Nutrition and Hydration Week (12-18 March 2018) provides an opportunity to reflect on the state of the British diet and how well it meets the needs of the population. This blog post has been reproduced from the Developing Health Lives blog site courtesy of the Instutite of Developmental Science (IDS).
We live in the midst of plenty, with enormous choice in our supermarkets and local food shops. Regular eating outside the home is normal practice. Even within the home, the use of prepared meals and processed food is now the norm for many. Snacking between meals is routine and there is a proliferation of vending machines, bakeries and coffee shops.
In parallel with these secular trends, portion sizes have increased in many settings (e.g., fast food outlets) and there are inducements to make these even larger (“supersizing”). Much of the food available in each of these contexts is high in fat or sugar or both. Given these simple observations it is no surprise that overweight and obesity have become common in Britain.
About 30% of adults in the UK are obese (body mass index – BMI – over 30 kg/m2) while about another 30% are overweight (BMI between 25 and 30 kg/m2). Rising levels of obesity are a major public health challenge because obesity increases the risk of developing type-2 diabetes, heart disease, several cancers and respiratory disease. It is estimated that by 2030 obesity will be responsible for over 650,000 more cases of diabetes, over 450,000 more cases of heart disease and stroke, over 130,000 more cases of cancer. Obesity-associated medical costs are estimated to increase by about £2 billion a year.
Unfortunately, the youngest members of our society are not protected from the wave of overweight and obesity that is sweeping across the country. In a 2016 20% of 10- 11 year olds were obese and another 14% were overweight. Similarly 9% of 4-5 year olds were obese and a further 13% were overweight. . The future health prospects of those youngsters are bleak, particularly because early life dietary habits persist into adulthood. The consumption of calorie-rich foods is, of course, only half of the story. The other half is the decline in physical activity, which would burn up the extra calories. But that’s a story for Get Active Week …….
We have a triple burden of malnutrition: overweight and obesity, poor essential nutrient intake, and undernutrition in the elderly and the ill. Together these affect all society and, in one way or another, all ages. This ticking time bomb is the current reality.
Prepared, processed and takeaway foods, while often high in energy, fat and sugar, can be relatively low in micronutrients (i.e. vitamins and minerals) and other essential nutrients like omega-3 fats. We know that fruits, vegetables, seeds, nuts and grains are good sources of many micronutrients, while fish is a good source of omega-3 fats and some micronutrients. Animal products have a role in providing micronutrients too: for example red meat is a good source of iron and zinc. The problem is that many people do not eat enough fruits, vegetables or fish to provide sufficient intake of essential nutrients to meet their needs.
Surveys of nutrient intake and blood levels of nutrients repeatedly show that a significant proportion of the British population have intakes and blood levels that are lower than they should be. There are differences between males and females, and across age groups and socio-economic groups, but the bottom line is clear: a significant number of people have intakes of essential nutrients that are lower than desired to achieve optimal health.
The final challenge to consider alongside the two issues highlighted already is the prevalence of generalised undernutrition in our society; this is what is commonly referred to as malnutrition. Despite living in a calorie-rich environment, many older people and people with particular illnesses have an insufficient intake of both energy and essential nutrients. This is an important and neglected public health problem in Britain: it is estimated that undernutrition affects 10% of people over the age of 65 years, but this can be much higher in sub-groups with particular illnesses. The consequences are clinically, and socially, significant.
Undernutrition increases risk of bone fragility and falls; heart disease, heart failure and stroke; anaemia, decreased mobility and tiredness; poor wound healing and ulcers; and cognitive decline. Undernutrition impairs the immune response making people more susceptible to infections and preventing vaccines from working properly.
Undernutrition increases the risk of being hospitalised and poor recovery from illness, injury and surgery. Undernourished people stay in hospital for longer and don’t do as well as well-nourished people. It is likely that undernutrition prevents some medicines from working as effectively as they should. Undernutrition increases the risk of mortality. A report from the NIHR Southampton Biomedical Research Centre in 2015 identified that annual public expenditure on undernutrition in healthcare was about £15 billion, while that on undernutrition in social care was about £4.5 billion. This accounted for about 15% of total health and social care expenditure. This is not trivial and is likely to become a greater problem with increased numbers of older people.
So where does this leave us as we think about the importance of nutrition and hydration this week? We have a triple burden of malnutrition: overweight and obesity, poor essential nutrient intake, and undernutrition in the elderly and the ill. Together these affect all society and, in one way or another, all ages. This ticking time bomb is the current reality. It is possible that, despite now being recognised, these problems will worsen in the next years and the economic and social consequences will become even more significant than they are now. I hope not.
The Government has a strategy for tackling overweight and obesity; this needs buy in from the population who may find old habits hard to break. The food industry has significant responsibility and a major role to play in helping to fix the overweight and obesity crisis and the problem of calorie-rich and essential nutrient poor foods and meals. The well-known Government strategies around “sugar reduction” have forced industry to respond in a positive way and that perhaps signals the start of a new era. Let’s see if the time bomb stops ticking …….
Philip Calder, Professor of Nutrional Immunology at The Institute of Developmental Sciences.