Do people give enough importance in having a proper meal? The answer is a resounding NO. If we all did, one in five deaths around the world would not have been caused by an unhealthy diet in 2016.
If we all ate a proper meal - including our children, the world would not see half of child deaths under 5 years being caused by malnutrition. One in five children are too short for their age and this is called stunting. Stunting also impacts intelligence or cognition. In the meantime, overweight even among children under five is creeping in. 2018 the globe was having 10 million more children in the overweight category.
A proper meal: we would not be so prone to colds and coughs.
If we eat safe food: Sri Lanka would not see so many kidney related deaths.
If we ate a balanced meal: we would not see such a loss of productivity, both in terms of the way the body works and the mind. An emerging field is nutritional psychiatry – how different diets work on reducing depression and increasing ebullience and brain power.
This matter could be argued that if people have money and can afford good food, the quality of diets would improve. However, this is not so. There are a large number of people who have limited incomes, but have a good food intake. There are much wealthy people with either poor intakes of healthy food or increased eating of expensive processed food. These people may also eat for example, too much of meat and less grain food and vegetables. As we all know the more processed the food, the higher rrisk of relationship to overweight and obesity. Processed food is generally very low in fibre, high in fat, sugar, salt and starch – the four white devils. Though poverty affects nutritional status, healthy food related behavior can go beyond poverty into sensible behavior that could make the most of what one has in one’s purse.
The central tool that could give messages on consumption of healthy meals to the population is called “Food Based Dietary Guidelines (FBDGs). These are usually disseminated by the governments of the world in particular the Ministries of Health together with other relevant partners such as the Ministries of Agriculture, academia, professional bodies and if there are no conflicts of interest, even private sector. FBDGs properly communicated could improve nutrition status across the whole population.
Many decades ago advice was given on how much nutrients one should get. Nutrients are the chemical components of food that are desirable for use in the body for the proper functioning of organs, provision of energy for activities, fighting disease and growth of children. However, this was found to be impractical as people cannot directly translate how much food is required to get the requisite nutrients. For example, how much calcium rich food should we eat to get a milligram of Calcium? This needs calculation. All these should be calculated in formulating these messages.
Though these Guidelines or messages should be simple and clearly understood, they should be based on sound scientific evidence. The evidence is categorized into how much nutrients are required for good health, what is the situation of the country with regard to under and over nutrition and what are the related diseases? What do people actually eat (dietary patterns)? Are these affected by culture, time spent on preparation? What are the behaviours related to food? How is pricing and availability of food? How does the food we eat affect the planet in the way it is produced? What is the food environment?
If we translate the above questions into examples; a country with a large percentage of overweight people must provide guidelines/messages which are specific about limiting sugar and processed food; if people’s dietary pattern has less diversity or eating a very narrow range of food types, messages need to say that the diets should consist of a variety of food especially fruit, vegetable, greens, nuts and so on; if planning meals is not in the national psyche, this should be included in messaging; if the food environment is, if a driver has to eat in restaurants and snack bars, home cooked food should be emphasized. A Global Review of Food-Based Dietary Guidelines cites interesting information as shown in the Extract from the Review ad verbatim; FBDG is currently available for 90 countries globally: seven in Africa, 17 in Asia and the Pacific, 33 in Europe, 27 in Latin America and the Caribbean, four in the Near East and two in North America.
The years of publication of current versions range from 1986 to 2017 (mean 2009). This review provides summaries of the key messages and food guides that are used to communicate national dietary guidance, organized by food group and evaluates the extent to which each set of FBDG includes existing recommendations articulated by the WHO. Some guidance appears nearly universally across countries: to consume a variety of foods; to consume some foods in higher proportion than others; to consume fruits and vegetables, legumes and animal-source foods and to limit sugar, fat and salt. Guidelines on dairy, red meat, fats, oils and nuts are more variable. Although WHO global guidance encourages consumption of nuts, whole grains and healthy fats, these messages are not universally echoed across countries.
In Sri Lanka too the formulation of FBDGS happened almost a decade ago. There are informative books which are for practitioners, revised once, together with an abridged version titled “a food guide”. While it is salutary that the Ministry of Health has initiated this process, the guidelines require revision by means of producing a technical review on evidence, formulating technical guidelines, converting these guidelines into short messages and disseminating widely for the public to actually change their behavior. Wide dissemination requires strategic communication which would result in the public internalizing these messages and changing their day-to-day behavior patterns accordingly. An approach that is practical would deliver the required results in changing the country’s nutrition status for the long haul.
Disseminating messages is not enough. An enabling environment should be created in order to obtain the recommended food at a reasonable price, at less cost to the environment (sustainable food resources), with convenience close at hand. So food related policies too need to evolve in order to support the take off for these messages.
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