Poor diets, both among the overindulged and malnourished, kill more people every year than smoking, Lancet study finds
- A study last week by The Lancet found that poor diets - both by the overindulged and the malnourished - cause one in five deaths worldwide every year, more than smoking
The British medical journal The Lancet last week resumed its war on “Big Food” with a report that estimates poor diets causing one in five deaths worldwide, significantly more than tobacco and smoking.
Health authorities should broaden their battles against obesity, heart disease, cancer and diabetes - currently aimed at specific harmful ingredients like sugar, starch and sodium - and encourage communities to eat fruit, vegetables, legumes, whole grains, seeds and nuts, the study said. In a massive study of people over 25 years old in 195 countries, it finds that almost everywhere, we eat too few of these.
“This study confirms what many have thought for several years – that poor diet is responsible for more deaths than any other risk factor in the world,” said co-author Christopher Murray at the University of Washington. “Dietary policies focusing on promoting the intake of components of diet for which current intake is less than optimal might have a greater effect than policies only targeting sugar and fat.”
“Shifting diet from unhealthy animal-based foods to healthy plant-based foods might (also) be associated with lower emission of greenhouse gases and thus might be environmentally more sustainable,” the report added.
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I can feel the world’s carnivores squirming. Of the 11 million estimated annual deaths from diet-related causes, 3 million can be blamed on sodium, but a further 3 million die because they don’t eat enough whole grains, and 2 million because their diets lack fruit. For comparison, about 7 million people die every year for tobacco-related reasons.
Apart from the fatalities, the report says diet-related ill health accounted for the loss of 255 million “disability-related life-years”, or DALYs, in 2017. In other words, there is a huge economic cost.
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The new report, funded by the Bill & Melinda Gates Foundation, and part of its ongoing Global Burden of Disease study, follows hot on the heels of a January report that attacked “Big Food” for its role in driving the “Great Global Syndemic” (GGS), a global health crisis arising from a combination of obesity, under-nutrition and climate change.
The earlier report fiercely attacked large food corporations, and the annual subsidies amounting to US$500 billion that reward overproduction of red meats and corn: “The greatest returns come from large-scale, ultra-processed products marketed around the globe – mass-produced, long shelf life food products that are typically high in fat, sugar and salt.”
Perhaps unsurprisingly, the world’s food multinationals got together to condemn the work of the Lancet Commission responsible for the reports as “deeply irresponsible”.
The latest report tracks consumption trends of 15 dietary factors in 195 countries over the 27 years from 1990 to 2017, and argues that as much harm arises from neglect of good foods as arises from overconsumption of the bad stuff – sugar, sodium, trans-fatty acids and so on: “Consumption of nearly all healthy foods and nutrients was suboptimal.”
Alongside ongoing campaigns against the bad stuff, the research team argues that we need “comprehensive interventions” to encourage us to reintroduce good foods into our diets.
Its research says the greatest shortfalls worldwide are in seeds and nuts, milk and whole grains, and the largest harmful excesses are in sugar-sweetened drinks, processed meat and sodium. On average the world eats only 12 per cent of the recommended amount of nuts and seeds (we need about 21 grammes a day). We drink on average 10 times more sugary drinks than the recommended 3 grammes a day.
But the report shows dramatic regional variations in our food sins. It found that no region eats the right amount of all of the 15 dietary factors, and that no single factor was eaten in the correct amount in every part of the world. Latin Americans, Australians and Americans are off the charts in overconsumption of red meat, with Central and North Americans significantly the worst for processed meats, sugary drinks and trans-fats.
For sodium – essentially too much salt in everything – East Asia stands alone, and is the biggest dietary death risk in China, Japan and Thailand.
While literally no region in the world consumes anywhere near enough fruit, milk, nuts and seeds, whole grains, calcium or fibre, at least people in high-income Asia – which means Japan, South Korea, Singapore (and probably Hong Kong) – consume enough fish to have enough Omega-3 fatty acids, and seem to have reasonable control over red meat and trans-fats.
Only in Central Asia, Central Europe, high-income Asia-Pacific and the Middle East do we get near to consuming enough vegetables.
The study revealed huge differences between countries. The worst country (Uzbekistan) saw 890 diet-related deaths per 100,000 of its population, 10 times higher than Israel with 89.
Among the world’s 20 most populous countries, Egypt dubiously boasted the highest level of diet-related deaths, at 552 per 100,000 of the population, while Japan boasted the lowest at less than 100. China boasted the highest rates of heart attack deaths at 299 per 100,000, and cancer deaths (42).
While the report complains that few health-focused campaigns have borne fruit in recent years, there might be encouragement from Chile, which was identified by The Lancet in 2015 as consuming more sugary drinks per capita than any other country.
Since then, Chile has waged war against “big sugar”, with the introduction of an 18 per cent tax on high-sugar drinks. In 2016, the government targeted child-friendly advertising. A new law limits cartoon food packaging, stops schools selling unhealthy foods, restricts TV advertisements, bans promotional toys and mandates large black cigarette-style warning labels on foods high in salt, saturated fat, sugar and calories.
It is early days for the Chilean government’s efforts to be assessed, but Senator Guido Girardi, a doctor and former president of Chile’s Senate claims early progress: “If you change food habits you can really reduce heart attacks, cancer, diabetes and high blood pressure,” he said.
The latest Lancet study punctiliously describes the global “death by dinner” problem that is being encouraged by “Big Food”, and provides strong indicators for how communities worldwide need to change what we put on our dinner plates.
But as science writer Anjana Ahuja at the Financial Times said: “Rebalancing the items on a dinner plate is only a dream for the estimated 821 million people worldwide who have no plate at all.”
David Dodwell researches and writes about global, regional and Hong Kong challenges from a Hong Kong point of view
