Hosam Ibrahim, Kibrom Abay and Lina Abdelfattah - IFPRI Egypt
On 14 January 2020 the United Nations Food and Agriculture Organization (FAO) and the International Food Policy Research Institute (IFPRI) hosted a joint seminar, which shed light on the latest trends and distinct patterns of overweight and obesity across the Near East and North Africa (NENA) region. The seminar took place at the FAO regional office as part of the IFPRI-Egypt seminar series, funded by the United States Agency for International Development (USAID).
The seminar involved three presentations. IFPRI and FAO shared preliminary findings from their joint project that aims at examining the role of food (trade) policies in explaining the high rates of overweight and obesity in the NENA region. Kibrom Abay, Research Fellow at IFPRI, presented the preliminary results of IFPRI’s study on food policies and their implications on overweight and obesity in the NENA countries. Ghada Nasr, Professor of Public Health and Community Medicine at Cairo University’s Faculty of Medicine, highlighted the latest obesity trends among Egyptian adults. The third presentation was given by Tamara Nanitashvili, Senior Nutrition and Food Systems Officer at FAO Regional Office for NENA region, which highlighted the conclusions and recommendations from the joint FAO-World Health Organization (WHO) regional multi-stakeholder workshop on food systems in the NENA region.
The main discussion points and findings highlighted in the seminar are given below:
Abay’s presentation highlighted regional and global trends in body weight. His presentation showed that the NENA region countries, especially the Gulf Cooperation Council (GCC) member countries, have among the highest average body mass index (BMI) and highest rates of overweight and obesity in the world. Figure 1 below shows the average BMI for women across the globe, highlighting that the NENA region countries are amongst the countries with the highest BMI in the world.
Figure 1 Mean BMI for women (excluding pregnant women)
Source: NCD-RisC (NCD-RisC, 2017)
Abay’s presentation mainly focused on the role of food policies, mainly trade policies and government food subsidies, in explaining existing high rates of overweight and obesity. Trade policies have the potential to shape global food systems and influence domestic food environment through their effects on food production, processing, and distribution. Trade policies can affect domestic food environments and global food systems through several direct and indirect channels. First, trade policies, including easing trade barriers and reducing tariff rates, can increase food imports, which increases the availability and affordability of domestic foods. Second, efforts to ease trade barriers may encourage the flow of foreign direct investment, including investment in food processing industries and supermarket chains. Third, trade policies can influence the relative prices of foods, which can affect consumers’ food choices, dietary preferences, and consumption patterns. Fourth, trade policies can affect the income and purchasing power of individuals.
The study found that food systems in the NENA region have evolved substantially, where overall food supply quadrupled in the periods from 1960–70 to 2010–13 and food import dependence likewise increased. The results show significant relationships between alternative trade (food) policy indicators and food availability indicators, and ultimately important relationships between trade policies and body weight outcomes. Contrary to the conventional view that overweight and obesity rates are urban problems, rural body weight has been rising over the past few decades, sometimes at higher rates than in urban areas.
Conditional on other observable factors; countries with low tariff rates (especially on unhealthy diets) have higher overweight and obesity rates. On the other hand, higher share of government expenditure on subsidies is significantly associated with higher overweight and obesity rates. Economic affordability of foods appears to be among the important mechanisms, as we find inverse relationships between prices of “unhealthy” diets and body weight outcomes.
Nanitashvili’s presentation summarized some of the main policy implications from the joint FAO-WHO workshop conducted in September 2019. Nanitashvili highlighted the need for a multi-sectoral and multi-stakeholder approach to leverage the food system to combat obesity challenges. Coordination and mainstreaming of nutrition considerations into the policies and actions across many sectors is necessary. She also added that a mapping exercise to better understand the food system nationally, is essential to identify opportunities for action plans to combat obesity.
Nasr’s presentation reflected on the fact that non-communicable diseases (NCDs) remain the top 20 causes of deaths in Egypt. She also emphasized that rising overweight and obesity rates are major risk factors for some of these NCDs. Nasr’s presentation also showed results from the latest Egyptian WHO STEPwise approach to Surveillance (STEPS) data collected in 2017, which indicate high rates of obesity (nearly 50% of females are obese). Nasr’s presentation relates the existing high obesity rates in Egypt to: (a) low levels of consumption of healthy diet, (b) increased levels of physical inactivity, (c) poor capacity for obesity early detection, treatment and care within the health system, and (d) poor implementation and enforcement of WHO ‘Best Buys’ and other recommended interventions for the prevention and control of NCDs.
The above findings have important implications for informing public health policies in the region. The ever-increasing trend in obesity rates calls for integrated interventions that can address diet-related weight gains and the associated burden of NCD in the NENA region. As the region’s population increases and arable land and water resources continue to shrink, trade and food policies will have to respond accordingly. Integrating nutritional targets and designing nutrition-sensitive food policies will be crucial to address the adverse public health implications of trade (food) policies.
During the seminar, policies such as taxes on energy-dense foods were discussed and lessons learned from other countries were highlighted. For example, Mexico introduced the sugar-sweetened beverage tax- a major nationwide policy intervention to encourage consumers to switch to healthier diets. Some NENA countries have made efforts to introduce sugar-sweetened beverage taxes, as in Saudi Arabia’s recently introduced 50 percent excise tax on sugar-sweetened beverages.
The panel discussions, led by Clemens Breisinger (IFPRI Country Program Leader) and Nomindelger Bayasgalanbat (Regional Nutrition Officer at FAO), raised potential ideas for addressing the increasing obesity epidemic in the region, while also highlighting the role of policy makers, international organizations and donors. The discussions also raised key policy gaps that require further research. In conclusion of the seminar, the panelists stated that there needs to be a multi-sectoral approach to the malnutrition problem in the region. For example, current subsidy programs that make unhealthy foods cheaper and more available are counterproductive. On the other hand, subsidizing healthy foods is both expensive and its efficacy remains unknown.
