion, the highest level of salt intake was observed in Morocco (10.6 g/day), while the lowest was observed in Lebanon (5.6 g/day) and the UAE (6.8 g/day) ( 19 ). Based on dietary assessment questionnaires, the highest levels of salt intake were observed amongst Iranian children and adolescents (14.3–16.2 g/day) and adults in Bahrain (9.3–13.3 g/day) and Lebanon (10.9 g/day). Per capita estimates were also high in Oman (11.5 g/day) and Tunisia (10.2 g/day) ( 19 ). Sodium is an essential nutrient necessary for the maintenance of plasma volume, acid-base balance, the transmission of nerve impulses, and normal cell function ( 95 ). In our diet, the main source of sodium is salt, despite it can be attained from sodium glutamate, used as a food additive in many processed foods ( 95 ). In 2019, a diet high in sodium (more than 3 g) was responsible for 44.9 million DALYs and 1.89 million deaths. It was the leading dietary risk factor for causing DALYs ( 96 ). The highest mean sodium intake has been recorded in Bahrain (5.8 g/day) followed by Tunisia (4.43 g/day), then Morocco (4.31 g/day), Libya (4.24 g/day), Qatar (4.21 g/day), Syria (4.18 g/day), and Jordan (4.13 g/day) ( 11 ) (see Table 4 ).

The EMR population should be aware of how much salt they consume as the disease burden of CVDs, resulting mainly due to salt and subsequent high blood pressure, is very high in the region ( 97 ). In a recent study, the salt intake levels were estimated in 15 out of the 22 countries in EMR, national salt reduction initiatives were identified in 13 countries including Bahrain, Egypt, Iran, Jordan, KSA, Kuwait, Lebanon, Morocco, Oman, Palestine, Qatar, Tunisia, and the UAE. The majority of countries were discovered to be implementing complex reduction measures, which included two or more implementation strategies. Taxation was the least popular implementation option, whereas reformulation was the most popular (100%), followed by consumer education (77%), initiatives in specialized situations (54%), and front-of-pack labeling (46%) ( 19 ).

The prevalence of obesity (BMI ≥ 30 kg/m 2 ) has almost tripled worldwide since 1975. There were 650 million obese adults aged 18 years in 2016, with a global prevalence of nearly 13%. High body-mass index (BMI) was responsible for 160 million DALYs and 5.02 million deaths in 2019. It was the seventh-ruling risk factor for attributable DALYs in 2019 ( 98 ). Being obese is usually linked to an increased risk of hypertension and many NCDs (including diabetes, CVDs, and cancers) ( 99 ). Shifts in eating behavior toward diets containing energy-dense foods, high in fat and sugars, and less physical activity due to the sedentary nature of many forms of work and modes of transportation are contributing to the rise in obesity. The prevalence of obesity in the EMR is the third-highest across all global regions ( 4 ). The current prevalence of obesity is estimated at 25.1%, while the prevalence of overweight is around 56.41%. Among the EMR, the gulf countries revealed the highest rate of obesity. The highest prevalence of obesity in EMR has been reported in Kuwait (37.9%), Jordan (35.5%), Saudi Arabia (35.4%), Qatar (35.1), Libya (32.5%), Egypt (32%), Lebanon (32%), and UAE (31.7%). According to the latest estimates, the prevalence of excess BMI in adults in EMR has increased by 3% between 2012 and 2016 ( 6 ) ( Table 2 ; Figure 3 ).

Overweight and obesity prevalence among adults in different regions ( 6 ).

The high prevalence of people who are overweight or have obesity in Saudi Arabia is considered a public health concern, as revealed in a cross-sectional study carried out on a representative sample of 1,681 adult patients. Being overweight and having obesity were found to be prevalent in 38.3% and 27.6% of the population, respectively. Obesity was not shown to be connected with smoking, although it was found to be associated with hypertension. The risk of overweight or obesity was significantly inversely correlated with the monthly income ( 100 ).

The most recent national survey conducted in Egypt revealed that 39.8% of adult Egyptians suffered from obesity with a more prevalent in adult females than males, nearly 25% have normal BMI while the rest are either obese or overweight ( 101 ). A study analyzing the health effects of being overweight and having obesity conducted over 25 years in 195 countries, revealed that 19 million Egyptians suffer from obesity, representing 35% of all adults, which is the highest rate in the world. Moreover, the study outlined that 3.6 million children (10.2% of Egyptian children) suffer from obesity ( 102 ).

Research published in 2020 indicated that almost three-quarters of men and women in Jordan were overweight or obese. Obesity rates in men were around twice as high in 2017 as they were in 2009. In the multivariate analysis, age, region of residence, and marital status were significantly associated with obesity in both genders. Obesity was significantly linked with increased odds of diabetes mellitus, hypertension, elevated triglycerides, and low high-density lipoprotein cholesterol after adjusting for age ( 103 ).

Ultimately, obesity is the first reported risk factor responsible for the total number of DALYs in 2019 in eight countries in the region (Bahrain, Jordan, Kuwait, Libya, Oman, Qatar, Saudi Arabia, and UAE). It is the second reported risk factor in the other seven countries (Egypt, Iran, Iraq, Morocco, Palestine, Syria, and Tunisia). The highest increase in obesity percentage between 2009 and 2019 in EMR was reported in UAE (133.4%) followed by Djibouti (106.5), then Jordan (96.3%), Qatar (88%), Bahrain (86.9%), and Afghanistan (80.1%). The dramatic increase in obesity involves low-income countries in the region also including Djibouti and Afghanistan ( 13 ) (as indicated in Table 5 ). The prevalence figures revealed that obesity constitutes a significant public health concern in EMR because of its significant correlation to NCDs (see Figures 4 , ​ ,5 5 ).

The rank of the nutrition related risk factors that causes deaths in 2019 and the percentage change between 2009–2019 ( 13 ).

Correlation between the prevalence of obesity, diabetes, and cumulative cancer risk among adults in EMR ( 6 , 26 ).

Correlation between the prevalence of obesity, probability of death due to CVDs, cancers, and diabetes among adults in EMR ( 6 ).

Physical Inactivity

In 2016 a study revealed that globally, 28% of all adults aged 18 years and older were insufficiently physically active, and not following the WHO recommendation to implement at least 150 min of moderate-intensity physical activity per week ( 104 ). According to the 2019 Global Burden of Disease Study, low physical activity was ranked 18th in attributable DALYs in 2019, accounting for 198.4 age-standardized DALYs per 100,000 and 11.1 age-standardized deaths per 100,000. The EMR has the highest prevalence of insufficient physical activity than any other region. There is a clear relationship between physical inactivity and country income group globally ( 4 ). In 2016, high-income countries had more than double the prevalence of physical inactivity (37%) than low-income countries (16%), however, the situation is reversed among EMR countries where the insufficient physical activity was the highest in Kuwait followed by Saudi Arabia and UAE while the lowest was recorded in Jordan ( 6 ). According to data from the UAE national health survey 2017–2018, 70.8% of the participants did not fulfill WHO standards for adequate physical exercise. Insufficient physical activity was reported by women at a higher rate than men (74.8 and 66.8%, respectively). When compared to non-Emirates, Emiratis had a higher percentage of insufficient physical activity (80.2 and 69.2%, respectively) ( 105 ).

Physical inactivity is also a modifiable factor that is involved in upregulating the magnitude of NCDs. People who are deficiently physically active have an enhanced risk of all-cause mortality, as compared to those who perform at least 30 min of moderate-intensity physical activity on most days of the week. Additionally, physical activity lowers the risk of stroke, hypertension, and depression ( 106 ).

Other Risk Factors Mediated by Unhealthy Diet and Obesity

Hypertension.

Hypertension or raised blood pressure is defined as systolic and/or diastolic blood pressure greater than, or equal to, 140/90 mmHg. Hypertension is a major risk factor for heart failure, ischemic heart disease, peripheral vascular disease, renal failure, retinal hemorrhage, stroke, and dementia ( 107 ). In 2019, high blood pressure was the second-leading contributor to 235 million (95% UI 211–261) DALYs and 10.8 million (9.51–12.1) deaths in 2019 ( 108 ). Several risk factors could be involved in the upregulated blood pressure, including high salt intake, being overweight or obese, excessive use of alcohol, low or lack of physical activity, stress, air pollution, and smoking ( 95 ). Globally, in 2015, one in four men, and one in five women (i.e., 22% of the adult population aged 18 years and older) had raised blood pressure. In 2015, 28% of the population in low-income countries had high blood pressure, compared with 18% of the population in high-income countries. Reviewing the current trends demonstrated that the number of adults with high blood pressure increased from 594 million in 1975 to 1.13 billion in 2015, with the peak revealed significantly in low- and middle-income countries ( 109 ).

Among all the WHO-geographical regions, EMR was the second-highest in the incidence of raised blood pressure after Africa ( 4 ). In 2015, within the EMR, the prevalence of raised blood pressure is the highest in Somalia (32.9%), then Yemen (30.7%), Afghanistan, and Pakistan (30.6% and 30.5%), respectively. In 2019, the highest prevalence of hypertension among adults was recorded in Iraq (40.7%) followed by Oman (38.6%), UAE (34.8%), Afghanistan (33.7%), Sudan (33.5%), and Kuwait (33.5%), followed by Egypt (33.2%) ( 6 ) ( Table 2 ; Figure 6 ).

High blood pressure prevalence among adults in different regions ( 6 ).

Raised blood pressure is the second risk factor responsible for the total number of DALYs worldwide. Among EMR countries, hypertension is the first reported risk factor responsible for the total number of DALYs in six countries (Egypt, Iran, Iraq, Morocco, Syria, and Tunisia) while it is the second reported risk factor in other nine countries (Jordan, Lebanon, Libya, Oman, Saudi Arabia, Sudan, UAE, and Yemen). The highest increase in blood pressure percentage between 2009 and 2019 in EMR was reported in UAE (140.1%) followed by Jordan (87.8%), Qatar (62.3%), Djibouti (56.9%), then Bahrain (55.7%). The increase in hypertension in the region has involved high-income countries including UAE, Qatar, and Bahrain ( 13 ) ( Table 5 ).

High Fasting Blood Glucose

Accordingly, all body tissues are affected by high blood glucose including the heart, blood vessels, eyes, kidneys, and nerves, with subsequent complications including heart attack, stroke, kidney failure, lower limb amputation, blindness, and nerve damage ( 110 ). Nearly 9% of the global population had raised blood glucose levels in 2014 ( 111 ). In 2019, high fasting plasma glucose (>4.8–5.4 mmol/L) was ranked as the sixth most prevalent DALYs risk factor worldwide, accounting for 2,223.8 all-age DALYs per 100,000 and 84.0 all-age deaths per 100,000 ( 112 ). The EMR showed the highest levels (14% of the population), while 7–9% of the population from other regions had high levels of blood glucose. The upper-middle-income group tended to have higher levels (9%) ( 4 ). Within the EMR countries, the highest percentage of fasting blood glucose (≥7.0) mmol/L has been reported in Kuwait (19.6%), Qatar (18.9%), Egypt (17.9%), Saudi Arabia, Iraq (17.4%), and Jordan (16.8%) ( 6 ) ( Table 2 ).

According to the 2019 Global Burden of Disease Study, raised fasting plasma glucose is the first reported risk factor accounted for the total number of DALYs in Palestine, while it is the second reported risk factor in three countries in the region (Bahrain, Kuwait, and Qatar) and it is the third risk factor in other seven countries (Iran, Iraq, Libya, Morocco, Oman, Saudi Arabia, and Tunisia). The highest increase in fasting plasma glucose percentage between 2009 and 2019 in EMR was reported in UAE (147%) followed by Bahrain (93.8%), Jordan and Qatar (85.9%), and Egypt (72.1%) ( 13 ) ( Table 5 ).

High Cholesterol

Blood cholesterol is one of the most important risk factors for ischemic heart disease and ischemic stroke ( 113 ). The global prevalence of elevated total cholesterol (≥5 mmol/l) among adults aged ≥25 years was 38.9% (37.3% for men and 40.2% for women). Among the WHO-designated regions, the prevalence of hyper-cholesterolemia was the third highest in the EMR, at 38.4% (40.4% for women and 36.2% for men) ( 6 ). In 2018, global age-standardized mean total cholesterol was 4.6 mmol/l for women and 4.5 mmol/l for men ( 114 ) while the mean total cholesterol in the EMR is 4.4 mmol/l for both sexes, 4.4 mmol/l for men, and 4.5 mmol/l for women ( 6 ). It is noteworthy that blood non-HDL cholesterol is strongly associated with the long-term risk of atherosclerotic cardiovascular diseases. In 2018, global age-standardized mean non-HDL cholesterol was 3.3 mmol/l for women and 3.3 mmol/l (3.3–3.4) for men ( 114 ) while the mean non-HDL cholesterol in EMR in 2018, was 3.2 mmol/l for both sexes. In 2018, the highest recorded mean total cholesterol was in Lebanon 5 mmol/l followed by Kuwait and Jordan 4.8 mmol/l followed by UAE 4.6 mmol/l then Egypt and Iraq 4.4 mmol/l. Within EMR countries, the highest mean non-HDL cholesterol in 2018 was recorded in Lebanon at 3.7 mmol/l, followed by Kuwait and Jordan 3.5 mmol/l, then Oman, UAE, and Yemen 3.4 mmol/l ( 6 ) ( Table 2 ).

According to the 2019 Global Burden of Disease Study, high LDL-c was the eighth-directing risk factor for DALYs. It contributed to 98.6 million DALYs and 4.40 million deaths in 2019 ( 115 ). High LDL-c is the fifth reported risk factor in three countries in the region (Morocco, Oman, and UAE), while it is the sixth reported risk factor in six countries in the region (Egypt, Iran, Lebanon, Libya, Syria, and Tunisia). The highest increase in fasting plasma glucose percentage between 2009 and 2019 in EMR was reported in UAE (141.5%) followed by Jordan (86.9), then Bahrain (48.6%), and Yemen (47.4%) ( 13 ) ( Table 5 ).

Interdisciplinary Relationships Between NCDs and Related Risk Factors

Both overweight and obesity-related to unhealthy dietary habits as well as insufficient physical activity are the key risk factors for NCDs ( 116 ). For instance, TFA consumption induces low-grade systemic inflammation and is positively correlated with endothelial dysfunction (a non-obstructive coronary artery disease) ( 117 – 121 ). Being overweight and having obesity also enhances low-grade systematic inflammation, creates a higher concentration of pro-inflammatory cytokines, and further endothelial dysfunction, all of which are metabolic risk factors for nutrition-related NCDs, and in particular, heart disease ( 122 , 123 ) ( Figure 1 ).

Nevertheless, its association with other risk factors, including diabetes, high body cholesterol, elevated blood pressure, and metabolic syndrome, obesity could serve as an independent risk factor for CVDs ( 124 ). Since abdominal obesity is an independent risk factor for coronary heart disease, the distribution of body fat represents an additional risk. The intra-abdominal fat buildup promotes insulin resistance, which can lead to glucose intolerance, elevated triglycerides, and low HDL as well as hypertension ( 125 ). Ultimately, obesity is the key risk factor for type 2 diabetes, cardiovascular disease, cancer, and premature death ( 126 ). Individuals who decreased 7% of their body weight significantly reduced all cardiovascular risk variables except LDL cholesterol levels, however, the rate of cardiovascular events did not decrease during the trial ( 127 ).

In a statewide cross-sectional study done by phone interviews in June 2020 in Saudi Arabia, obesity was found to be prevalent at 24.7%, and overweight at 21.7%. Type 2 diabetes, hypertension, hypercholesterolemia, sleep apnea, lung diseases, rheumatoid arthritis, colon diseases, and thyroid issues have all been significantly linked to obesity ( 128 ). A further study conducted in Qatar confirmed that obesity risk factors (c-peptide, insulin, albumin, and uric acid) and obesity-related comorbidities such as diabetes (e.g., HbA1c, glucose), liver function (e.g., alkaline phosphatase, gamma-glutamyl transferase), lipid profile (e.g., triglyceride, LDL-c, HDL-c), as well as most of the dual-energy x-ray absorptiometry measurements (e.g., bone area, bone mineral composition, bone mineral density, etc.) were significantly ( p <0.05) higher in the obese group ( 129 ).

Substantially, elevated blood pressure has been linked to the consumption of food high in salt and NCDs. An intervention trial that included 9,000 adults with baseline systolic blood pressure between 130 and 180 mmHg indicated that a lower blood pressure target was accompanied by a significantly lower incidence of myocardial infarction, acute coronary syndrome, stroke, heart failure, or death ( 130 ). Diabetes also is a recognized and significant risk factor for CVDs ( 131 ). CVDs is the leading cause of morbidity and mortality among individuals with diabetes. It is therefore recommended that individuals with diabetes should have a target blood pressure of <130/80 mmHg to prevent the incidence of CVDs ( 132 ).

Discussing the Cultural and Sociodemographic Effect on the NCDs Related Risk Factors

Of the 22 countries and territories in the EMR, 16 are considered low-income or middle-income countries. Several countries in the EMR have lengthy histories of political instability, war, and social conflict, which have resulted in the large-scale internal and external displacement of citizens; half of the region's countries and territories are now under an acute or chronic state of emergency. These socioeconomic determinants of health, as well as accompanying inequities, have an impact on health status and access to care throughout the EMR as well as access to healthy food, which is unsurprising. Moreover, disease epidemiological data on disease incidence, prevalence, and management are scarce and lacking ( 133 ). Furthermore, NCDs mortality, and its social, environmental, behavioral, nutritional, and clinical determinants are not distributed evenly within countries ( 134 ). The most deprived communities have a higher risk of premature death than those in the most affluent. Therefore, reducing national-level NCDs risk requires actions that address the disproportionate burden in deprived communities ( 29 ).

The lowest risk of NCDs mortality is seen in high-income countries in western Europe, Asia-Pacific, Australia, and Canada, whereas, the highest risk was observed in low-income and middle-income countries. The highest probabilities were seen in parts of sub-Saharan Africa, and Guyana. In EMR, Yemen, and Afghanistan (one in four to one in three people are at risk of dying from NCDs), people are about 3–7 times more likely to die than those in high-income countries. Similarly, the probability of dying from NCDs between the age of 30 and 70 in EMR is 24.5% (one in four adults will die before the age of 70) ( 29 ).

Literature on this subject usually shows a positive association between socioeconomic status and obesity in low-income countries. However, contrary to this, a multinomial regression analysis study conducted in Cairo, Egypt reported no significant associations between most SES spectrum and overweight/obesity in the studied population. The study suggested that obesity programs and policies should be targeted at all socioeconomic status groups in Egypt ( 135 ). A study conducted in Jordan revealed that the prevalence of overweight/obese women was 70.6%. Furthermore, the association between age and overweight/obesity was significant ( p < 0.0001). The high prevalence of overweight/obesity among women in Jordan was related to high parity and low education level ( 136 ). Conversely, in research conducted in Saudi Arabia, the prevalence of overweight and obesity in men was 35.1% and 34.8%, respectively, and in women, it was 30.1% and 35.6%. Obesity and overweight increased in prevalence until 60 years of age, then declined in both sexes in the oldest age group. After adjusting for age, earning a postgraduate degree raised the risk of obesity in men, but increased physical activity decreased it in both sexes. Obese women had a higher risk of prediabetes and diabetes, obese males had a higher risk of hypertension, and both sexes had a higher risk of dyslipidemia. A familial history of dyslipidemia was linked to a lower risk of obesity in women, whereas women who were overweight were more liable to develop prediabetes, diabetes, and dyslipidemia, while men who were overweight were more liable to hypertension ( 137 ).

Analyzing the data from a population-based cross-sectional survey of diabetes and obesity in Kuwait, revealed that the prevalence of overweight, obesity, and central obesity were 40.6%, 42.1%, and 73.7%, respectively. Men were 26% more likely than women to be overweight, while women had 54% and seven-fold higher probabilities of obesity and central obesity, respectively. Young adults aged 18–29 years have a significant prevalence of obesity and overweight. Obesity/central obesity was associated with higher educational attainment, physical activity, and being non-Kuwaiti. Smoking history, high blood pressure, higher income, and marital status are all linked to an increased risk of obesity/central obesity ( 138 ). In another cross-sectional study conducted among 3,915 Kuwaiti adults, obesity prevalence was 40.3% (men, 36.5%; women, 44.0%); and overweight prevalence was 37% (men, 42%; women, 32.1%). Obesity prevalence was linked to female sex, age, diabetes history, and marital status in both men and women, but was inversely linked to education level in women. Men were more likely to have an increased waist-to-hip ratio (46.91%) as compared to women (37.9%). In both men and women, waist circumference, waist-hip, and waist-height ratios were found to be directly associated with diabetes and negatively associated with education level in women ( 139 ).

In a study conducted in Libya that explored the key risk and protective factors beyond the high prevalence rates of overweight and obesity, 11 factors were identified to be associated with obesity among men and women. These include socio-demographic and biological factors, socioeconomic status, unhealthy eating behaviors, knowledge about obesity, social-cultural influences, healthcare facilities, physical activity, the effect of the neighborhood environment, sedentary behavior, food-subsidy policy, and suggestions for preventing and controlling obesity ( 140 ). Another cross-sectional survey revealed that the prevalence of obesity, overweight, and normal weight among Libyan adults was 42.4%, 32.9%, and 24.7%, respectively. Women were more likely than men to be overweight or obese (the prevalence of overweight was 33.2% in women vs. 32.4% in men, and the prevalence of obesity was 47.4% in women versus 33.8% in men) ( 141 ).

Sustainable Development Goals Target 3.4: Pathways and Forward Steps

The Sustainable Development Goals (SDGs) target 3.4 is to reduce NCDs-related premature mortality by a third by 2030 compared to 2015 levels, as well as to enhance mental health and wellbeing through prevention and treatment ( 142 ). It has been reported that the progress in most international countries is too slow to meet this goal ( 143 ).

Although SDG target 3.4 is the same, differences exist between countries in terms of risk of dying from various NCDs ( 29 , 144 ). Throughout this review, the percentages of different risk factors associated with NCDs incidence have been elaborated. This is important to highlight the pathways through which each country can achieve SDG target 3.4 and to guide governments and donors in prioritizing resources and interventions in their national NCDs response.

Based on 2010–2016 trends, women in 17 of 176 (9.7%) countries and men in 15 of 176 (8.5%) countries are expected to achieve SDG target 3.4 by 2030. The high-income countries that are on track include Denmark, Luxembourg, New Zealand, Norway, Singapore, and South Korea as well as central and eastern European countries. Furthermore, NCDs death rates among men and women in EMR countries as Iran are falling quickly enough to meet the 2030 target. Kuwaiti women and Bahraini men are likewise on pace ( 29 ). In contrast, the risk of dying from NCDs is expected to remain stable or increased among women in 14 (8%) countries and men in 20 (11.4%) countries according to 2010 and 2016 trends. Bangladesh (men), Egypt (women) from EMR, Ghana (men and women), Côte d'Ivoire (men and women), Kenya (men and women), Mexico (men), Sri Lanka (women), Tanzania (men), and the United States (women) were involved. This could be referred to the changes in population size and age structure, even if the risk of dying from NCDs reduces, the number of deaths from NCDs may continue to rise ( 29 ).

According to a new World Health Organization report, if low and lower-middle income nations invest less than a dollar per person per year in the prevention and treatment of NCDs, close to seven million deaths could be avoided by 2030 ( 145 ) 1 . These include low-cost strategies for reducing tobacco and alcohol use, improving diets, increasing physical activity, lowering the risk of cardiovascular disease and diabetes, and preventing cervical cancer ( 145 ) (see text footnote 1 ).

The regional framework for action on obesity prevention 2019–2023 ( 146 ), set a road map for countries of the region to accelerate the action on NCDs and obesity prevention. It sets out six key action areas for improving nutrition and food security including, sustainable, resilient food systems for healthy diets; aligned health systems providing universal coverage of essential nutrition actions; social protection and nutrition education; trade and investment for improved nutrition; safe and supportive environm ents for nutrition at all ages; and strengthened governance and accountability for nutrition ( 17 , 146 ) 2 .

By investing in the Best Buy policies, countries will protect people from NCDs. Best Buy actions include increasing health taxes, restrictions on marketing and sales of unhealthy dietary products, food labeling, and education. They also include actions connected to managing metabolic risk factors, such as hypertension and diabetes, to prevent more severe disease or complications ( 145 ) (see text footnote 1 ). Table 6 reveals the key policies and action plans available and implemented among EMR countries ( 6 , 17 – 20 ).

The polices available and implemented in EMR countries.

The interventions have already been used successfully in many countries around the world. Among EMR countries that are on track to meet SDG target 3.4 are Iran, Kuwait, and Bahrain ( 29 ). These three countries have policies to reduce salt/sodium consumption, tax on sugar sweetened beverages, policy to eliminate industrially produced trans-fatty acids, policy to limit saturated/ trans-fatty acids intake, policy to reduce the impact of marketing of food to children, and policy on salt iodization ( 6 , 17 – 20 ) (see Table 6 ).

Among the top causes of morbidity and mortality related to nutrition in EMR are cardiovascular heart diseases followed by cancer and then diabetes. Globally, the disease burden attributable to hypertension, alcohol consumption, high body mass index, high fasting blood glucose, high sodium intake, and unhealthy diet consumption is increasing significantly, while the disease burden attributable to children being underweight, suboptimal breastfeeding, and micronutrient deficiencies have all decreased significantly. Among the EMR countries, UAE followed by Jordan revealed a significant increase in the percentage change of nearly all the risk factors that are involved in NCDs causing morbidity and mortality ( 150 ).

The data and correlation figures included in this study represent evidence that constitutes a significant public health concern about the relationship between unhealthy diet consumption and obesity that further induces other risk factors including (hypertension, insulin resistance, and a systemic inflammatory milieu), leading to NCDs ( Figure 1 ). It is therefore important to recognize the key therapeutic modalities for treating and prohibiting NCDs, which are to fight against weight gain and obesity and to advocate lifestyle-based therapies; including proper nutrition and regular physical activity. These are the key therapeutic modalities that will reduce the risk of NCDs. Additionally, body mass index should be used as a first step in establishing the criteria to judge potential health risks.

Countries in the EMR need to continue building on the achieved progress and scale up action across the region while boosting efforts in areas where concrete action is absent through the following key stakeholders to reach the agreed global and regional goals relating to nutrition and diet-related NCDs. This could be achieved through the following key stakeholders, Governments can provide and improve access to quality NCDs and obesity care, as well as develop and implement policies that promote and normalize healthy eating and living, in addition to banning the marketing of unhealthy foods and beverages high in fat, sugar, and salt. Civil society groups, including non-governmental organizations and the media, can work with individuals and communities to educate and diffuse key messages on the root causes of NCDs and obesity, the importance of prevention and treatment, as well as the impact of adopting healthy behaviors like keeping physically active and choosing healthy food and drinks. Health care professionals, whether working directly in NCDs and obesity care or supporting and working with those living with obesity, can learn more about obesity, expand their knowledge, and have up-to-date, evidence-based obesity management resources to help them understand and address the root causes of this disease. Individuals and families can adopt healthier behaviors, share experiences, as well as ask for support, whilst also supporting others to improve their health and well-being and that of their children ( 17 ) (see text footnote 2 ).

Countries in EMR are encouraged to adopt and implement the regional nutrition strategy for nutrition 2020–2030 ( 21 ), the regional framework for action on obesity prevention 2019–2023 ( 151 ), and the regional framework for action to implement the United Nations Political Declaration on the NCDs ( 152 ).

Author Contributions

All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

1 Available online at: https://www.who.int/news/item/13-12-2021-investing-1-dollar-per-person-per-year-could-save-7-million-lives-in-low-and-lower-middle-income-countries .

2 Available online at: https://apps.who.int/iris/bitstream/handle/10665/346443/EMRC68INFDOC8-eng.pdf .

Essay on Importance of Healthy Eating Habits

Students are often asked to write an essay on Importance of Healthy Eating Habits in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Importance of Healthy Eating Habits

The necessity of healthy eating.

Healthy eating is crucial for growing bodies. Consuming a balanced diet gives our bodies the nutrients needed to function correctly.

Benefits of Healthy Eating

Eating healthy foods reduces the risk of chronic diseases. It also helps maintain a healthy weight, boosts energy, and improves brain function.

Healthy Eating Habits

Incorporate fruits, vegetables, whole grains, and lean proteins into your meals. Avoid processed foods and sugary drinks. Remember, moderation is key.

Healthy eating habits are essential for a healthy life. Start today and reap the benefits tomorrow.

250 Words Essay on Importance of Healthy Eating Habits

The vitality of healthy eating habits, nutrition and physical health.

A diet rich in vitamins, minerals, and other essential nutrients fuels our bodies, supporting vital functions. It aids in maintaining a healthy weight, reducing the risk of chronic diseases like heart disease and diabetes. Consuming fruits, vegetables, lean proteins, and whole grains can significantly improve physical health.

Nutrition and Mental Health

Moreover, our diet directly affects our mental health. Foods rich in omega-3 fatty acids, such as fish and nuts, can enhance brain function, improving memory and mood. Simultaneously, a deficiency in certain nutrients can lead to mental health issues like depression and anxiety.

Establishing Healthy Eating Habits

Establishing healthy eating habits involves more than just choosing the right food. It also includes regular meal times, appropriate portion sizes, and mindful eating. It’s about creating a sustainable lifestyle rather than a temporary diet.

In conclusion, healthy eating habits are a cornerstone of overall well-being. They contribute to physical health, mental health, and quality of life. As college students, it is crucial to prioritize these habits to ensure not only academic success but lifelong health. Let’s remember, our food choices today will shape our health tomorrow.

500 Words Essay on Importance of Healthy Eating Habits

Introduction.

The importance of healthy eating habits cannot be overstated, particularly in a world where fast food and processed meals have become the norm. Healthy eating habits are not just about maintaining an ideal weight or avoiding obesity; they are also about ensuring optimal physical and mental health, and enhancing overall quality of life.

The Role of Nutrition in Human Health

The impact of unhealthy eating habits.

On the contrary, unhealthy eating habits such as consuming high amounts of processed foods, sugary snacks, and fatty meals can lead to numerous health issues. These include obesity, heart disease, diabetes, and certain types of cancer. Moreover, poor nutrition can also affect mental health, contributing to conditions like depression and anxiety.

Healthy Eating and Cognitive Function

Healthy eating habits are also crucial for cognitive function. Nutrients like Omega-3 fatty acids, antioxidants, and B vitamins, which are found in foods like fish, nuts, fruits, and vegetables, are essential for brain health. They enhance memory, improve mood, and protect against cognitive decline.

Importance of Healthy Eating Habits in College Students

In conclusion, healthy eating habits are a cornerstone of good health and well-being. They play a critical role in maintaining physical health, supporting mental well-being, and enhancing cognitive function. For college students, they are particularly important for academic success and stress management. Therefore, it is essential to prioritize healthy eating and make it a part of our daily routine. By doing so, we can improve our health, enhance our quality of life, and set ourselves up for long-term success.

That’s it! I hope the essay helped you.

Happy studying!

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“While we’ve seen some modest improvement in American diets in the last two decades, those improvements are not reaching everyone, and many Americans are eating worse,” says Dariush Mozaffarian, director of the Food is Medicine Institute. Photo: Alonso Nichols

American Diets Have a Long Way to Go to Achieve Health Equity

A new study found that Americans are eating better, but disparities persist in marginalized communities   

Poor diet continues to take a toll on American adults. It’s a major risk factor for obesity, type 2 diabetes, cardiovascular disease, and certain cancers, and more than one million Americans die every year from diet-related diseases, according to the Food and Drug Administration . Poor diet and food insecurity is also costly, attributing to an estimated $1.1 trillion in healthcare expenditures and lost productivity . These burdens also contribute to major health disparities by income, education, zip code, race, and ethnicity.

In a study from the Food is Medicine Institute at the Friedman School of Nutrition Science and Policy at Tufts University published today in the Annals of Internal Medicine , researchers found that diet quality among U.S. adults improved modestly between 1999 and 2020. However, they also found that the number of Americans with poor diet quality remains stubbornly high. Most notably, disparities persist and, in some cases, are worsening.  

“While we’ve seen some modest improvement in American diets in the last two decades, those improvements are not reaching everyone, and many Americans are eating worse,” says Dariush Mozaffarian , cardiologist and director of the Food is Medicine Institute , and senior author on the study . “Our new research shows that the nation can’t achieve nutritional and health equity until we address the barriers many Americans face when it comes to accessing and eating nourishing food.”   

In the study, researchers investigated data from 10 cycles of the National Health and Nutrition Examination Survey between 1999 and 2020, a nationally representative survey that includes repeated 24-hour dietary recalls, where people report all foods and beverages consumed during the prior day . The study analyzed 51,703 adults who completed at least one valid 24-hour recall, with 72.6% having done two recalls.   

Diet quality was measured using the American Heart Association diet score, a validate d s measure of a healthy diet that includes components like fruits, vegetables, beans and nuts, whole grains, sugary beverages, and processed meat. Researchers found that the proportion of adults with poor dietary quality decreased from 48.8% to 36.7% over these two decades, while those with intermediate diet quality increased from 50.6% to 61.1%. They also found that the proportion of adults with an ideal diet improved but remained starkly low, from 0.66% to 1.58%.  

Specific changes contributed to these trends, including higher intakes of nuts/seeds, whole grains, poultry, cheese and eggs. Researchers also found lower consumption of refined grains, drinks with added sugar, fruit juice , and milk. Total intake of fruits and vegetables, fish/shellfish, processed meat, potassium , and sodium remained relatively stable.  

When the analysis focused on key subgroups, the researchers found that these improvements were not universal. Gains in dietary quality were highest among younger adults, women, Hispanic adults, and people with higher levels of education, income, food security , and access to private health insurance . They were lower among older adults, men, Black adults, and people with lower education, less income, food insecurity, or non-private health insurance. For example, the proportion of adults with poor diet quality decreased from 51.8% to 47.3% among individuals with lower income, decreased from 50.0% to 43.0% among individuals with middle income, and decreased from 45.7% to 29.9% among individuals with higher income.  

“While some improvement, especially lower consumption of added sugar and fruit drinks, is encouraging to see, we still have a long way to go, especially for people from marginalized communities and backgrounds,” adds first author Junxiu Liu, a postdoctoral scholar at the Friedman School at the time of the study, now assistant professor at the Icahn School of Medicine at Mount Sinai.   

“We face a national nutrition crisis, with continuing climbing rates of obesity and type 2 diabetes,” Mozaffarian said. “These diseases afflict all Americans, but especially those who are socioeconomically and geographically vulnerable. We must address nutrition security and other social determinants of health including housing, transportation, fair wages, and structural racism to address the human and economic costs of poor diets.”  

Citation and Disclaimer

Citation: This research was supported by funding from the National Institutes of Health’s National Heart, Lung and Blood Institute under award R01HL115189. Complete information on authors, methodology, funders, and conflicts of interest is available in the published paper.    

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders.  

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Food and Diet

Beyond Willpower: Diet Quality and Quantity Matter

It’s no secret that the amount of calories people eat and drink has a direct impact on their weight: Consume the same number of calories that the body burns over time, and weight stays stable. Consume more than the body burns, weight goes up. Less, weight goes down. But what about the type of calories: Does it matter whether they come from specific nutrients-fat, protein, or carbohydrate? Specific foods-whole grains or potato chips? Specific diets-the Mediterranean diet or the “Twinkie” diet? And what about when or where people consume their calories: Does eating breakfast make it easier to control weight? Does eating at fast-food restaurants make it harder?

There’s ample research on foods and diet patterns that protect against heart disease, stroke, diabetes, and other chronic conditions. The good news is that many of the foods that help prevent disease also seem to help with weight control-foods like whole grains, vegetables, fruits, and nuts. And many of the foods that increase disease risk-chief among them, refined grains and sugary drinks-are also factors in weight gain.Conventional wisdom says that since a calorie is a calorie, regardless of its source, the best advice for weight control is simply to eat less and exercise more. Yet emerging research suggests that some foods and eating patterns may make it easier to keep calories in check, while others may make people more likely to overeat.

This article briefly reviews the research on dietary intake and weight control, highlighting diet strategies that also help prevent chronic disease.

Macronutrients and Weight: Do Carbs, Protein, or Fat Matter?

When people eat controlled diets in laboratory studies, the percentage of calories from fat, protein, and carbohydrate do not seem to matter for weight loss. In studies where people can freely choose what they eat, there may be some benefits to a higher protein, lower carbohydrate approach. For chronic disease prevention, though, the quality and food sources of these nutrients matters more than their relative quantity in the diet. And the latest research suggests that the same diet quality message applies for weight control.

Dietary Fat and Weight

Low-fat diets have long been touted as the key to a healthy weight and to good health. But the evidence just isn’t there: Over the past 30 years in the U.S., the percentage of calories from fat in people’s diets has gone down, but obesity rates have skyrocketed. ( 1 , 2 ) Carefully conducted clinical trials have found that following a low-fat diet does not make it any easier to lose weight than following a moderate- or high-fat diet. In fact, study volunteers who follow moderate- or high-fat diets lose just as much weight, and in some studies a bit more, as those who follow low-fat diets. ( 3 , 4 ) And when it comes to disease prevention, low-fat diets don’t appear to offer any special benefits. ( 5 )

Part of the problem with low-fat diets is that they are often high in carbohydrate, especially from rapidly digested sources, such as white bread and white rice. And diets high in such foods increase the risk of weight gain, diabetes, and heart disease. (See Carbohydrates and Weight , below.)

For good health, the type of fat people eat is far more important that the amount (see box), and there’s some evidence that the same may be true for weight control. ( 6 – 9 ) In the Nurses’ Health Study, for example, which followed 42,000 middle-age and older women for eight years, increased consumption of unhealthy fats-trans fats, especially, but also saturated fats-was linked to weight gain, but increased consumption of healthy fats-monounsaturated and polyunsaturated fat-was not. ( 6 )

Protein and Weight

Higher protein diets seem to have some advantages for weight loss, though more so in short-term trials; in longer term studies, high-protein diets seem to perform equally well as other types of diets. ( 3 , 4 ) High-protein diets tend to be low in carbohydrate and high in fat, so it is difficult to tease apart the benefits of eating lots of protein from those of eating more fat or less carbohydrate. But there are a few reasons why eating a higher percentage of calories from protein may help with weight control:

• More satiety: People tend to feel fuller, on fewer calories, after eating protein than they do after eating carbohydrate or fat. ( 10 )
• Greater thermic effect: It takes more energy to metabolize and store protein than other macronutrients, and this may help people increase the energy they burn each day. ( 10 , 11 )
• Improved body composition: Protein seems to help people hang on to lean muscle during weight loss, and this, too, can help boost the energy-burned side of the energy balance equation. ( 11 )

Higher protein, lower carbohydrate diets improve blood lipid profiles and other metabolic markers, so they may help prevent heart disease and diabetes. ( 4 , 12 , 13 ) But some high-protein foods are healthier than others: High intakes of red meat and processed meat are associated with an increased risk of heart disease, diabetes, and colon cancer. ( 14 – 16 )

Replacing red and processed meat with nuts, beans, fish, or poultry seems to lower the risk of heart disease and diabetes. ( 14 , 16 ) And this diet strategy may help with weight control, too, according to a recent study from the Harvard School of Public Health. Researchers tracked the diet and lifestyle habits of 120,000 men and women for up to 20 years, looking at how small changes contributed to weight gain over time. ( 9 ) People who ate more red and processed meat over the course of the study gained more weight-about a pound extra every four years. People who ate more nuts over the course of the study gained less weight-about a half pound less every four years.

Carbohydrates and Weight

Lower carbohydrate, higher protein diets may have some weight loss advantages in the short term. ( 3 , 4 ) Yet when it comes to preventing weight gain and chronic disease, carbohydrate quality is much more important than carbohydrate quantity.

Read more about carbohydrates on The Nutrition Source

Milled, refined grains and the foods made with them-white rice, white bread, white pasta, processed breakfast cereals, and the like-are rich in rapidly digested carbohydrate. So are potatoes and sugary drinks. The scientific term for this is that they have a high glycemic index and glycemic load. Such foods cause fast and furious increases in blood sugar and insulin that, in the short term, can cause hunger to spike and can lead to overeating-and over the long term, increase the risk of weight gain, diabetes, and heart disease. ( 17 – 19 )

For example, in the diet and lifestyle change study, people who increased their consumption of French fries, potatoes and potato chips, sugary drinks, and refined grains gained more weight over time-an extra 3.4, 1.3, 1.0, and 0.6 pounds every four years, respectively. ( 9 ) People who decreased their intake of these foods gained less weight.

Specific Foods that Make It Easier or Harder to Control Weight

There’s growing evidence that specific food choices may help with weight control. The good news is that many of the foods that are beneficial for weight control also help prevent heart disease, diabetes, and other chronic diseases. Conversely, foods and drinks that contribute to weight gain—chief among them, refined grains and sugary drinks—also contribute to chronic disease.

Whole Grains, Fruits and Vegetables, and Weight

Read more about whole grains on The Nutrition Source

Whole grains-whole wheat, brown rice, barley, and the like, especially in their less-processed forms-are digested more slowly than refined grains. So they have a gentler effect on blood sugar and insulin, which may help keep hunger at bay. The same is true for most vegetables and fruits. These “slow carb” foods have bountiful benefits for disease prevention, and there’s also evidence that they can help prevent weight gain.

Read more about vegetables and fruits on The Nutrition Source

The weight control evidence is stronger for whole grains than it is for fruits and vegetables. ( 20 – 22 ) The most recent support comes from the Harvard School of Public Health diet and lifestyle change study: People who increased their intake of whole grains, whole fruits (not fruit juice), and vegetables over the course of the 20-year study gained less weight-0.4, 0.5, and 0.2 pounds less every four years, respectively. ( 9 )

Of course, the calories from whole grains, whole fruits, and vegetables don’t disappear. What’s likely happening is that when people increase their intake of these foods, they cut back on calories from other foods. Fiber may be responsible for these foods’ weight control benefits, since fiber slows digestion, helping to curb hunger. Fruits and vegetables are also high in water, which may help people feel fuller on fewer calories.

Nuts and Weight

Read more about nuts on The Nutrition Source

Nuts pack a lot of calories into a small package and are high in fat, so they were once considered taboo for dieters. As it turns out, studies find that eating nuts does not lead to weight gain and may instead help with weight control, perhaps because nuts are rich in protein and fiber, both of which may help people feel fuller and less hungry. ( 9 , 23 – 25 ) People who regularly eat nuts are less likely to have heart attacks or die from heart disease than those who rarely eat them, which is another reason to include nuts in a healthy diet. ( 19 )

Dairy and Weight

Read more about calcium and milk on The Nutrition Source

The U.S. dairy industry has aggressively promoted the weight-loss benefits of milk and other dairy products, based largely on findings from short-term studies it has funded. ( 26 , 27 ) But a recent review of nearly 50 randomized trials finds little evidence that high dairy or calcium intakes help with weight loss. ( 28 ) Similarly, most long-term follow-up studies have not found that dairy or calcium protect against weight gain, ( 29 – 32 ) and one study in adolescents found high milk intakes to be associated with increased body mass index. ( 33 )

One exception is the recent dietary and lifestyle change study from the Harvard School of Public Health, which found that people who increased their yogurt intake gained less weight; increases in milk and cheese intake, however, did not appear to promote weight loss or gain. ( 9 ) It’s possible that the beneficial bacteria in yogurt may influence weight control, but more research is needed.

Sugar-Sweetened Beverages and Weight

Read more about healthy drinks on The Nutrition Source

There’s convincing evidence that sugary drinks increase the risk of weight gain, obesity, and diabetes: ( 34 – 36 ) A systematic review and meta-analysis of 88 studies found “clear associations of soft drink intake with increased caloric intake and body weight.” ( 34 ) In children and adolescents, a more recent meta analysis estimates that for every additional 12-ounce serving of sugary beverage consumed each day, body mass index increases by 0.08 units. ( 35 ) Another meta analysis finds that adults who regularly drink sugared beverages have a 26 percent higher risk of developing type 2 diabetes than people who rarely drink sugared beverages. ( 36 ) Emerging evidence also suggests that high sugary beverage intake increases the risk of heart disease. ( 37 )

Like refined grains and potatoes, sugary beverages are high in rapidly-digested carbohydrate. (See Carbohydrates and Weight , above.) Research suggests that when that carbohydrate is delivered in liquid form, rather than solid form, it is not as satiating, and people don’t eat less to compensate for the extra calories. ( 38 )

These findings on sugary drinks are alarming, given that children and adults are drinking ever-larger quantities of them: In the U.S., sugared beverages made up about 4 percent of daily calorie intake in the 1970s, but by 2001, represented about 9 percent of calories. ( 36 ) The most recent data find that on any given day, half of Americans consume some type of sugared beverage, 25 percent consume at least 200 calories from sugared drinks, and 5 percent of consume at least 567 calories-the equivalent of four cans of sugary soda. ( 39 )

The good news is that studies in children and adults have also shown that cutting back on sugary drinks can lead to weight loss. ( 40 , 41 ) Sugary drinks have become an important target for obesity prevention efforts, prompting discussions of policy initiatives such as taxing soda. ( 42 )

Fruit Juice and Weight

It’s important to note that fruit juices are not a better option for weight control than sugar-sweetened beverages. Ounce for ounce, fruit juices-even those that are 100 percent fruit juice, with no added sugar- are as high in sugar and calories as sugary sodas. So it’s no surprise that a recent Harvard School of Public Health study, which tracked the diet and lifestyle habits of 120,000 men and women for up to 20 years, found that people who increased their intake of fruit juice gained more weight over time than people who did not. ( 9 ) Pediatricians and public health advocates recommend that children and adults limit fruit juice to just a small glass a day, if they consume it at all.

Alcohol and Weight

Read more about alcohol on The Nutrition Source

Even though most alcoholic beverages have more calories per ounce than sugar-sweetened beverages, there’s no clear-cut evidence that moderate drinking contributes to weight gain. While the recent diet and lifestyle change study found that people who increased their alcohol intake gained more weight over time, the findings varied by type of alcohol. ( 9 ) In most previous prospective studies, there was no difference in weight gain over time between light-to-moderate drinkers and nondrinkers, or the light-to-moderate drinkers gained less weight than nondrinkers. ( 43 – 47 )

Diet Patterns, Portion Size, and Weight

People don’t eat nutrients or foods in isolation. They eat meals that fall into an overall eating pattern, and researchers have begun exploring whether particular diet or meal patterns help with weight control or contribute to weight gain. Portion sizes have also increased dramatically over the past three decades, as has consumption of fast food-U.S. children, for example, consume a greater percentage of calories from fast food than they do from school food ( 48 )-and these trends are also thought to be contributors to the obesity epidemic.

Dietary Patterns and Weight

So-called “prudent” dietary patterns-diets that feature whole grains, vegetables, and fruits-seem to protect against weight gain, whereas “Western-style” dietary patterns-with more red meat or processed meat, sugared drinks, sweets, refined carbohydrates, or potatoes-have been linked to obesity. ( 49 – 52 ) The Western-style dietary pattern is also linked to increased risk of heart disease, diabetes, and other chronic conditions.

Following a Mediterranean-style diet, well-documented to protect against chronic disease, ( 53 ) appears to be promising for weight control, too. The traditional Mediterranean-style diet is higher in fat (about 40 percent of calories) than the typical American diet (34 percent of calories ( 54 )), but most of the fat comes from olive oil and other plant sources. The diet is also rich in fruits, vegetables, nuts, beans, and fish. A 2008 systematic review found that in most (but not all) studies, people who followed a Mediterranean-style diet had lower rates of obesity or more weight loss. ( 55 ) There is no single “Mediterranean” diet, however, and studies often use different definitions, so more research is needed.

Breakfast, Meal Frequency, Snacking, and Weight

There is some evidence that skipping breakfast increases the risk of weight gain and obesity, though the evidence is stronger in children, especially teens, than it is in adults. ( 56 ) Meal frequency and snacking have increased over the past 30 years in the U.S. ( 57 )-on average, children get 27 percent of their daily calories from snacks, primarily from desserts and sugary drinks, and increasingly from salty snacks and candy. But there have been conflicting findings on the relationship between meal frequency, snacking, and weight control, and more research is needed. ( 56 )

Portion Sizes and Weight

Since the 1970s, portion sizes have increased both for food eaten at home and for food eaten away from home, in adults and children. ( 58 , 59 ) Short-term studies clearly demonstrate that when people are served larger portions, they eat more. One study, for example, gave moviegoers containers of stale popcorn in either large or medium-sized buckets; people reported that they did not like the taste of the popcorn-and even so, those who received large containers ate about 30 percent more popcorn than those who received medium-sized containers. ( 60 ) Another study showed that people given larger beverages tended to drink significantly more, but did not decrease their subsequent food consumption . ( 67 ) An additional study provided evidence that when provided with larger portion sizes, people tended to eat more, with no decrease in later food intake. ( 68 ) There is an intuitive appeal to the idea that portion sizes increase obesity, but long-term prospective studies would help to strengthen this hypothesis.

Fast Food and Weight

Fast food is known for its large portions, low prices, high palatability, and high sugar content, and there’s evidence from studies in teens and adults that frequent fast-food consumption contributes to overeating and weight gain. ( 61 – 66 ) The CARDIA study, for example, followed 3,000 young adults for 13 years. People who had higher fast-food-intake levels at the start of the study weighed an average of about 13 pounds more than people who had the lowest fast-food-intake levels. They also had larger waist circumferences and greater increases in triglycercides, and double the odds of developing metabolic syndrome. ( 62 ) More research is needed to tease apart the effect of eating fast food itself from the effect of the neighborhood people live in, or other individual traits that may make people more likely to eat fast food.

The Bottom Line: Healthy Diet Can Prevent Weight Gain and Chronic Disease

Weight gain in adulthood is often gradual, about a pound a year ( 9 )-too slow of a gain for most people to notice, but one that can add up, over time, to a weighty personal and public health problem. There’s increasing evidence that the same healthful food choices and diet patterns that help prevent heart disease, diabetes, and other chronic conditions may also help to prevent weight gain:

• Choose minimally processed, whole foods-whole grains, vegetables, fruits, nuts, healthful sources of protein (fish, poultry, beans), and plant oils.
• Limit sugared beverages, refined grains, potatoes, red and processed meats, and other highly processed foods, such as fast food.

Though the contribution of any one diet change to weight control may be small, together, the changes could add up to a considerable effect, over time and across the whole society. ( 9 ) Since people’s food choices are shaped by their surroundings, it’s imperative for governments to promote policy and environmental changes that make healthy foods more accessible and decrease the availability and marketing of unhealthful foods.

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Unhealthy diets and malnutrition

Home / why ncds / risk factors & prevention / unhealthy diets and malnutrition.

• Unhealthy diets and the resulting malnutrition are major drivers of noncommunicable diseases (NCDs) around the world.
• Malnutrition includes undernutrition, overweight and obesity, and other diet-related NCDs like type 2 diabetes , cardiovascular disease (heart diseases) and stroke, and some cancers .
• What people eat has changed dramatically over the last few decades. This has been driven by shifts towards calorific and fatty foods, eating out, and an increase in food portion sizes, combined with a lower intake of fruit, vegetables, and high-fibre foods.
• Healthy diets are unaffordable for the poor in every region of the world and people are increasingly exposed to ultra-processed, unhealthy foods and diets that lead to poorer health.
• Policy solutions to tackle poor diets are considered low-cost. The World Health Organization (WHO) ‘Best Buys’ include interventions to reduce salt and sugar intake, such as front-of-pack labelling, fiscal tools and educational initiatives, and measures to eliminate industrial trans-fats.

Malnutrition occurs when the body is not receiving enough of the right nutrients to function properly. This can present as under-nutrition, such as wasting and stunting, but also as overweight, obesity, and diet-related NCDs such as cardiovascular disease and stroke, type 2 diabetes and some cancers.

Many countries now experience a ‘double burden’ of malnutrition. This is where under-nutrition occurs alongside over-nutrition, where unhealthy diets are contributing to unhealthy weight gain and diet-related poor health.[ 1] These unhealthy diets consist of food and drinks with high levels of energy (calories), salt, sugar, and fats, notably industrial trans fats (also known as trans-fatty acids, TFAs or iTFA).

Around the world, 1.9 billion adults are overweight or obese, while 462 million are underweight.[ 2 ] In a study that looked at global deaths from 1990 to 2017, it was found that one in every five deaths were the result of poor nutrition. [3 ]

What is a healthy diet?

According to the WHO, healthy diets are rich in fibre, fruit, vegetables, lentils, beans, nuts, and wholegrains. These diets are balanced, diverse and meet a person’s macronutrient (protein, fat, carbohydrate and fibre) and micronutrient (minerals and vitamins) needs depending on their stage of life.

Generally, healthy diets contain:

• Fat intake of less than 30% of total energy. These should be mainly unsaturated fats, with less from saturated fats. Trans fats should not be consumed.
• Sugar intake of less than 10% of total energy, but preferably less than 5%.
• Salt intake of less than 5g per day.
• Fruit and vegetables intake at least 400g per day.[ 4 ]

Food systems and changes in the way we eat

A person’s ability to maintain a healthy diet is often not within their control – it is influenced by the food environment where they live, early life nutrition, income, and accessibility.[ 5 ] The ‘food system’ refers to all processes of getting food from production to our plates. The food system is often dictated by location, climate, culture, consumer behaviour, industry practices and the regulatory environment, among other factors.

Rise in ultra-processed foods and drinks

Over several decades, dietary habits have changed dramatically around the world. Globalisation and urbanisation have paved the way for a rise in convenience food and drinks products, junk food, and eating out, with fewer people growing or making their food from scratch.

These cheap and ready-to-consume food and drinks products are often ‘ultra-processed’ and high in calories, fats, salt and sugar and low in nutrients. They are produced to be hyper-palatable and attractive to the consumer, like burgers, crisps, biscuits, confectionery, cereal bars, and sugary drinks.[ 6 ]

Ultra-processed foods and drinks typically have a long shelf life, making them appealing for businesses like supermarkets, rather than highly perishable fresh goods. Intensive marketing by the industry – especially to children – has also increased the consumption of these types of goods. Increasingly, these products are displacing fresh, nutritious, and minimally processed goods, shifting population diets and food systems.

Vulnerable populations and poorer people in all parts of the world struggle to access and maintain a healthy diet. It is in these settings where ultra-processed food and beverage products are most prevalent. An estimated three billion people cannot afford healthier food choices with poverty negatively impacting the nutritional quality of food.[ 7 ]

Which diseases are linked to unhealthy diets and malnutrition?

Unhealthy diets and resulting malnutrition are linked to several noncommunicable diseases, including:

• Overweight and obesity – also associated with elevated blood pressure, high cholesterol, diabetes, cardiovascular disease and stroke, cancers and resistance to the action of insulin.
• Cardiovascular disease (heart disease) and stroke.
• Type 2 diabetes and hypertension (high blood pressure).
• Some cancers – including oesophageal cancer; tracheal, bronchus and lung cancer; lip and oral cavity cancer; nasopharynx cancer; colon and rectum cancer.[ 8 ]

These diseases are driven by common dietary risk factors, including:

• High salt intake – a leading dietary risk factor for death and illness worldwide. High salt consumption increases blood pressure, which increases the risk of cardiovascular disease and stroke, chronic kidney disease and some cancers.
• High sugar intake – excess sugars can contribute to tooth decay and weight gain, leading to overweight and obesity, as well as higher blood pressure, cardiovascular disease and stroke, and some cancers.[ 9 ]
• High trans fats intake – linked to cardiovascular disease and stroke.
• Low fruit and veg intake – linked to several cancers, cardiovascular disease and stroke.
• Low intake of fibres, grains, nuts, seeds, micronutrients – linked to diabetes, cardiovascular disease and stroke, and some cancers.[ 10 ]

Childhood malnutrition

Early life nutrition has important impacts on the likelihood of disease and poor health later in life. But childhood malnutrition remains one of the biggest challenges in public health today.

In 2020, an estimated 22% and 7% of children under five were affected by stunting and wasting, respectively, and 7% were overweight. Most of these children live in lower- and middle-income countries. Asia and Africa account for nine out of ten of all children with stunting and wasting and more than seven out of ten children who are affected by overweight. [11 ]

Breastfeeding is one of the most effective ways to ensure the development of a healthy immune system in children, protecting against childhood malnutrition and poor health throughout the life course. But aggressive marketing of formula and baby foods seeds doubt in mothers, compromising breastfeeding and other healthy feeding practices in early childhood.[ 12 ] Policies that protect and promote breastfeeding, including the regulation of breast milk substitute industry, are critical public health interventions.

What can be done to tackle unhealthy diets and malnutrition?

Strategies to tackle unhealthy diets and malnutrition – leading to overweight, obesity and many noncommunicable diseases – should be part of a comprehensive package of policies that aim to improve the food system.

One of the most straightforward nutrition policies is the elimination of industrially-produced trans fats, or trans fatty acids (iTFA), from the global food supply. If all countries removed this harmful compound that causes heart disease, 17 million lives could be saved by 2040. An additional estimated 2.5 million deaths could be prevented each year if global salt consumption were reduced to the recommended level. [13 ]

Implementing strong nutrition policies will not only accelerate progress towards global NCD targets – but is essential to build healthier and more resilient populations that are better prepared to deal with future health emergencies, such as COVID-19.

What’s more, many nutrition measures are considered cost-effective by the WHO and included in their ‘Best Buys’ of recommended interventions to reduce the burden of NCDs around the world. [14 ]

Specific measures include:

• Reformulation of food and drinks products to contain less salt, sugar and fats – with the goal of eliminating all trans-fats.
• Limiting marketing and promotion of unhealthy food and drink products – especially to children and adolescents, including online and in places where they congregate.
• Front-of-pack nutrition labels which clearly warn of the high content of ingredients including fats, sugar, and salt. Front-of-pack labelling systems have now been implemented in more than 30 countries (where governments have led and supported their development), and systems are under development in many other countries.
• Taxes on sugar-sweetened beverages to reduce sugar consumption.
• Subsidies on fruit and vegetables to increase intake of healthier food choices.
• Increasing incentives for producers and retailers to grow, use and sell fresh fruit and vegetables.
• Protecting and promoting breastfeeding.
• Promoting awareness of better nutrition through mass media campaigns.
• Nutrition education and counselling in preschools, schools, workplaces and health centres.

Case study: Bold action in Mexico leads the way

*NCD Alliance acknowledges support from Resolve to Save Lives in the production of this video.

Mexico has among the highest prevalence of diet-related NCDs and obesity in the world. Around three-quarters of people in Mexico live with overweight or obesity, including one-third of all children. Diet-related conditions such as type 2 diabetes and hypertension are rising in prevalence.

Mexico has been taking big steps to improve health by reducing the high prevalence of largely preventable chronic diseases like obesity, type 2 diabetes and some cancers. But the government and health civil society have faced fierce challenges from the big businesses behind the products that are making people sick. As the pandemic took hold in 2020, and world leaders debated the crisis, the Mexican Minister of Health drew attention to how neglecting to prevent NCDs had made the world’s people more vulnerable to the novel coronavirus.

Health authorities urged Mexicans to transition to healthier diets and habits to reduce the COVID-19 burden. Yet the junk food industry continues to operate despite the government’s efforts, using the pandemic food crisis to put foods high in sugar, salt and fat into children’s hands as much as possible, with no regard to the harmful impact of these foods.

So, while the Mexican federal government persists with its effective soda tax, they have also strengthened their position with strong front-of-pack labelling and trans-fats elimination to create healthier environments for the people of Mexico.

“The tax on sugar-sweetened beverages in Mexico is projected to prevent 239,900 instances of obesity, of which almost 40% would be among children.”

But impatient for Federal regulations to come into force and be implemented, Congress in the region of Oaxaca went a step further, voting to ban the sale of junk food to children altogether and placing the control of purchasing into the hands of parents. The Ley Anti Charra (Anti-Junk Food Law), applies to stores, schools and vending machines. Enforcement is complex, but there is strong public support to defend the health of the most vulnerable population: children. One thing is for sure, with rates of obesity and diet-related NCDs rising in most countries, more must take bigger, braver steps like Mexico to fix food systems and protect children from the foods and drinks that are making us all sick.

Page last updated in November 2021

Turning the table: Fighting back against the junk food industry

In the lead up to World Diabetes Day on 14 November, and Nutrition for Growth Summit in December, this new blog from Lucy Westerman looks at governments taking action to ensure access to healthy diets for kids.

Subscribe to updates

Home — Essay Samples — Nursing & Health — Eating Habits — Poor Nutritional Habits Of College Students: Causes, Effects, And The Way Forward

Poor Nutritional Habits of College Students: Causes, Effects, and The Way Forward

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Published: Nov 22, 2018

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Poor Nutrition and its Effects on Learning

How it works

Nutrition is essential to human welfare, however, numerous number of people are badly affected by poor nutrition especially children. Malnutrition is a major concern which ranges from undernutrition to problems of overweight and obesity. It’s usually caused by deficiency in essential vitamins and nutrients needed for intellectual development and learning. The most critical stage for brain development is mainly from conception to the first 2 years of life. It’s highly important that pregnant mothers are given the necessary vitamins and nutrients required to enable the baby develop to its full potential.

Poverty plays a major role in lack of good nutrition and it’s a fundamental cause of malnutrition. Poverty-stricken families don’t have enough funds to spend on food. In most cases, their kids are sent to school without nutritional meal and are unable to concentrate in school.

According to Carlos Lee in his thesis,“Poverty, regardless of level, is robustly linked to reduced academic achievement. Students who live in poverty come to school every day without the proper tools for success. As a result, they are commonly behind their classmates physically, socially, emotionally or cognitively.” Some of the kids tend to become withdrawn or become aggressive towards their peers in school. For instance, a child going to school without have breakfast would make the child absent minded which would lead to lagging behind in class. Several measures has been put in place to eradicate poverty on the long run. However, some of the short term solutions include; Government should provide aids for parents in low-income families, it would enable them gain appropriate education, training, and working skills which would help them get better paid jobs. Also, social workers in schools should identify children from low income households and give them nutritious meals for free. It would help them develop mentally and physically. Another major problem of poor nutrition is caused by change in climate. It affects the society in several ways which includes human health, influences yield from crops, and in most cases alters rainfall that results in drought. For instance, When drought occurs, it leads to severe poverty, food insecurity, and malnutrition. Alice Moyo, project manager for CRS’ vulnerable children programs stated, “Drought is very connected to education in many ways. To start with, there’s no food if there’s drought. Children concentrate less when they’re hungry, and also there’s a lot of running that takes place at school,” To solve this problem, the government should enforce policies on recycling waste water and desert landscaping to enable areas with drought get good clean water. Also, the government can use advanced transportation means to move water from areas where it rains to areas with drought. Lastly, Food insecurity can delay a child’s learning abilities if not attended to.

Research has shown that in the US, a considerable number of kids under the age of 5 live in households that lack adequate quality of food that is needed to improve healthy and energetic living. Anna Johnson, an assistant professor at Georgetown University declared, ‘In our study, food insecurity in infancy and toddlerhood predicted lower cognitive and social-emotional skills in kindergarten, skills that can predict later success in academics and life.’ To this end, it is imperative for the government to provide food pantry in each communities whereby low income families can fed at least twice a day. In conclusion, it is obvious that malnutrition has a major effect on the learning , most especially in third world countries whereby people are affected by poverty, climate change, and food insecurity. The government can do its bit in eradicating poverty but the onus still lies with the entire community who live among the poor to ensure that all the policies are implemented.

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