October 22, 2018
Tamara Nanitashvili, Senior Nutrition and Food Systems Officer, FAO Regional Office
The Near East and North Africa (NENA) Region, is characterized with multiple burdens of malnutrition, including under-nutrition (wasting and stunting), over-nutrition (overweight and obesity) and micronutrient deficiencies. The prevalence of obesity in the region, which is rising at a fast pace and significantly exceeds the global average (FAO, IFAD, UNICEF, WFP and WHO, 2017), is particularly concerning (Figure 1). Obesity represents a substantial economic burden for countries, mostly due to its link to non-communicable diseases (NCD), including diabetes, cardiovascular disease and certain forms of cancer, which are the leading causes of mortality worldwide (WHO, 2013).
An extensive literature highlights changing lifestyles and unhealthy dietary patterns as major causes for rising obesity around the globe. Countries in the NENA Region have experienced significant changes in dietary habits in recent decades, shifting from a Mediterranean-style diet of traditional products (e.g. dates, vegetables and wheat) (The Economist Intelligence Unit, 2016) towards diets high in saturated fats, trans-fats, sugars, and salt, which are the major contributors to unhealthy weight gain.
Global Dietary Database (GDD), which brings together data from nutrition surveys for 187 countries between 1990 and 2013, allows an examination of dietary changes in the region over the past two decades. The data shows that consumption of sugar-sweetened beverages, which have a high energy density and little nutritional value and are generally associated with weight gain, has increased in most countries of the region (Figure 2).
In contrast, consumption of whole grains, which are good sources of fiber and an important part of a healthy diet, has reduced significantly in the period between 1990 and 2010 (Figure 3). Intake of fruits and vegetable, the major components of a healthy diet, mostly remained stable or declined.
Dietary intake of trans-fatty acid and saturated fat, generally exceeded the levels recommended by the World Health Organization (WHO) (<1% of trans-fats and <10% of saturated fats in total energy intake).
The Second International Conference on Nutrition (ICN2), jointly held by Food and Agriculture Organization (FAO) and WHO in 2014, stressed the importance of a food system approach for promoting healthy diets and improving nutrition. Sustainable, resilient food systems for healthy diets is one of the six action areas of the United Nations (UN) Decade of Action on Nutrition, proclaimed by the UN General Assembly in April 2016. As food systems encompass multiple stages from farm to fork (production, processing, trading/ marketing and consumption), multiple policy solutions are required to improve diets and nutrition. This comprises both supply side food policies (production, harvesting, processing, trading and marketing) as well as demand–side policies, including nutrition promotion and education as well as food price policies.
Most countries in the NENA region have developed operational policy/strategy or action plans to reduce unhealthy diet related to NCDs and / or policies to reduce physical inactivity. On the other hand, food-based dietary guidelines (FBDG), which greatly supports nutrition education among the general public and can serve as a basis for policy-making across food systems, is largely absent for most countries in the region. While worldwide over 100 countries have developed FBDGs (FAO, n.d.), only four countries in the region, including Iran, Lebanon, Oman and Qatar, have such guidelines thus far. The FBDGs in these four countries are in line with WHO recommendations for healthy diets emphasizing intake of fruits and vegetables, wholegrains and nuts, while limiting consumption of free sugars and salt and replacing saturated and industrial trans-fats with unsaturated fats (WHO, 2018).
While policies are an important step for ensuring political commitment of governments to address nutrition issues, adequate enforcement mechanisms and better coordination between stakeholders as well as coherence in national policies in various sectors (trade, food and agricultural policies) are equally important to achieve positive nutrition outcomes. This is particularly relevant for a multi-factorial phenomenon of obesity that requires re-shaping and realigning every aspect of food system to deliver improved nutrition through healthy diets.
References
FAO. (n.d.). Food-based dietary guidelines. Retrieved from http://www.fao.org/nutrition/education/food-dietary-guidelines/home/en/ FAO, IFAD, UNICEF, WFP and WHO. (2017). The state of food insecurity and nutrition in the world. Rome: FAO. http://www.fao.org/3/I9553EN/i9553en.pdf The Economist Intelligence Unit. (2016). Confronting Obesity in the Middle East; Cultural, social and policy changes. Retrieved from https://www.janssen.com/emea/sites/www_janssen_com_emea/files/confrontingobesityinthemiddleeast.pdf WHO. (2013). Sixty-Sixth World Health Assembly. Retrieved from http://apps.who.int/gb/ebwha/pdf_files/WHA66/A66_R10-en.pdf?ua=1 WHO. (2018). Healthy diets. Fact Sheet . Retrieved 2018, from http://www.who.int/news-room/fact-sheets/detail/healthy-diet
