cause and effect essay of unhealthy diet

Dangers of Dieting: Why Dieting Can Be Harmful

Posted on February 8, 2024 March 25, 2024

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BY: Anna Guerdjikova, PhD, LISW, CCRC, Lindner Center of HOPE, Director of Administrative Services, Harold C. Schott Foundation Eating Disorders Program University of Cincinnati, Department of Psychiatry, Research Assistant Professor

An estimated 45 million Americans diet each year and spend $33 billion annually on weight loss products. WebMD lists over 100 different diets, starting with the African Mango diet, moving on to the South Beach and Mediterranean diets and ending up with the Zone. Most diets, regardless of their particular nature, result in short-term weight loss that is not sustainable. Weight cycling or recurrent weight loss through dieting and subsequent weight gain (yo-yo effect) can be harmful for mental and physical health for both healthy weight and overweight individuals. Furthermore, weight fluctuations have been related to increased risk of development of cardiovascular disease, Type 2 diabetes, and high blood pressure.

What is Dieting

The word “diet” originates from the Greek word “ diaita”, literally meaning “manner of living”. In the contemporary language, dieting is synonymous with a quick fix solution for an overwhelming obesity epidemic. Dieting implies restriction, limitation of pleasurable foods and drinks, and despite of having no benefits, the omnipresent dieting mentality remains to be the norm.

Most diets fail most of the time. Repeated diet failure is a negative predictor for successful long term weight loss. Chronic dieters consistently report guilt and self-blame, irritability, anxiety and depression, difficulty concentrating and fatigue. Their self-esteem is decreased by continuous feelings of failure related to “messing my diet up again”, leading to feelings of lack of control over one’s food choices and further … life in general. Dieting can be particularly problematic in adolescents and it remains a major precursor to disordered eating, with moderate dieters being five times more likely to develop an eating disorder than those who do not diet at all.

Diets imply restriction. Psychologically, dietary restraint can lead to greater reactivity to food cues, increased cravings and disinhibition, and overeating and binge eating. Biologically, dieting can lead to unhealthy changes in body composition, hormonal changes, reduced bone density, menstrual disturbances, and lower resting energy expenditure.

The Potential Harmful Effects of Dieting

Aggressive dieting lowers the base metabolic rate, meaning one burns less energy when resting, resulting in significantly lower daily needs in order to sustain achieved weight after the diet is over. Returning to normalized eating habits at this lower base metabolic rate results in commonly seen post dieting weight gain. Biologically, dieting is perceived as harmful and physiology readjusts trying to get back to initial weight even after years since the initial rapid weight loss. Recent data examining 14 participants in the “Biggest Loser” contest showed they lost on average 128 pounds and their baseline resting metabolic rates dropped from 2,607 +/-649 kilocalories/ day to 1,996 +/- 358 kcal/day at the end of the 30 weeks contest. Those that lost the most weight saw the biggest drops in their metabolic rate. Six years after the show, only one of the 14 contestants weighed less than they did after the competition; five contestants regained almost all of or more than the weight they lost, but despite the weight gain, their metabolic rates stayed low, with a mean of 1,903 +/- 466 kcal/day. Proportional to their individual weights the contestants were burning a mean of ~500 fewer kilocalories a day than would be expected of people their sizes leading to steady weight gain over the years. Metabolic adaptation related to rapid weight loss thus persisted over time suggesting a proportional, but incomplete, response to contemporaneous efforts to reduce body weight from its defined “set point”.

Dieting emphasizes food as “good” or “bad”, as a reward or punishment, and increases food obsessions. It does not teach healthy eating habits and rarely focuses on the nutritional value of foods and the benefit of regulated eating. Unsatisfied hunger increases mood swings and risk of overeating. Restricting food, despite drinking enough fluids, can leads to dehydration and further complications, like constipation. Dieting and chronic hunger tend to exacerbate dysfunctional behaviors like smoking cigarettes or drinking alcohol.

Complex entities like health and wellness cannot be reduced to the one isolated number of what we weigh or to what body mass index (BMI) is. Purpose and worth cannot be measured in weight. Dieting mentality tempts us into “If I am thin- I will be happy” or “If I am not thin-I am a failure” way of thinking but only provides a short term fictitious solution with long term harmful physical and mental consequences. Focusing on sustainable long term strategies for implementing regulated eating habits with a variety of food choices without unnecessary restrictions will make a comprehensive diet and maintaining healthy weight a true part of our “manner of living”.

Reference: Obesity (Silver Spring). 2016 May ;Persistent metabolic adaptation 6 years after “The Biggest Loser” competition.; Fothergill E , Guo J , Howard L , Kerns JC , Knuth ND , Brychta R , Chen KY , Skarulis MC , Walter M , Walter PJ , Hall KD .

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• Food and mood: how do...

Food and mood: how do diet and nutrition affect mental wellbeing?

Read our food for thought 2020 collection.

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• Food and mood: how do diet and nutrition affect mental wellbeing? - November 09, 2020
• Joseph Firth , research fellow 1 2 ,
• James E Gangwisch , assistant professor 3 4 ,
• Alessandra Borsini , researcher 5 ,
• Robyn E Wootton , researcher 6 7 8 ,
• Emeran A Mayer , professor 9 10
• 1 Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Oxford Road, University of Manchester, Manchester M13 9PL, UK
• 2 NICM Health Research Institute, Western Sydney University, Westmead, Australia
• 3 Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, USA
• 4 New York State Psychiatric Institute, New York, NY, USA
• 5 Section of Stress, Psychiatry and Immunology Laboratory, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, King’s College London, London, UK
• 6 School of Psychological Science, University of Bristol, Bristol, UK
• 7 MRC Integrative Epidemiology Unit, Oakfield House, Bristol, UK
• 8 NIHR Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
• 9 G Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA Vatche and Tamar Manoukian Division of Digestive Diseases, UCLA, Los Angeles, CA, USA
• 10 UCLA Microbiome Center, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
• Correspondence to: J Firth joseph.firth{at}manchester.ac.uk

Poor nutrition may be a causal factor in the experience of low mood, and improving diet may help to protect not only the physical health but also the mental health of the population, say Joseph Firth and colleagues

Key messages

Healthy eating patterns, such as the Mediterranean diet, are associated with better mental health than “unhealthy” eating patterns, such as the Western diet

The effects of certain foods or dietary patterns on glycaemia, immune activation, and the gut microbiome may play a role in the relationships between food and mood

More research is needed to understand the mechanisms that link food and mental wellbeing and determine how and when nutrition can be used to improve mental health

Depression and anxiety are the most common mental health conditions worldwide, making them a leading cause of disability. 1 Even beyond diagnosed conditions, subclinical symptoms of depression and anxiety affect the wellbeing and functioning of a large proportion of the population. 2 Therefore, new approaches to managing both clinically diagnosed and subclinical depression and anxiety are needed.

In recent years, the relationships between nutrition and mental health have gained considerable interest. Indeed, epidemiological research has observed that adherence to healthy or Mediterranean dietary patterns—high consumption of fruits, vegetables, nuts, and legumes; moderate consumption of poultry, eggs, and dairy products; and only occasional consumption of red meat—is associated with a reduced risk of depression. 3 However, the nature of these relations is complicated by the clear potential for reverse causality between diet and mental health ( fig 1 ). For example, alterations in food choices or preferences in response to our temporary psychological state—such as “comfort foods” in times of low mood, or changes in appetite from stress—are common human experiences. In addition, relationships between nutrition and longstanding mental illness are compounded by barriers to maintaining a healthy diet. These barriers disproportionality affect people with mental illness and include the financial and environmental determinants of health, and even the appetite inducing effects of psychiatric medications. 4

Hypothesised relationship between diet, physical health, and mental health. The dashed line is the focus of this article.

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While acknowledging the complex, multidirectional nature of the relationships between diet and mental health ( fig 1 ), in this article we focus on the ways in which certain foods and dietary patterns could affect mental health.

Mood and carbohydrates

Consumption of highly refined carbohydrates can increase the risk of obesity and diabetes. 5 Glycaemic index is a relative ranking of carbohydrate in foods according to the speed at which they are digested, absorbed, metabolised, and ultimately affect blood glucose and insulin levels. As well as the physical health risks, diets with a high glycaemic index and load (eg, diets containing high amounts of refined carbohydrates and sugars) may also have a detrimental effect on psychological wellbeing; data from longitudinal research show an association between progressively higher dietary glycaemic index and the incidence of depressive symptoms. 6 Clinical studies have also shown potential causal effects of refined carbohydrates on mood; experimental exposure to diets with a high glycaemic load in controlled settings increases depressive symptoms in healthy volunteers, with a moderately large effect. 7

Although mood itself can affect our food choices, plausible mechanisms exist by which high consumption of processed carbohydrates could increase the risk of depression and anxiety—for example, through repeated and rapid increases and decreases in blood glucose. Measures of glycaemic index and glycaemic load can be used to estimate glycaemia and insulin demand in healthy individuals after eating. 8 Thus, high dietary glycaemic load, and the resultant compensatory responses, could lower plasma glucose to concentrations that trigger the secretion of autonomic counter-regulatory hormones such as cortisol, adrenaline, growth hormone, and glucagon. 5 9 The potential effects of this response on mood have been examined in experimental human research of stepped reductions in plasma glucose concentrations conducted under laboratory conditions through glucose perfusion. These findings showed that such counter-regulatory hormones may cause changes in anxiety, irritability, and hunger. 10 In addition, observational research has found that recurrent hypoglycaemia (low blood sugar) is associated with mood disorders. 9

The hypothesis that repeated and rapid increases and decreases in blood glucose explain how consumption of refined carbohydrate could affect psychological state appears to be a good fit given the relatively fast effect of diets with a high glycaemic index or load on depressive symptoms observed in human studies. 7 However, other processes may explain the observed relationships. For instance, diets with a high glycaemic index are a risk factor for diabetes, 5 which is often a comorbid condition with depression. 4 11 While the main models of disease pathophysiology in diabetes and mental illness are separate, common abnormalities in insulin resistance, brain volume, and neurocognitive performance in both conditions support the hypothesis that these conditions have overlapping pathophysiology. 12 Furthermore, the inflammatory response to foods with a high glycaemic index 13 raises the possibility that diets with a high glycaemic index are associated with symptoms of depression through the broader connections between mental health and immune activation.

Diet, immune activation, and depression

Studies have found that sustained adherence to Mediterranean dietary patterns can reduce markers of inflammation in humans. 14 On the other hand, high calorie meals rich in saturated fat appear to stimulate immune activation. 13 15 Indeed, the inflammatory effects of a diet high in calories and saturated fat have been proposed as one mechanism through which the Western diet may have detrimental effects on brain health, including cognitive decline, hippocampal dysfunction, and damage to the blood-brain barrier. 15 Since various mental health conditions, including mood disorders, have been linked to heightened inflammation, 16 this mechanism also presents a pathway through which poor diet could increase the risk of depression. This hypothesis is supported by observational studies which have shown that people with depression score significantly higher on measures of “dietary inflammation,” 3 17 characterised by a greater consumption of foods that are associated with inflammation (eg, trans fats and refined carbohydrates) and lower intakes of nutritional foods, which are thought to have anti-inflammatory properties (eg, omega-3 fats). However, the causal roles of dietary inflammation in mental health have not yet been established.

Nonetheless, randomised controlled trials of anti-inflammatory agents (eg, cytokine inhibitors and non-steroidal anti-inflammatory drugs) have found that these agents can significantly reduce depressive symptoms. 18 Specific nutritional components (eg, polyphenols and polyunsaturated fats) and general dietary patterns (eg, consumption of a Mediterranean diet) may also have anti-inflammatory effects, 14 19 20 which raises the possibility that certain foods could relieve or prevent depressive symptoms associated with heightened inflammatory status. 21 A recent study provides preliminary support for this possibility. 20 The study shows that medications that stimulate inflammation typically induce depressive states in people treated, and that giving omega-3 fatty acids, which have anti-inflammatory properties, before the medication seems to prevent the onset of cytokine induced depression. 20

However, the complexity of the hypothesised three way relation between diet, inflammation, and depression is compounded by several important modifiers. For example, recent clinical research has observed that stressors experienced the previous day, or a personal history of major depressive disorders, may cancel out the beneficial effects of healthy food choices on inflammation and mood. 22 Furthermore, as heightened inflammation occurs in only some clinically depressed individuals, anti-inflammatory interventions may only benefit certain people characterised by an “inflammatory phenotype,” or those with comorbid inflammatory conditions. 18 Further interventional research is needed to establish if improvements in immune regulation, induced by diet, can reduce depressive symptoms in those affected by inflammatory conditions.

Brain, gut microbiome, and mood

A more recent explanation for the way in which our food may affect our mental wellbeing is the effect of dietary patterns on the gut microbiome—a broad term that refers to the trillions of microbial organisms, including bacteria, viruses, and archaea, living in the human gut. The gut microbiome interacts with the brain in bidirectional ways using neural, inflammatory, and hormonal signalling pathways. 23 The role of altered interactions between the brain and gut microbiome on mental health has been proposed on the basis of the following evidence: emotion-like behaviour in rodents changes with changes in the gut microbiome, 24 major depressive disorder in humans is associated with alterations of the gut microbiome, 25 and transfer of faecal gut microbiota from humans with depression into rodents appears to induce animal behaviours that are hypothesised to indicate depression-like states. 25 26 Such findings suggest a role of altered neuroactive microbial metabolites in depressive symptoms.

In addition to genetic factors and exposure to antibiotics, diet is a potentially modifiable determinant of the diversity, relative abundance, and functionality of the gut microbiome throughout life. For instance, the neurocognitive effects of the Western diet, and the possible mediating role of low grade systemic immune activation (as discussed above) may result from a compromised mucus layer with or without increased epithelial permeability. Such a decrease in the function of the gut barrier is sometimes referred to as a “leaky gut” and has been linked to an “unhealthy” gut microbiome resulting from a diet low in fibre and high in saturated fats, refined sugars, and artificial sweeteners. 15 23 27 Conversely, the consumption of a diet high in fibres, polyphenols, and unsaturated fatty acids (as found in a Mediterranean diet) can promote gut microbial taxa which can metabolise these food sources into anti-inflammatory metabolites, 15 28 such as short chain fatty acids, while lowering the production of secondary bile acids and p-cresol. Moreover, a recent study found that the ingestion of probiotics by healthy individuals, which theoretically target the gut microbiome, can alter the brain’s response to a task that requires emotional attention 29 and may even reduce symptoms of depression. 30 When viewed together, these studies provide promising evidence supporting a role of the gut microbiome in modulating processes that regulate emotion in the human brain. However, no causal relationship between specific microbes, or their metabolites, and complex human emotions has been established so far. Furthermore, whether changes to the gut microbiome induced by diet can affect depressive symptoms or clinical depressive disorders, and the time in which this could feasibly occur, remains to be shown.

Priorities and next steps

In moving forward within this active field of research, it is firstly important not to lose sight of the wood for the trees—that is, become too focused on the details and not pay attention to the bigger questions. Whereas discovering the anti-inflammatory properties of a single nutrient or uncovering the subtleties of interactions between the gut and the brain may shed new light on how food may influence mood, it is important not to neglect the existing knowledge on other ways diet may affect mental health. For example, the later consequences of a poor diet include obesity and diabetes, which have already been shown to be associated with poorer mental health. 11 31 32 33 A full discussion of the effect of these comorbidities is beyond the scope of our article (see fig 1 ), but it is important to acknowledge that developing public health initiatives that effectively tackle the established risk factors of physical and mental comorbidities is a priority for improving population health.

Further work is needed to improve our understanding of the complex pathways through which diet and nutrition can influence the brain. Such knowledge could lead to investigations of targeted, even personalised, interventions to improve mood, anxiety, or other symptoms through nutritional approaches. However, these possibilities are speculative at the moment, and more interventional research is needed to establish if, how, and when dietary interventions can be used to prevent mental illness or reduce symptoms in those living with such conditions. Of note, a recent large clinical trial found no significant benefits of a behavioural intervention promoting a Mediterranean diet for adults with subclinical depressive symptoms. 34 On the other hand, several recent smaller trials in individuals with current depression observed moderately large improvements from interventions based on the Mediterranean diet. 35 36 37 Such results, however, must be considered within the context of the effect of people’s expectations, particularly given that individuals’ beliefs about the quality of their food or diet may also have a marked effect on their sense of overall health and wellbeing. 38 Nonetheless, even aside from psychological effects, consideration of dietary factors within mental healthcare may help improve physical health outcomes, given the higher rates of cardiometabolic diseases observed in people with mental illness. 33

At the same time, it is important to be remember that the causes of mental illness are many and varied, and they will often present and persist independently of nutrition and diet. Thus, the increased understanding of potential connections between food and mental wellbeing should never be used to support automatic assumptions, or stigmatisation, about an individual’s dietary choices and their mental health. Indeed, such stigmatisation could be itself be a casual pathway to increasing the risk of poorer mental health. Nonetheless, a promising message for public health and clinical settings is emerging from the ongoing research. This message supports the idea that creating environments and developing measures that promote healthy, nutritious diets, while decreasing the consumption of highly processed and refined “junk” foods may provide benefits even beyond the well known effects on physical health, including improved psychological wellbeing.

Contributors and sources: JF has expertise in the interaction between physical and mental health, particularly the role of lifestyle and behavioural health factors in mental health promotion. JEG’s area of expertise is the study of the relationship between sleep duration, nutrition, psychiatric disorders, and cardiometabolic diseases. AB leads research investigating the molecular mechanisms underlying the effect of stress and inflammation on human hippocampal neurogenesis, and how nutritional components and their metabolites can prevent changes induced by those conditions. REW has expertise in genetic epidemiology approaches to examining casual relations between health behaviours and mental illness. EAM has expertise in brain and gut interactions and microbiome interactions. All authors contributed to, read, and approved the paper, and all the information was sourced from articles published in peer reviewed research journals. JF is the guarantor.

Competing interests: We have read and understood BMJ policy on declaration of interests and declare the following: JF is supported by a University of Manchester Presidential Fellowship and a UK Research and Innovation Future Leaders Fellowship and has received support from a NICM-Blackmores Institute Fellowship. JEG served on the medical advisory board on insomnia in the cardiovascular patient population for the drug company Eisai. AB has received research funding from Johnson & Johnson for research on depression and inflammation, the UK Medical Research Council, the European Commission Horizon 2020, the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, and King’s College London. REW receives funding from the National Institute for Health Research Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol. EAM has served on the external advisory boards of Danone, Viome, Amare, Axial Biotherapeutics, Pendulum, Ubiome, Bloom Science, Mahana Therapeutics, and APC Microbiome Ireland, and he receives royalties from Harper & Collins for his book The Mind Gut Connection. He is supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases, and the US Department of Defense. The views expressed are those of the authors and not necessarily those of the organisations above.

Provenance and peer review: Commissioned; externally peer reviewed.

This article is part of series commissioned by The BMJ. Open access fees are paid by Swiss Re, which had no input into the commissioning or peer review of the articles. T he BMJ thanks the series advisers, Nita Forouhi, Dariush Mozaffarian, and Anna Lartey for valuable advice and guiding selection of topics in the series.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ .

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Frontiers for Young Minds

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The Impacts of Junk Food on Health

Energy-dense, nutrient-poor foods, otherwise known as junk foods, have never been more accessible and available. Young people are bombarded with unhealthy junk-food choices daily, and this can lead to life-long dietary habits that are difficult to undo. In this article, we explore the scientific evidence behind both the short-term and long-term impacts of junk food consumption on our health.

Introduction

The world is currently facing an obesity epidemic, which puts people at risk for chronic diseases like heart disease and diabetes. Junk food can contribute to obesity and yet it is becoming a part of our everyday lives because of our fast-paced lifestyles. Life can be jam-packed when you are juggling school, sport, and hanging with friends and family! Junk food companies make food convenient, tasty, and affordable, so it has largely replaced preparing and eating healthy homemade meals. Junk foods include foods like burgers, fried chicken, and pizza from fast-food restaurants, as well as packaged foods like chips, biscuits, and ice-cream, sugar-sweetened beverages like soda, fatty meats like bacon, sugary cereals, and frozen ready meals like lasagne. These are typically highly processed foods , meaning several steps were involved in making the food, with a focus on making them tasty and thus easy to overeat. Unfortunately, junk foods provide lots of calories and energy, but little of the vital nutrients our bodies need to grow and be healthy, like proteins, vitamins, minerals, and fiber. Australian teenagers aged 14–18 years get more than 40% of their daily energy from these types of foods, which is concerning [ 1 ]. Junk foods are also known as discretionary foods , which means they are “not needed to meet nutrient requirements and do not belong to the five food groups” [ 2 ]. According to the dietary guidelines of Australian and many other countries, these five food groups are grains and cereals, vegetables and legumes, fruits, dairy and dairy alternatives, and meat and meat alternatives.

Young people are often the targets of sneaky advertising tactics by junk food companies, which show our heroes and icons promoting junk foods. In Australia, cricket, one of our favorite sports, is sponsored by a big fast-food brand. Elite athletes like cricket players are not fuelling their bodies with fried chicken, burgers, and fries! A study showed that adolescents aged 12–17 years view over 14.4 million food advertisements in a single year on popular websites, with cakes, cookies, and ice cream being the most frequently advertised products [ 3 ]. Another study examining YouTube videos popular amongst children reported that 38% of all ads involved a food or beverage and 56% of those food ads were for junk foods [ 4 ].

What Happens to Our Bodies Shortly After We Eat Junk Foods?

Food is made up of three major nutrients: carbohydrates, proteins, and fats. There are also vitamins and minerals in food that support good health, growth, and development. Getting the proper nutrition is very important during our teenage years. However, when we eat junk foods, we are consuming high amounts of carbohydrates, proteins, and fats, which are quickly absorbed by the body.

Let us take the example of eating a hamburger. A burger typically contains carbohydrates from the bun, proteins and fats from the beef patty, and fats from the cheese and sauce. On average, a burger from a fast-food chain contains 36–40% of your daily energy needs and this does not account for any chips or drinks consumed with it ( Figure 1 ). This is a large amount of food for the body to digest—not good if you are about to hit the cricket pitch!

• Figure 1 - The nutritional composition of a popular burger from a famous fast-food restaurant, detailing the average quantity per serving and per 100 g.
• The carbohydrates of a burger are mainly from the bun, while the protein comes from the beef patty. Large amounts of fat come from the cheese and sauce. Based on the Australian dietary guidelines, just one burger can be 36% of the recommended daily energy intake for teenage boys aged 12–15 years and 40% of the recommendations for teenage girls 12–15 years.

A few hours to a few days after eating rich, heavy foods such as a burger, unpleasant symptoms like tiredness, poor sleep, and even hunger can result ( Figure 2 ). Rather than providing an energy boost, junk foods can lead to a lack of energy. For a short time, sugar (a type of carbohydrate) makes people feel energized, happy, and upbeat as it is used by the body for energy. However, refined sugar , which is the type of sugar commonly found in junk foods, leads to a quick drop in blood sugar levels because it is digested quickly by the body. This can lead tiredness and cravings [ 5 ].

• Figure 2 - The short- and long-term impacts of junk food consumption.
• In the short-term, junk foods can make you feel tired, bloated, and unable to concentrate. Long-term, junk foods can lead to tooth decay and poor bowel habits. Junk foods can also lead to obesity and associated diseases such as heart disease. When junk foods are regularly consumed over long periods of time, the damages and complications to health are increasingly costly.

Fiber is a good carbohydrate commonly found in vegetables, fruits, barley, legumes, nuts, and seeds—foods from the five food groups. Fiber not only keeps the digestive system healthy, but also slows the stomach’s emptying process, keeping us feeling full for longer. Junk foods tend to lack fiber, so when we eat them, we notice decreasing energy and increasing hunger sooner.

Foods such as walnuts, berries, tuna, and green veggies can boost concentration levels. This is particularly important for young minds who are doing lots of schoolwork. These foods are what most elite athletes are eating! On the other hand, eating junk foods can lead to poor concentration. Eating junk foods can lead to swelling in the part of the brain that has a major role in memory. A study performed in humans showed that eating an unhealthy breakfast high in fat and sugar for 4 days in a row caused disruptions to the learning and memory parts of the brain [ 6 ].

Long-Term Impacts of Junk Foods

If we eat mostly junk foods over many weeks, months, or years, there can be several long-term impacts on health ( Figure 2 ). For example, high saturated fat intake is strongly linked with high levels of bad cholesterol in the blood, which can be a sign of heart disease. Respected research studies found that young people who eat only small amounts of saturated fat have lower total cholesterol levels [ 7 ].

Frequent consumption of junk foods can also increase the risk of diseases such as hypertension and stroke. Hypertension is also known as high blood pressure and a stroke is damage to the brain from reduced blood supply, which prevents the brain from receiving the oxygen and nutrients it needs to survive. Hypertension and stroke can occur because of the high amounts of cholesterol and salt in junk foods.

Furthermore, junk foods can trigger the “happy hormone,” dopamine , to be released in the brain, making us feel good when we eat these foods. This can lead us to wanting more junk food to get that same happy feeling again [ 8 ]. Other long-term effects of eating too much junk food include tooth decay and constipation. Soft drinks, for instance, can cause tooth decay due to high amounts of sugar and acid that can wear down the protective tooth enamel. Junk foods are typically low in fiber too, which has negative consequences for gut health in the long term. Fiber forms the bulk of our poop and without it, it can be hard to poop!

Tips for Being Healthy

One way to figure out whether a food is a junk food is to think about how processed it is. When we think of foods in their whole and original forms, like a fresh tomato, a grain of rice, or milk squeezed from a cow, we can then start to imagine how many steps are involved to transform that whole food into something that is ready-to-eat, tasty, convenient, and has a long shelf life.

For teenagers 13–14 years old, the recommended daily energy intake is 8,200–9,900 kJ/day or 1,960 kcal-2,370 kcal/day for boys and 7,400–8,200 kJ/day or 1,770–1,960 kcal for girls, according to the Australian dietary guidelines. Of course, the more physically active you are, the higher your energy needs. Remember that junk foods are okay to eat occasionally, but they should not make up more than 10% of your daily energy intake. In a day, this may be a simple treat such as a small muffin or a few squares of chocolate. On a weekly basis, this might mean no more than two fast-food meals per week. The remaining 90% of food eaten should be from the five food groups.

In conclusion, we know that junk foods are tasty, affordable, and convenient. This makes it hard to limit the amount of junk food we eat. However, if junk foods become a staple of our diets, there can be negative impacts on our health. We should aim for high-fiber foods such as whole grains, vegetables, and fruits; meals that have moderate amounts of sugar and salt; and calcium-rich and iron-rich foods. Healthy foods help to build strong bodies and brains. Limiting junk food intake can happen on an individual level, based on our food choices, or through government policies and health-promotion strategies. We need governments to stop junk food companies from advertising to young people, and we need their help to replace junk food restaurants with more healthy options. Researchers can focus on education and health promotion around healthy food options and can work with young people to develop solutions. If we all work together, we can help young people across the world to make food choices that will improve their short and long-term health.

Obesity : ↑ A disorder where too much body fat increases the risk of health problems.

Processed Food : ↑ A raw agricultural food that has undergone processes to be washed, ground, cleaned and/or cooked further.

Discretionary Food : ↑ Foods and drinks not necessary to provide the nutrients the body needs but that may add variety to a person’s diet (according to the Australian dietary guidelines).

Refined Sugar : ↑ Sugar that has been processed from raw sources such as sugar cane, sugar beets or corn.

Saturated Fat : ↑ A type of fat commonly eaten from animal sources such as beef, chicken and pork, which typically promotes the production of “bad” cholesterol in the body.

Dopamine : ↑ A hormone that is released when the brain is expecting a reward and is associated with activities that generate pleasure, such as eating or shopping.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

[1] ↑ Australian Bureau of Statistics. 2013. 4324.0.55.002 - Microdata: Australian Health Survey: Nutrition and Physical Activity, 2011-12 . Australian Bureau of Statistics. Available online at: http://bit.ly/2jkRRZO (accessed December 13, 2019).

[2] ↑ National Health and Medical Research Council. 2013. Australian Dietary Guidelines Summary . Canberra, ACT: National Health and Medical Research Council.

[3] ↑ Potvin Kent, M., and Pauzé, E. 2018. The frequency and healthfulness of food and beverages advertised on adolescents’ preferred web sites in Canada. J. Adolesc. Health. 63:102–7. doi: 10.1016/j.jadohealth.2018.01.007

[4] ↑ Tan, L., Ng, S. H., Omar, A., and Karupaiah, T. 2018. What’s on YouTube? A case study on food and beverage advertising in videos targeted at children on social media. Child Obes. 14:280–90. doi: 10.1089/chi.2018.0037

[5] ↑ Gómez-Pinilla, F. 2008. Brain foods: the effects of nutrients on brain function. Nat. Rev. Neurosci. 9, 568–78. doi: 10.1038/nrn2421

[6] ↑ Attuquayefio, T., Stevenson, R. J., Oaten, M. J., and Francis, H. M. 2017. A four-day western-style dietary intervention causes reductions in hippocampal-dependent learning and memory and interoceptive sensitivity. PLoS ONE . 12:e0172645. doi: 10.1371/journal.pone.0172645

[7] ↑ Te Morenga, L., and Montez, J. 2017. Health effects of saturated and trans-fatty acid intake in children and adolescents: systematic review and meta-analysis. PLoS ONE. 12:e0186672. doi: 10.1371/journal.pone.0186672

[8] ↑ Reichelt, A. C. 2016. Adolescent maturational transitions in the prefrontal cortex and dopamine signaling as a risk factor for the development of obesity and high fat/high sugar diet induced cognitive deficits. Front. Behav. Neurosci. 10. doi: 10.3389/fnbeh.2016.00189

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What we eat matters: Health and environmental impacts of diets worldwide

Dr Marco Springmann (Lead author) , Dr Dariush Mozaffarian , Dr Cynthia Rosenzweig , Dr Renata Micha

• The previous decade has seen little progress in improving diets, and a quarter of all deaths among adults are attributable to poor diets – those low in fruits, vegetables, nuts/seeds and whole grains, and high in red and processed meat and sugary drinks.
• Food production currently generates more than a third of all greenhouse gas emissions globally, and uses substantial and rising amounts of environmental resources, including land, water and nitrogen- and phosphorus-containing fertilisers.
• Current dietary patterns globally and in most regions are neither healthy nor sustainable. No region is on track to meet the Sustainable Development Goals aimed at limiting health and environmental burdens related to diets and the food system.

Introduction

Our diets affect both our own health and the health of the planet. [1] [2] Imbalanced diets low in fruits, vegetables, legumes, nuts/seeds and whole grains, and high in red and processed meat are responsible for one of the greatest health burdens globally and in most regions. [3] [4] At the same time, our diets and the food system underpinning them are major drivers of environmental pollution and resource demand, which is contributing to the crossing of key planetary boundaries that attempt to define a safe operating space for humanity on a stable Earth system. [5] Preserving the integrity of our environment and the health of populations will require substantial changes in the foods we produce and eat. [6] [7]

This chapter discusses the current state of diets worldwide and presents new estimates of the associated health and environmental impacts both globally and nationally. First, we survey how the demand for health and environmentally important foods has changed between 2010 and 2018 (the last year for which data is available) and compare the current dietary trends to food-group targets for healthy and sustainable diets. Second, based on epidemiological relationships that connect food intake with risks for diet-related diseases, we estimate the health implications of current diets. Third, based on the environmental footprints of foods, we estimate the environmental impacts of the food supply. The forthcoming methodology for this chapter contains a detailed description of the analytical methods used. We start by identifying key foods important for both human health and the environment.

Foods of concern

A healthy diet consists of plenty of fruits, vegetables, legumes, nuts/seeds, whole grains and oils high in unsaturated fats, and little to no red and processed meat, sugar-sweetened beverages, refined grains and oils high in saturated fats. [8] [9] [10] [11] Nutritional epidemiology has identified many of those aspects as key risk factors for or against leading causes of overall illness and death, including coronary heart disease, stroke, type-2 diabetes and several cancers. Between 20% and 25% of all deaths in adults have been associated with imbalanced diets. [12] [13] [14]

Advances in nutritional science in the last two decades now provide a substantial body of evidence to identify key dietary priorities for action. The evidence linking diets to intermediate risk factors (e.g. raised blood pressure) and final health (disease) outcomes (e.g. heart disease) comes from various lines of evidence. These include studies of biological processes, clinical trials of risk factors, long-term observational studies of health outcomes, and clinical trials of health outcomes. The different study designs have complementary strengths and weaknesses, and their similar conclusions from different approaches provide increasingly robust evidence. [15] [16] [17] [18] [19] [20]

For our analysis, we followed several steps to ensure that our selection or diet factors reflects the current evidence on healthy eating. First, we focused on evidence from meta-analyses that have pooled all available studies linking diets to health outcomes, to minimise bias from any one study. Second, we only used diet–disease associations whose strength of evidence in meta-analyses was graded as moderate or high, or as probable and convincing. Third, we did not include diet–disease associations, e.g. for dairy products [21] [22] and fish, [23] [24] [25] [26] which became statistically non-significant when adjusted for potential confounding factors, such as co-consumption with other foods. Fourth, we focused on foods and not nutrients, to reduce the risk of double-counting as foods often include several nutrients. Further details are provided in the forthcoming methodology (see the section called Data for comparative risk assessment). We focused on foods with impacts on coronary heart disease, stroke, diabetes, cancers and respiratory disease.

When it comes to the environmental impacts of foods, it is generally recognised that animal-based foods have greater environmental impacts than plant-based foods. [27] [28] [29] For example, for greenhouse gas emissions, beef and lamb have about ten times the emissions per serving as pork, poultry and dairy products, and those have about ten times the emissions of plant-based foods, including grains, fruits and vegetables, and legumes. Similarly for water, the average fresh-water footprint per tonne of animal-based product is greater than that of plant-based products, with the exception of milk, which has a relatively low water footprint, and nuts, which have a relatively high water footprint when measured on a per-tonne basis, but not on a per-calorie or per-protein basis. [30]

Much of the evidence linking environmental impacts to foods comes from life-cycle analyses that record the various impacts across all stages of the food chain, including production, transport, processing and consumption. The strength of life-cycle analysis is that both direct and indirect impacts are accounted for, something that explains the differentiated impacts of foods. Animal-based foods tend to have greater footprints of greenhouse gas emissions than plant-based foods because, in addition to direct emissions from manure and, for ruminant animals, their digestion, animals also generate indirect emissions from their feed whose production generates emissions and requires large amounts of environmental resources, including land, water and fertilisers.

For our analysis, we used the most recent and comprehensive set of life-cycle assessments to estimate the environmental impacts of diets (see the section called Environmental analysis in the forthcoming methodology). We included in our assessment the impacts of foods on greenhouse gas emissions, cropland use, fresh-water use and nitrogen and phosphorus application related to fertilisers. Dietary changes towards more plant-based diets have been identified as the most efficient way of reducing the greenhouse gas emissions of the food system. [31] Several technological and management options exist for reducing other environmental impacts. However, when it comes to greenhouse gas emissions, those are relatively ineffective because most emissions are associated with the characteristics of animals, such as feed requirements and digestion-related gases, that cannot be altered substantially. This makes dietary changes towards less-impact foods one of the most important climate-change measures. [32] Therefore, we focus here on the greenhouse gas emissions associated with food demand, but also highlight other impacts.

The global and regional state of dietary intakes

The last decade, based on data for 2010 and 2018, has seen little progress in improving diets (Figure 2.1). Based on analyses of the latest data on average per-person dietary intakes from the Global Dietary Database, [33] intakes of whole grains, and of fruit and vegetables, both critical components of healthy diets, have increased by a mere 2% globally, fish intake remained unchanged, while legume consumption has decreased on average (−4%) and the consumption of sugary drinks has increased (+4%). Among the health-promoting foods, only nut/seed intake showed more substantial increases (+17%), albeit from a very low baseline. Global dairy intake (measured in milk equivalent in grams per day, g/d) has decreased (−7%), but the intake of other foods associated with high environmental and health impacts, in particular red meat and processed meat, has increased (+2–3%). In addition, overeating and, associated with that, the proportion of overweight and obesity, have increased almost five times more (+0.70%) than levels of underweight have decreased (−0.15%). [34]

Both positive and negative dietary changes were often confined to high- and upper-middle-income countries, with least progress in low-income countries (Figure 2.1). For example, the average fruit and vegetable intake per person increased in Latin America and the Caribbean (+8%), Europe (+5%), Asia (+4%); it stayed unchanged in Northern America; and it decreased in Africa (−4%) and Oceania (−13%). Likewise, red and processed meat intake increased in Oceania (+59%), Latin America and the Caribbean (+7%), Asia (+6%) and Europe (+4%); it changed little in Northern America (+1%); and it decreased in Africa (−10%). Overweight and obesity increased in every region, with up to 3% in Asia, while underweight decreased least in Africa (−0.2%).

Figure 2.1 The last decade has seen little progress in improving diets

Food intake by food group, year and region (grams per person per day), 2010 and 2018

Source: Authors, based on new analysis based on the Global Dietary Database. [35]

Notes: Dairy is reported in milk equivalents. The selection of food groups is based on their health and environmental impacts. Our analysis includes diet–disease association for low intake of fruits, vegetables, legumes, nuts/seeds and whole grains; and for high intake of red meat, processed meat and sugary drinks. All food groups have environmental impacts, with particularly high impacts for animal source foods.

• Download data: Figure 2.1

Current dietary patterns are neither healthy, nor sustainable. Compared to recommendations for healthy and sustainable diets developed by the EAT-Lancet Commission on Healthy Diets from Sustainable Food Systems (Box 2.1), the intake of health-promoting foods in 2018 remains too low and that of foods with high health and environmental impacts remains too high (Figure 2.2). Global vegetable intake is 40% below the recommended three servings per day, fruit intake 60% below the recommended two servings per day and legume and nuts intake 68–74% below the one to two recommended servings. Red and processed meat intake is almost five times above recommendations. Only milk and fish intakes are within recommended ranges. In addition, about half of the global population (48%) eats too many or too few calories and exhibits imbalanced weight levels, including overweight (26%), obesity (13%) and underweight (9%).

Box 2.1: Recommendations for healthy diets from sustainable food systems

Marco Springmann

The EAT-Lancet Commission on Healthy Diets from Sustainable Food Systems was a scientific commission on how to achieve a sustainable food system that can deliver healthy diets for a growing population. Convened between 2017 and 2019, it consisted of 19 commissioners and 18 co-authors from 16 countries and various fields, including human health, agriculture, political science and environmental sustainability. Its report was published in the medical science journal The Lancet in 2019. [36]

The Commission’s work included the development of: new recommendations for healthy diets based on a comprehensive review of the literature on healthy eating; science-based targets for sustainable food production that included the definition of planetary boundaries of the food system; analyses of the health, nutritional and environmental impacts of dietary and food-system changes that would be needed to stay within planetary boundaries; and strategies for a ‘great food transformation’ towards healthy diets from sustainable food systems by 2050.

In this chapter, we use the EAT-Lancet Commission’s dietary recommendations and the science-based targets for sustainable food production to compare current dietary patterns with the current scientific understanding of healthy eating and sustainable diets. The EAT-Lancet recommendations provide ranges of intake for all major food groups that allow for the adoption of various dietary patterns and culinary traditions, and their impacts on health and the environment have been widely assessed, both within the Commission and independently.

Dietary patterns in line with the recommendations have been found to be associated with improvements in diet-related disease mortality, nutritional adequacy and environmental sustainability, [37] [38] [39] [40] exceeding existing national food-based dietary guidelines and those of the World Health Organization on each dimension. [41] Although many healthy and dietary patterns are currently more affordable than typical Western diets in high- and middle-income countries, their adoption can be challenging in low-income contexts where diets are dominated by low-cost roots and grains and lack the diverse set of more expensive healthy foods. [42] [43] This stresses the need for food-system strategies that would make healthy and sustainable diets affordable for all, including full costing approaches, income support and socioeconomic development.

Despite variation, no region met the recommendations for healthy and sustainable diets. Lower-income countries continue to have the lowest intake levels of health-promoting foods and the highest levels of underweight, while higher-income countries have the highest intake levels of foods with high environmental and health impacts, and the highest levels of overweight and obesity (Figure 2.2). For example, fruit and vegetable consumption in 2018 was 59% below recommended intake in Africa, but also 41% and 56% below recommendations in Europe and Northern America, respectively. Red and processed meat intake was eight to nine times too high in Europe, Oceania and Latin America, but it was also double the recommended value in Africa and four times above the target in Asia.

Figure 2.2 Dietary patterns do not meet recommendations for healthy and sustainable diets

Percentage deviation by year and region from recommendations of the EAT-Lancet Commission on Healthy Diets from Sustainable Food Systems

Source: New analysis using the Global Dietary Database and recommendations of the EAT-Lancet Commission.

Notes: Includes minimum recommended intake of health-promoting foods (fruits, vegetables, legumes, nuts, whole grains), maximum recommended intake of foods with detrimental health and/or environmental impacts (red meat, processed meat, dairy, fish), and from normal weight levels (underweight, overweight, obesity). Colours indicate that intake is either in line with recommendations (ranging from green to yellow with decreasing compliance) or deviate from recommendations (ranging from yellow to red with increasing deviation).

• Download data: Figure 2.2

The health burden of diets

The current level of dietary imbalance can have serious implications for human and planetary health. For this report, we produced new estimates of the health burden of poor diets by using a global comparative assessment of dietary risks with country-level detail (see the sections called Comparative risk assessment and Data for comparative risk assessment in the forthcoming methodology). The assessment combines estimates of food intake with cause-specific mortality rates via a comprehensive set of diet–disease relationships, each accounting for physiological (age, sex) and geographic (country-level) variation. [44] In this framework, we accounted for risks for diet-related, non-communicable diseases (NCDs) associated with imbalanced diets, such as those low in fruits and vegetables, as well as for risk associated with imbalanced energy intake related to underweight, overweight and obesity. Because risks for NCDs primarily affect adults, we focused on risks to those aged 20 and above. In this chapter, we report the mean values of our estimates for ease of presentation. The low and high values of 95% confidence intervals are provided in the forthcoming dataset that will be online.

According to our estimates, today’s diets are associated with a large and increasing health burden (Figure 2.3). Overall, poor diets were responsible for more than 12 million avoidable deaths in 2018, which represents 26% of all deaths among adults. Compared to 2010, the number of avoidable deaths due to diet grew by 15%, more rapidly than the population (10%). Almost half of the avoidable deaths were from coronary heart disease (5.9 million, 47%), about a fifth each from cancers (2.8 million, 22%) and stroke (2.4 million, 19%) and around 5% each from type-2 diabetes (690,000) and respiratory diseases (760,000). Our estimate of attributable deaths is comparable to the combination of diet- and weight-related risk estimates of the Global Burden of Disease project (7.8 and 4.8 million attributable deaths, respectively).

About two-thirds of the avoidable deaths in our analysis (9.3 million, 65%) were due to risks related to dietary composition, including low intake of fruits (2.8 million, 25% of the avoidable composition-related risks), whole grains (2.3 million, 20%), vegetables (1.7 million, 14%), legumes (1.5 million, 13%), nuts and seeds (1.0 million, 9%), and high intake of red meat (980,000, 9%), processed meat (880,000, 8%) and sugar-sweetened beverages (290,000, 3%). The remaining third (5.0 million, 35%) of the avoidable deaths were due to risks related to total energy intake and body weight, including obesity (2.7 million, 54% of the avoidable weight-related deaths), overweight (1.2 million, 24%) and underweight (1.1 million, 22%).

Figure 2.3 The dietary health burden is increasing

Deaths attributable to dietary risk factors by cause of death for risks related to dietary composition and weight levels, 2010 and 2018

Source: New analysis based on estimates of food intake from the Global Dietary Database, [45] weight measurements from the NCD Risk Factor Collaboration, [46] diet-disease relationships from the epidemiological literature, [47] [48] [49] [50] [51] [52] and mortality and population estimates from the Global Burden of Disease project. [53]

Note: The combined risk is less than the sum of individual risks because individuals can be exposed to multiple risks, but mortality is ascribed to one risk and cause.

• Download data: Figure 2.3

The proportion of premature death attributed to dietary risks differs markedly by region, reflecting regional differences in diets as well as the contribution of NCDs (Figure 2.4). It is highest in higher-income regions, including Northern America (31%) and Europe (31%), and lowest in lower-income regions such as Africa (17%). Among the dietary risks evaluated, the leading causes of dietary ill health were similar in each region and included low intake of fruits and vegetables (5–8% of premature mortality across regions), whole grains (2–5%), and high intake of red and processed meat (1–6%), as well as high levels of overweight and obesity (5–13%).

No region was in line with the health-related sustainable development goal (SDG) of reducing premature mortality from NCDs by a third between 2015 and 2030 (SDG 3.4). Among the regions, there was either very little progress, with a 3% reduction in Northern America in premature mortality from dietary risks, or trends towards higher premature mortality from dietary risks in the remaining regions, with particularly large increases in Africa (+22%), Latin America and the Caribbean (+8%) and Asia (+7%), followed by Oceania (+4%) and Europe (+2%).

Figure 2.4 The rise in premature death from dietary risks is not in line with global health goals

Percentage of premature death attributable to dietary risks by region, 2010 and 2018

Source: New analysis based on estimates of food intake from the Global Dietary Database, weight measurements from the NCD Risk Factor Collaboration, diet-disease relationships from the epidemiological literature, and mortality and population estimates from the Global Burden of Disease project.

• Download data: Figure 2.4

The environmental burden of diets

Our dietary habits and the current level and mix of foods we demand are also associated with substantial and increasing levels of environmental pollution and resource use (Figure 2.5). For this new analysis, we paired data on food demand for each country from the Food and Agriculture Organization of the United Nations with a comprehensive database of environmental footprints, differentiated by country, food group and environmental impact (see the section called Environmental analysis in the forthcoming methodology). [54] The footprints take into account all food production, including inputs such as fertilisers and feed, transport and processing e.g. of oil seeds to oils and sugar crops to sugar.

According to our estimates, the global food demand, including food loss and waste, generated 17.2 billion tonnes of greenhouse gas emissions (measured in carbon dioxide equivalents, GtCO2eq) in 2018, which represents more than a third (35%) of global emissions. Methane and nitrous oxide, two greenhouse gases primarily associated with agriculture, contributed 7.5GtCO2eq. The food system also required 15.8 million square kilometres (Mkm2) of cropland and 43.9Mkm2 of pastureland, 2,500 cubic kilometres (km3) of fresh water, 108.7 million tonnes (Mt) of nitrogen and 18.6Mt phosphorus. Compared to 2010, the environmental impacts of food demand increased by up to 14%. Our estimates are in line with other available estimates.

Animal-source foods have generally higher environmental footprints per product than plant-based foods. Consequently, they were responsible for the majority of food-related greenhouse gas emissions (80% of methane and nitrous oxide emissions and 56% of all food-related greenhouse emissions) and land use (85%), with particularly large impacts from beef, lamb and dairy. Through feed demand, animal-source foods were also responsible for about a quarter each of nitrogen and phosphorus application and a tenth of fresh-water use. Among plant-based foods, grain production (including rice) required almost half (43–52%) of the food-related fresh water, nitrogen and phosphorus, not because of its high footprint, but because of the large absolute quantity of production.

Figure 2.5 Environmental impacts of the food system are increasing

Food-related environmental impacts by environmental domain and food group, 2010 and 2018

Source: New analysis based on estimates of food demand from the Food and Agriculture Organization of the United Nations [55] and a database of country and food-group-specific environmental footprints.

Note: Values for environmental impact for 2018 are expressed as a ratio to the impacts for 2010.

• Download data: Figure 2.5

The environmental impacts of the global food system are not in line with global environmental targets (Figure 2.6) as specified by the EAT-Lancet Commission on Healthy Diets from Sustainable Food Systems (Box 2.1). In 2018, food-related greenhouse gas emissions exceeded by three-quarters (74%) the limit required by the Paris Climate Agreement (target 13 of the sustainable development goals, SDGs) to limit global warming to below 2°C. Cropland use was 60% above the value that would be in line with limiting the loss of natural habitat (Aichi Biodiversity Targets and SDG 15). Freshwater use exceeded rates of sustainable withdrawals by more than 52% (SDG 6.4). Nitrogen application was more than double (113%) and phosphorus application two-thirds (67%) above values that would limit marine pollution to acceptable levels (SDG 14.1).

No region is on track to fulfil the set of sustainable development goals related to the environmental impacts of the food system (Figure 2.6). This can best be illustrated by a global sustainability test in which the dietary pattern and food demand of a particular region or country is adopted globally (see the section called Global health and environmental targets in the forthcoming methodology). If the globalised impacts exceed the targets for sustainable food production that would be in line with the SDGs, then the dietary pattern of that particular region or country can be considered unsustainable in light of global environmental targets and disproportionate in the context of an equitable distribution of environmental resources and mitigation efforts. For example, if globally adopted, the dietary patterns of Northern America would result in a level of greenhouse gas emissions more than six times above a value in line with limiting global warming to below 2°C. The corresponding emission levels are more than five times above the target value in Oceania, four times the target value in Latin America and Europe, and 60–75% above sustainable levels in Africa and Asia.

Figure 2.6 No region is on track to meet global environmental targets related to the food system

Global sustainability test comparing global impacts with global environmental targets

Source: New analysis based on estimates of food demand from the Food and Agriculture Organization of the United Nations [56] and a database of country and food group-specific environmental footprints. The target values for sustainable food production that would be in line with Sustainable Development Goals were specified by and adapted from the EAT-Lancet Commission.

Note: In this test, regional diets in 2010 and 2018 are universally adopted and compared to global environmental targets.

• Download data: Figure 2.6

The past decade has seen little progress in improving diets, especially in low-income countries. Diets everywhere continue to lack enough fruits, vegetables, legumes, nuts and whole grains, and include too much – and, in some regions, rising amounts – of red and processed meat and sugary drinks. As a result, premature mortality related to dietary risks is substantial and increasing. Our analysis based on 11 diet and weight-related risk factors suggests that a quarter of all deaths among adults are associated with poor diets. The diet-related contribution to mortality is largest in higher-income countries, but the leading causes of dietary ill health are similar and increasing in every region.

The environmental impacts related to dietary choices are similarly daunting. According to our analysis, the foods currently demanded generate more than a third of all greenhouse gas emissions and use substantial and rising amounts environmental resources, such as cropland, fresh water and nitrogen- and phosphorus-containing fertilisers. Neither the global food system nor the various regional dietary patterns are on track to meet targets for sustainable food production and the set of diet-related health and environmental targets agreed by the international community of nations as part of the Sustainable Development Goals.

Part of the reason for the poor health and environmental performance of the food system might be a mismatch between current policy initiatives and the dietary and food-system changes that would be most beneficial for increasing the food system’s healthiness and sustainability. For example, recent years have seen many initiatives aimed at discouraging the consumption of sugary drinks by increasing their prices. [57] [58] Our analysis suggests that the health burden attributable to red and processed meat is more than six times as large as that associated with sugary drinks. Extending policy initiatives to these foods therefore warrants serious consideration from a public health perspective.

There are similar mismatches when it comes to the environmental impacts of our diets. Our analysis and past assessments indicate that most impacts occur at the production stage, with largest differences between food types, especially between animal- and plant-based foods, irrespective of the type of production system. [59] [60] Initiatives to improve production methods, reduce food loss and waste, and improve supply chains can be important measures for reducing environmental resource use. However, for reducing greenhouse gas emissions enough to avoid dangerous levels of global warming, it will be necessary to increase and strengthen policy initiatives aimed at reducing the amounts of animal-based foods in our diets and in food production.

Key recommendations

With little progress in improving diets throughout the last decade, there is an urgent need in every region to address dietary risk factors and reduce diet-related deaths from non-communicable diseases.

To improve population health, policy measures are needed to support increased intake of health-promoting foods such as fruits and vegetables, whole grains, legumes and nuts/seeds, and reduce the intake of unhealthy foods such as red and processed meat and sugary beverages.

As the environmental impacts of current dietary patterns are increasing, there is an urgent need in every region for large-scale dietary changes towards healthy and sustainable diets to preserve planetary health.

To improve planetary health, policy measures are required to transform the food system towards healthy and sustainable food production by prioritising adoption of healthy and sustainable diets and disincentivising the production and consumption of high-impact foods such as meat and dairy.

To transition towards healthy and sustainable diets and make meaningful progress, policy priorities need to align the dietary and food system changes most beneficial for health and the sustainability of the food system.

To reduce greenhouse gas emissions enough to avoid dangerous levels of global warming, it will be necessary to prioritise policy initiatives aimed at reducing the amounts of animal-based foods in our diets, something also warranted on health grounds.

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Rosenzweig C, Mbow C, Barioni LG, et al. Climate change responses benefit from a global food system approach. Nat Food 2020; 1: 94–7.

Miller V, Singh GM, Onopa J, et al. Global Dietary Database 2017: data availability and gaps on 54 major foods, beverages and nutrients among 5.6 million children and adults from 1220 surveys worldwide. BMJ Glob Health 2021; 6: e003585.

NCD Risk Factor Collaboration (NCD-RisC). Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants. Lancet 2016; 387: 1377–96.

Springmann M, Spajic L, Clark MA, et al. The healthiness and sustainability of national and global food based dietary guidelines: modelling study. BMJ 2020; 370: 2322.

Springmann M, Clark M, Rayner M, Scarborough P and Webb P. The global and regional costs of healthy and sustainable dietary patterns: a modelling study. Lancet 2021; 5: 797-807. (doi:10.1016/S2542-5196(21)00251-5).

Springmann M. Valuation of the health and climate-change benefits of healthy diets: Background paper for The State of Food Security and Nutrition in the World 2020. Rome, Italy: FAO, 2020 (doi:10.4060/cb1699en).

Roth GA, Abate D, et al. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392: 1736–88.

Aune D, Keum N, Giovannucci E, et al. Nut consumption and risk of cardiovascular disease, total cancer, all-cause and cause-specific mortality: a systematic review and dose-response meta-analysis of prospective studies. BMC Med 2016; 14: 207.

Aune D, Giovannucci E, Boffetta P, et al. Fruit and vegetable intake and the risk of cardiovascular disease, total cancer and all-cause mortality: a systematic review and dose-response meta-analysis of prospective studies. Int J Epidemiol 2016; published online 18 March.

Di Angelantonio E, Bhupathiraju S, et al. Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents. Lancet 2016; 388: 776–86.

Aune D, Keum N, Giovannucci E, et al. Whole grain consumption and risk of cardiovascular disease, cancer, and all cause and cause specific mortality: systematic review and dose-response meta-analysis of prospective studies. BMJ 2016; 353: i2716.

Imamura F, O’Connor L, Ye Z, et al. Consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice and incidence of type 2 diabetes: systematic review, meta-analysis, and estimation of population attributable fraction. BMJ 2015; 351: h3576.

Xi B, Huang Y, Reilly KH, et al. Sugar-sweetened beverages and risk of hypertension and CVD: a dose-response meta-analysis. Br J Nutr 2015; 113: 709–17.

Food and Agriculture Organization of the United Nations. Food Balance Sheets: A Handbook. Rome, Italy: FAO, 2001.

Allcott H, Lockwood BB, Taubinsky D. Should we tax sugar-sweetened beverages? An overview of theory and evidence. J Econ Perspect 2019; 33: 202–27.

Afshin A, Penalvo JL, Del Gobbo L, et al. The prospective impact of food pricing on improving dietary consumption: a systematic review and meta-analysis. PLoS One 2017; 12 (e0172277 %U https://www.ncbi.nlm.nih.gov/pubmed/28249003 ).

The link between food and mental health

New research connects nutrition and mental illness, though more rigorous research is needed

By Rebecca A. Clay

September 2017, Vol 48, No. 8

Print version: page 26

• Mental Health
• Psychotherapy

Can nutrition affect your mental health? A growing research literature suggests the answer could be yes.

Western-style dietary habits, in particular, come under special scrutiny in much of this research. A meta-analysis including studies from 10 countries, conducted by researchers at Linyi People's Hospital in Shandong, China, suggests that dietary patterns may contribute to depression ( Psychiatry Research , Vol. 253, 2017), for example. Dietary patterns are also related to hippocampal volume in older adults, according to a study led by Felice Jacka, PhD, director of the Food and Mood Centre at Deakin University in Australia ( BMC Medicine , Vol. 13, No. 215, 2015).

And in a new study of 120 children and adolescents, consuming fast food, sugar and soft drinks was associated with a higher prevalence of diagnosed attention-deficit/hyperactivity disorder (ADHD) ( Pediatrics , Vol. 139, No. 2, 2017). Led by Maria Izquierdo-Pulido, PharmD, PhD, of the University of Barcelona's department of nutrition, food science and gastronomy, the study also found that children who ate fewer vegetables, fruit, fatty fish and other foods associated with the Mediterranean diet were more likely to have ADHD symptoms, even after accounting for potential confounders. While these associations don't prove causality, the authors note, they suggest that diet could play a role in ADHD's development through as yet unknown mechanisms.

And small dietary changes can make a big difference. In another study led by Jacka, 67 depressed adults were randomly assigned to seven individual nutritional consulting sessions with a dietician or seven social support sessions over 12 weeks. The dietician helped participants make adjustments to their diets, such as eating less junk food and more ­nutrient-rich foods such as produce, fish and legumes. While just 8 percent of the control group achieved remission, almost a third of the dietary intervention group did ( BMC Medicine , Vol. 15, No. 23, 2017).

Such studies are part of the growing evidence base within nutritional psychology, the study of the role that nutrition—whether dietary patterns, broad-based multinutrient supplements or specific vitamins, minerals or other nutrients—plays in the etiology of mental health problems as well as their treatment. Although much of the research is still limited to single-case studies and observational studies—with researchers themselves calling for more rigorous, more expansive research designs and larger, more diverse research samples—it offers tantalizing hints at the potential for new prevention strategies and treatments for people with a wide range of psychological problems.

A growing body of research

In the 1990s, when experimental psychologist Bonnie J. Kaplan, PhD, first heard people claiming they could treat ADHD with a multinutrient compound, she was dismissive. Then she saw preliminary data showing improvements in children with ADHD who had received the supplement. She changed her mind and her research focus, becoming a pioneer in the emerging field of nutritional psychology.

One of the broad-based formulas that Kaplan—now a professor emerita at the University of Calgary's Cumming School of Medicine—and many others study was originally developed by a father seeking to cure his family's mental health problems without the side effects of psychotropic medications. A mix of vitamins, minerals and amino acids, the supplement aims to address deficiencies in the nutrients required for optimal brain functioning.

The family's story and that early research convinced Kaplan to open her mind and subject the compound to scientific inquiry. Since then, in several small studies, she has found promising evidence for its use in such diverse areas as improving emotional control after a traumatic brain injury ( Annals of Psychiatry and Mental Health , Vol. 4, No. 5, 2016), treating emotional and behavioral problems in children ( Journal of Medical Case Reports , Vol. 9, No. 240, 2015) and minimizing distress after a natural disaster ( Psychiatry Research , Vol. 228, No. 3, 2015).

According to Kaplan, one overall finding in studies on the impact of broad-spectrum micronutrients is that people improve their functioning across the board, not just in target areas such as ADHD symptoms.

In one randomized controlled trial, for instance, Julia J. Rucklidge, PhD, a professor of clinical psychology at the University of Canterbury in New Zealand, and colleagues assigned 80 adults with ADHD to receive either a broad-based micronutrient formula or a placebo.

After eight weeks, participants in the intervention group and their spouses rated their ADHD symptoms as having decreased more than the placebo group, although ­clinicians saw no significant group difference in ADHD symptoms ( British Journal of Psychiatry , Vol. 204, No. 4, 2014).

However, on ratings of global functioning, the clinicians indicated that about half of the intervention group had improved, as compared with only a quarter of the placebo group. And those in the intervention arm who were moderately or severely depressed at baseline had a bigger change in mood than those in the placebo arm. "As disappointing as it is not to get significant group differences across the board on all the ADHD measures, what's relevant at the end of the day is that your impairment is reduced and you're functioning better," says Rucklidge.

A look at omega-3

Other psychologists are exploring the role of omega-3 fatty acids. Thanks to its anti-inflammatory properties and effects on dopamine and serotonin transmission, omega-3 has a role in brain development and functioning, with deficiencies linked to mental health problems, says Mary A. Fristad, PhD, of the Ohio State University Wexner Medical Center.

Fristad is studying the use of omega-3 in conjunction with an evidence-based intervention she developed, called psychoeducational psychotherapy. In a pilot randomized controlled trial funded by the National Institute of Mental Health, Fristad and colleagues assigned 72 depressed 7- to 14-year-olds to receive 12 weeks of omega-3 alone, omega-3 plus psychotherapy, psychotherapy plus placebo or just a placebo.

Seventy-seven percent of those who received psychotherapy and omega-3 achieved remission, compared with 56 percent of those who received a placebo. While children in all four groups showed improvement during the study, children whose mothers had histories of depression and children who had become depressed with fewer social stressors fared better with any of the active treatments than with the placebo ( Journal of Clinical Child & Adolescent ­Psychology , Online, 2016).

"What we demonstrated was that children with what appears to be endogenous, versus situational, depression required an active treatment," says ­Fristad. "Psychotherapy worked; omega-3 worked; their combination worked the best."

In another NIMH-funded examination of the same sample, Fristad and colleagues looked at the intervention's effect on ­co-occurring behavioral problems. The children who received omega-3, whether on its own or in conjunction with psychotherapy, saw significant improvements in hyperactivity and impulsivity compared with those who received placebos on their own or with psychotherapy, as well as smaller improvements in inattention, disruptive behavior and overall behavior problems ( Journal of Abnormal Child Psychology , Vol. 45, No. 5, 2016).

Now, Fristad hopes to continue the research with larger sample sizes. "We really need more science wrapped around this," she says. 

To watch a TEDx talk on the role of nutrition and mental health given by clinical psychologist Julia Rucklidge, PhD, go to YouTube and search for "Julia Rucklidge."

For more information

• Center for Nutritional Psychology. The center offers an online certificate program in nutritional psychology through John F. Kennedy University. www.nutritional-psychology.org
• International Society for Nutritional Psychiatry Research. The society aims to expand the field of nutritional psychiatry and share knowledge; its first major international meeting took place July 30–Aug. 2 in Bethesda, Maryland; see www.isnpr2017.org/program for details.
• Clinical Psychological Science Special Section on Nutrition and Mental Health. This special issue showcases research that explores nutrition's impact on such conditions as obsessive-compulsive disorder, insomnia and depression. http://journals.sagepub.com/toc/cpxa/4/6
• Food & Mood Centre. Led by Australia's Deakin University, this multidisciplinary team focuses on nutritional psychiatry research. www.foodandmoodcentre.com.au

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How Unhealthy Foods Affect the Body

Eating unhealthy foods on a regular basis may contribute to health problems. Studies continue to show the negative effects of many common unhealthy food products. For optimal health and wellness, eat a balanced diet with plenty of fruits, vegetables and whole grains -- and save the empty calories for occasional treats.

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In addition to other causes such as inactivity and medical problems, obesity is also related to an unhealthy diet. Because you must burn more calories than you consume, a high-calorie diet combined with physical inactivity will most likely result in excessive weight gain. Foods that contain large amounts of trans fats, saturated fat and sugar all contribute to increased chances of obesity. For maximum health benefit, always eat breakfast and avoid skipping meals throughout the day to help regulate your metabolism and avoid unhealthy snacking.

Heart Health

The quality of your diet has a significant impact on your cardiovascular health. Salt and fatty foods can be particularly detrimental when consumed in excessive quantities on a regular basis. For maximum heart health, Medline Plus recommends limiting salt intake to 2,400 mg each day. Other unhealthy foods to avoid include soda, butter, high-fat meats, organ meats and fried foods. Use skinless poultry whenever possible. Avoid eating more than three to four egg yolks per week, and always choose low or non-fat dairy products.

Disease Prevention

Eating unhealthy foods also contributes to increased susceptibility to illness and chronic disease. Not only does a healthy diet help prevent heart disease, but it may also aid in the prevention of type 2 diabetes, osteoporosis and even cancer. An unhealthy diet may also cause nutrient deficiencies, which are particularly common in those who do not meet daily calorie requirements. According to the World Health Organization the most threatening nutrient deficiencies are iron deficiency anemia, vitamin A deficiency and iodine deficiency disorders.

Mental Health

As noted by HelpGuide.org, diet plays a crucial role in mental health. Eating too much junk food may aggravate symptoms of mental illnesses such as depression and anxiety. Sugary foods and refined carbohydrates are particularly harmful, since they result in a rapid increase in blood sugar. Potatoes, brown rice, oatmeal and other complex carbohydrates are wiser choices. According to MayoClinic.com, unhealthy food choices and diet habits may also increase your chances of developing mental diseases like Alzheimer's later in life.

• World Health Organization: Diet
• Medline Plus: Heart Disease and Diet
• World Health Organization: Micronutrients
• HelpGuide.org: Dealing with Depression: Self-Help and Coping Tips

Home — Essay Samples — Nursing & Health — Junk Food — The Impact of an Unhealthy Diet on Our Health

The Impact of an Unhealthy Diet on Our Health

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Published: Nov 8, 2019

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Cause And Effect Essay Guide

Cause And Effect Essay Examples

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How To Write A Cause and Effect Essay - Outline & Examples

230+ Cause and Effect Essay Topics to Boost Your Academic Writing

How to Create a Cause and Effect Outline - An Easy Guide

You need to write a cause and effect essay for your assignment. Well, where should you start?

Establishing a relationship between causes and effects is no simple task. You need to ensure logical connections between variables with credible evidence.

However, don't get overwhelmed by the sound of it. You can start by reading some great cause and effect essay examples. 

In this blog, you can read cause and effect essays to get inspiration and learn how to write them. With these resources, you'll be able to start writing an awesome cause and effect paper.

Let’s dive in!

• 1. What is a Cause and Effect Essay?
• 2. Cause and Effect Essay Examples for Students
• 3. Free Cause and Effect Essay Samples
• 4. Cause and Effect Essay Topics
• 5. Tips For Writing a Good Cause and Effect Essay

What is a Cause and Effect Essay?

A cause and effect essay explores why things happen (causes) and what happens as a result (effects). This type of essay aims to uncover the connections between events, actions, or phenomena. It helps readers understand the reasons behind certain outcomes.

In a cause and effect essay, you typically:

• Identify the Cause: Explain the event or action that initiates a chain of events. This is the "cause."
• Discuss the Effect: Describe the consequences or outcomes resulting from the cause.
• Analyze the Relationship: Clarify how the cause leads to the effect, showing the cause-and-effect link.

Cause and effect essays are common in various academic disciplines. For instance, studies in sciences, history, and the social sciences rely on essential cause and effect questions. For instance, "what are the effects of climate change?", or "what are the causes of poverty?"

Now that you know what a cause and effect is, let’s read some examples.

Cause and Effect Essay Examples for Students

Here is an example of a well-written cause and effect essay on social media. Let’s analyze it in parts to learn why it is good and how you can write an effective essay yourself. 

The essay begins with a compelling hook that grabs the reader's attention. It presents a brief overview of the topic clearly and concisely. The introduction covers the issue and ends with a strong thesis statement , stating the essay's main argument – that excessive use of social media can negatively impact mental health.

The first body paragraph sets the stage by discussing the first cause - excessive social media use. It provides data and statistics to support the claim, which makes the argument more compelling. The analysis highlights the addictive nature of social media and its impact on users. This clear and evidence-based explanation prepares the reader for the cause-and-effect relationship to be discussed.

The second body paragraph effectively explores the effect of excessive social media use, which is increased anxiety and depression. It provides a clear cause-and-effect relationship, with studies backing the claims. The paragraph is well-structured and uses relatable examples, making the argument more persuasive. 

The third body paragraph effectively introduces the second cause, which is social comparison and FOMO. It explains the concept clearly and provides relatable examples. It points out the relevance of this cause in the context of social media's impact on mental health, preparing the reader for the subsequent effect to be discussed.

The fourth body paragraph effectively explores the second effect of social comparison and FOMO, which is isolation and decreased self-esteem. It provides real-world consequences and uses relatable examples. 

The conclusion effectively summarizes the key points discussed in the essay. It restates the thesis statement and offers practical solutions, demonstrating a well-rounded understanding of the topic. The analysis emphasizes the significance of the conclusion in leaving the reader with a call to action or reflection on the essay's central theme.

This essay follows this clear cause and effect essay structure to convey the message effectively:

Read our cause and effect essay outline blog to learn more about how to structure your cause and effect essay effectively.

Free Cause and Effect Essay Samples

The analysis of the essay above is a good start to understanding how the paragraphs in a cause and effect essay are structured. You can read and analyze more examples below to improve your understanding.

Cause and Effect Essay Elementary School

Cause and Effect Essay For College Students

Short Cause and Effect Essay Sample

Cause and Effect Essay Example for High School

Cause And Effect Essay IELTS

Bullying Cause and Effect Essay Example

Cause and Effect Essay Smoking

Cause and Effect Essay Topics

Wondering which topic to write your essay on? Here is a list of cause and effect essay topic ideas to help you out.

• The Effects of Social Media on Real Social Networks
• The Causes And Effects of Cyberbullying
• The Causes And Effects of Global Warming
• The Causes And Effects of WW2
• The Causes And Effects of Racism
• The Causes And Effects of Homelessness
• The Causes and Effects of Parental Divorce on Children.
• The Causes and Effects of Drug Addiction
• The Impact of Technology on Education
• The Causes and Consequences of Income Inequality

Need more topics? Check out our list of 150+ cause and effect essay topics to get more interesting ideas.

Tips For Writing a Good Cause and Effect Essay

Reading and following the examples above can help you write a good essay. However, you can make your essay even better by following these tips.

• Choose a Clear and Manageable Topic: Select a topic that you can explore thoroughly within the essay's word limit. A narrowly defined topic will make it easier to establish cause-and-effect relationships.
• Research and Gather Evidence: Gather relevant data, statistics, examples, and expert opinions to support your arguments. Strong evidence enhances the credibility of your essay.
• Outline Your Essay: Create a structured outline that outlines the introduction, body paragraphs, and conclusion. This will provide a clear roadmap for your essay and help you present causes and effects clearly and coherently.
• Transitional Phrases: Use transitional words and phrases like "because," "due to," "as a result," "consequently," and "therefore" to connect causes and effects within your sentences and paragraphs.
• Support Each Point: Dedicate a separate paragraph to each cause and effect. Provide in-depth explanations, examples, and evidence for each point.
• Proofread and Edit: After completing the initial draft, carefully proofread your essay for grammar, punctuation, and spelling errors. Additionally, review the content for clarity, coherence, and flow.
• Peer Review: Seek feedback from a peer or someone familiar with the topic to gain an outside perspective. They can help identify any areas that need improvement.
• Stay Focused: Avoid going off-topic or including irrelevant information. Stick to the causes and effects you've outlined in your thesis statement.
• Revise as Needed: Don't hesitate to make revisions and improvements as needed. The process of revising and refining your essay is essential for producing a high-quality final product. 

To Sum Up , 

Cause and effect essays are important for comprehending the intricate relationships that shape our world. With the help of the examples and tips above, you can confidently get started on your essay. 

If you still need further help, you can hire a professional writer to help you out. At MyPerfectWords.com , we’ve got experienced and qualified essay writers who can help you write an excellent essay on any topic and for all academic levels.

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Unhealthy diets and malnutrition

Home / why ncds / risk factors & prevention / unhealthy diets and malnutrition.

• Unhealthy diets and the resulting malnutrition are major drivers of noncommunicable diseases (NCDs) around the world.
• Malnutrition includes undernutrition, overweight and obesity, and other diet-related NCDs like type 2 diabetes , cardiovascular disease (heart diseases) and stroke, and some cancers .
• What people eat has changed dramatically over the last few decades. This has been driven by shifts towards calorific and fatty foods, eating out, and an increase in food portion sizes, combined with a lower intake of fruit, vegetables, and high-fibre foods.
• Healthy diets are unaffordable for the poor in every region of the world and people are increasingly exposed to ultra-processed, unhealthy foods and diets that lead to poorer health.
• Policy solutions to tackle poor diets are considered low-cost. The World Health Organization (WHO) ‘Best Buys’ include interventions to reduce salt and sugar intake, such as front-of-pack labelling, fiscal tools and educational initiatives, and measures to eliminate industrial trans-fats.

Malnutrition occurs when the body is not receiving enough of the right nutrients to function properly. This can present as under-nutrition, such as wasting and stunting, but also as overweight, obesity, and diet-related NCDs such as cardiovascular disease and stroke, type 2 diabetes and some cancers.

Many countries now experience a ‘double burden’ of malnutrition. This is where under-nutrition occurs alongside over-nutrition, where unhealthy diets are contributing to unhealthy weight gain and diet-related poor health.[ 1] These unhealthy diets consist of food and drinks with high levels of energy (calories), salt, sugar, and fats, notably industrial trans fats (also known as trans-fatty acids, TFAs or iTFA).

Around the world, 1.9 billion adults are overweight or obese, while 462 million are underweight.[ 2 ] In a study that looked at global deaths from 1990 to 2017, it was found that one in every five deaths were the result of poor nutrition. [3 ]

What is a healthy diet?

According to the WHO, healthy diets are rich in fibre, fruit, vegetables, lentils, beans, nuts, and wholegrains. These diets are balanced, diverse and meet a person’s macronutrient (protein, fat, carbohydrate and fibre) and micronutrient (minerals and vitamins) needs depending on their stage of life.

Generally, healthy diets contain:

• Fat intake of less than 30% of total energy. These should be mainly unsaturated fats, with less from saturated fats. Trans fats should not be consumed.
• Sugar intake of less than 10% of total energy, but preferably less than 5%.
• Salt intake of less than 5g per day.
• Fruit and vegetables intake at least 400g per day.[ 4 ]

Food systems and changes in the way we eat

A person’s ability to maintain a healthy diet is often not within their control – it is influenced by the food environment where they live, early life nutrition, income, and accessibility.[ 5 ] The ‘food system’ refers to all processes of getting food from production to our plates. The food system is often dictated by location, climate, culture, consumer behaviour, industry practices and the regulatory environment, among other factors.

Rise in ultra-processed foods and drinks

Over several decades, dietary habits have changed dramatically around the world. Globalisation and urbanisation have paved the way for a rise in convenience food and drinks products, junk food, and eating out, with fewer people growing or making their food from scratch.

These cheap and ready-to-consume food and drinks products are often ‘ultra-processed’ and high in calories, fats, salt and sugar and low in nutrients. They are produced to be hyper-palatable and attractive to the consumer, like burgers, crisps, biscuits, confectionery, cereal bars, and sugary drinks.[ 6 ]

Ultra-processed foods and drinks typically have a long shelf life, making them appealing for businesses like supermarkets, rather than highly perishable fresh goods. Intensive marketing by the industry – especially to children – has also increased the consumption of these types of goods. Increasingly, these products are displacing fresh, nutritious, and minimally processed goods, shifting population diets and food systems.

Vulnerable populations and poorer people in all parts of the world struggle to access and maintain a healthy diet. It is in these settings where ultra-processed food and beverage products are most prevalent. An estimated three billion people cannot afford healthier food choices with poverty negatively impacting the nutritional quality of food.[ 7 ]

Which diseases are linked to unhealthy diets and malnutrition?

Unhealthy diets and resulting malnutrition are linked to several noncommunicable diseases, including:

• Overweight and obesity – also associated with elevated blood pressure, high cholesterol, diabetes, cardiovascular disease and stroke, cancers and resistance to the action of insulin.
• Cardiovascular disease (heart disease) and stroke.
• Type 2 diabetes and hypertension (high blood pressure).
• Some cancers – including oesophageal cancer; tracheal, bronchus and lung cancer; lip and oral cavity cancer; nasopharynx cancer; colon and rectum cancer.[ 8 ]

These diseases are driven by common dietary risk factors, including:

• High salt intake – a leading dietary risk factor for death and illness worldwide. High salt consumption increases blood pressure, which increases the risk of cardiovascular disease and stroke, chronic kidney disease and some cancers.
• High sugar intake – excess sugars can contribute to tooth decay and weight gain, leading to overweight and obesity, as well as higher blood pressure, cardiovascular disease and stroke, and some cancers.[ 9 ]
• High trans fats intake – linked to cardiovascular disease and stroke.
• Low fruit and veg intake – linked to several cancers, cardiovascular disease and stroke.
• Low intake of fibres, grains, nuts, seeds, micronutrients – linked to diabetes, cardiovascular disease and stroke, and some cancers.[ 10 ]

Childhood malnutrition

Early life nutrition has important impacts on the likelihood of disease and poor health later in life. But childhood malnutrition remains one of the biggest challenges in public health today.

In 2020, an estimated 22% and 7% of children under five were affected by stunting and wasting, respectively, and 7% were overweight. Most of these children live in lower- and middle-income countries. Asia and Africa account for nine out of ten of all children with stunting and wasting and more than seven out of ten children who are affected by overweight. [11 ]

Breastfeeding is one of the most effective ways to ensure the development of a healthy immune system in children, protecting against childhood malnutrition and poor health throughout the life course. But aggressive marketing of formula and baby foods seeds doubt in mothers, compromising breastfeeding and other healthy feeding practices in early childhood.[ 12 ] Policies that protect and promote breastfeeding, including the regulation of breast milk substitute industry, are critical public health interventions.

What can be done to tackle unhealthy diets and malnutrition?

Strategies to tackle unhealthy diets and malnutrition – leading to overweight, obesity and many noncommunicable diseases – should be part of a comprehensive package of policies that aim to improve the food system.

One of the most straightforward nutrition policies is the elimination of industrially-produced trans fats, or trans fatty acids (iTFA), from the global food supply. If all countries removed this harmful compound that causes heart disease, 17 million lives could be saved by 2040. An additional estimated 2.5 million deaths could be prevented each year if global salt consumption were reduced to the recommended level. [13 ]

Implementing strong nutrition policies will not only accelerate progress towards global NCD targets – but is essential to build healthier and more resilient populations that are better prepared to deal with future health emergencies, such as COVID-19.

What’s more, many nutrition measures are considered cost-effective by the WHO and included in their ‘Best Buys’ of recommended interventions to reduce the burden of NCDs around the world. [14 ]

Specific measures include:

• Reformulation of food and drinks products to contain less salt, sugar and fats – with the goal of eliminating all trans-fats.
• Limiting marketing and promotion of unhealthy food and drink products – especially to children and adolescents, including online and in places where they congregate.
• Front-of-pack nutrition labels which clearly warn of the high content of ingredients including fats, sugar, and salt. Front-of-pack labelling systems have now been implemented in more than 30 countries (where governments have led and supported their development), and systems are under development in many other countries.
• Taxes on sugar-sweetened beverages to reduce sugar consumption.
• Subsidies on fruit and vegetables to increase intake of healthier food choices.
• Increasing incentives for producers and retailers to grow, use and sell fresh fruit and vegetables.
• Protecting and promoting breastfeeding.
• Promoting awareness of better nutrition through mass media campaigns.
• Nutrition education and counselling in preschools, schools, workplaces and health centres.

Case study: Bold action in Mexico leads the way

*NCD Alliance acknowledges support from Resolve to Save Lives in the production of this video.

Mexico has among the highest prevalence of diet-related NCDs and obesity in the world. Around three-quarters of people in Mexico live with overweight or obesity, including one-third of all children. Diet-related conditions such as type 2 diabetes and hypertension are rising in prevalence.

Mexico has been taking big steps to improve health by reducing the high prevalence of largely preventable chronic diseases like obesity, type 2 diabetes and some cancers. But the government and health civil society have faced fierce challenges from the big businesses behind the products that are making people sick. As the pandemic took hold in 2020, and world leaders debated the crisis, the Mexican Minister of Health drew attention to how neglecting to prevent NCDs had made the world’s people more vulnerable to the novel coronavirus.

Health authorities urged Mexicans to transition to healthier diets and habits to reduce the COVID-19 burden. Yet the junk food industry continues to operate despite the government’s efforts, using the pandemic food crisis to put foods high in sugar, salt and fat into children’s hands as much as possible, with no regard to the harmful impact of these foods.

So, while the Mexican federal government persists with its effective soda tax, they have also strengthened their position with strong front-of-pack labelling and trans-fats elimination to create healthier environments for the people of Mexico.

“The tax on sugar-sweetened beverages in Mexico is projected to prevent 239,900 instances of obesity, of which almost 40% would be among children.”

But impatient for Federal regulations to come into force and be implemented, Congress in the region of Oaxaca went a step further, voting to ban the sale of junk food to children altogether and placing the control of purchasing into the hands of parents. The Ley Anti Charra (Anti-Junk Food Law), applies to stores, schools and vending machines. Enforcement is complex, but there is strong public support to defend the health of the most vulnerable population: children. One thing is for sure, with rates of obesity and diet-related NCDs rising in most countries, more must take bigger, braver steps like Mexico to fix food systems and protect children from the foods and drinks that are making us all sick.

Page last updated in November 2021

Turning the table: Fighting back against the junk food industry

In the lead up to World Diabetes Day on 14 November, and Nutrition for Growth Summit in December, this new blog from Lucy Westerman looks at governments taking action to ensure access to healthy diets for kids.

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How diet affects mental health

Summary: Study reveals a link between certain diets and their impact on mental health. Poor diets, researchers say, play a role in worsening mood disorders, such as anxiety and depression. However, diets rich in vegetables and olive oil, such as the Mediterranean diet, can improve symptoms of depression and anxiety.

Source: ECNP

A new expert review confirms that diet significantly influences mental health and wellbeing, but cautions that the evidence for many diets is comparatively weak. This, the most up to date overview of the new field of Nutritional Psychiatry, is produced, by the Nutrition Network of the ECNP and is published in the peer-reviewed journal European Neuropsychopharmacology .

Lead author, Professor Suzanne Dickson (University of Gothenburg, Sweden) said:

“We have found that there is increasing evidence of a link between a poor diet and the worsening of mood disorders, including anxiety and depression. However, many common beliefs about the health effects of certain foods are not supported by solid evidence”.

The researchers found that there are some areas where this link between diet and mental health is firmly established, such as the ability of a high fat and low carbohydrate diet (a ketogenic diet) to help children with epilepsy, and the effect of vitamin B12 deficiency on fatigue, poor memory, and depression.

They also found that there is good evidence that a Mediterranean diet, rich in vegetables and olive oil, shows mental health benefits, such as giving some protection against depression and anxiety. However, for many foods or supplements, the evidence is inconclusive, as for example with the use of vitamin D supplements, or with foods believed to be associated with ADHD or autism.

“With individual conditions, we often found very mixed evidence”, said Suzanne Dickson. “With ADHD for example, we can see an increase in the quantity of refined sugar in the diet seems to increase ADHD and hyperactivity, whereas eating more fresh fruit and vegetables seems to protect against these conditions. But there are comparatively few studies, and many of them don’t last long enough to show long-term effects”.

The study confirms that while certain foods can be associated with a mental health condition, this tells us little about why the food causes this effect. It concludes that the need to link mental health effects with provable dietary causes needs to be the main focus of future research in nutritional psychiatry.

Professor Dickson continued:

“There is a general belief that dietary advice for mental health is based on solid scientific evidence. In reality, it is very difficult to prove that specific diets or specific dietary components contribute to mental health.

The scientists confirmed that some foods had readily provable links to mental health, for example, that nutrition in the womb and in early life can have significant effects on brain function in later life. Proving the effect of diet on mental health in the general population was more difficult.

Suzanne Dickson said “In healthy adults dietary effects on mental health are fairly small, and that makes detecting these effects difficult: it may be that dietary supplementation only works if there are deficiencies due to a poor diet. We also need to consider genetics: subtle differences in metabolism may mean that some people respond better to changes in diet that others.

There are also practical difficulties which need to be overcome in testing diets. A food is not a drug, so it needs to be tested differently to a drug. We can give someone a dummy pill to see if there is an improvement due to the placebo effect, but you can’t easily give people dummy food. Nutritional psychiatry is a new field. The message of this paper is that the effects of diet on mental health are real, but that we need to be careful about jumping to conclusions on the base of provisional evidence. We need more studies on the long-term effects of everyday diets”.

Commenting, the Chair of the ECNP Scientific Programme Committee, Professor Andreas Reif (University Hospital, Frankfurt am Main) said:

“The interface between gut and the brain on the one side and diet and mental health on the other side is one of the most debated issues in biological psychiatry at the moment, and is an exciting development which has gained momentum in the last decade. Many high-quality findings (mainly from animal studies) have been published in top notch journals in recent years, but this contrasts with the comparative shortage of hard evidence on how nutrition and mental health are connected in humans. This leaves room for speculation and flawed science. This comprehensive review is therefore much-needed as it sheds light on hypes and hopes, facts and fiction in the new field of Nutritional Psychiatry. As the potential societal impact of this rapidly developing field is enormous, we must be scientifically sound in making our recommendations. This review is an important and scholarly contribution”.

This is an independent comment; Professor Reif was not involved in this work.

Source: ECNP Media Contacts: Press Office – ECNP Image Source: The image is in the public domain.

Original Research: Open access “Nutritional psychiatry: Towards improving mental health by what you eat “. Roger A.H.Adan, Eline M.van der Beek, Jan K.Buitelaar, John F. Cryan, Johannes Hebebrand, Suzanne Higgs, Harriet Schellekens, Suzanne L. Dickson . European Neuropsychopharmacology doi: 10.1016/j.euroneuro.2019.10.011 .

Nutritional psychiatry: Towards improving mental health by what you eat

Does it matter what we eat for our mental health? Accumulating data suggests that this may indeed be the case and that diet and nutrition are not only critical for human physiology and body composition, but also have significant effects on mood and mental wellbeing. While the determining factors of mental health are complex, increasing evidence indicates a strong association between a poor diet and the exacerbation of mood disorders, including anxiety and depression, as well as other neuropsychiatric conditions. There are common beliefs about the health effects of certain foods that are not supported by solid evidence and the scientific evidence demonstrating the unequivocal link between nutrition and mental health is only beginning to emerge. Current epidemiological data on nutrition and mental health do not provide information about causality or underlying mechanisms. Future studies should focus on elucidating mechanism. Randomized controlled trials should be of high quality, adequately powered and geared towards the advancement of knowledge from population-based observations towards personalized nutrition. Here, we provide an overview of the emerging field of nutritional psychiatry, exploring the scientific evidence exemplifying the importance of a well-balanced diet for mental health. We conclude that an experimental medicine approach and a mechanistic understanding is required to provide solid evidence on which future policies on diet and nutrition for mental health can be based.

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Food Inequality: How Poor Nutrition Affects Health, Wealth, & Opportunity (And What We Can Do About It!)

When millions of people suffer from malnutrition, either due to insufficient calories or a lack of access to affordable, wholesome food, their health, wealth, resilience, and even their mental clarity are impacted. If we want to create a just and sustainable world, we must tackle the twin issues of food inequality and food insecurity.

We all need food to live. At Food Revolution Network, we are dedicated to healthy, ethical and sustainable food for all.

But unfortunately, that isn’t the world we live in right now.

Not everyone has access to a grocery store to buy what they need to support their health. Not everyone has the knowledge, time, or energy to prepare healthy food. And not everyone has the money to afford healthy food.

And just as poverty and income insecurity can lead to poor nutrition, the same dynamic exists in reverse. Poor nutrition undermines health, and then poor health can also contribute to poverty. Poor nutrition not only leads to chronic disease and emotional distress. It also robs people of opportunities to move out of poverty and improve the prospects of future generations.

In this article, I’ll look at how social factors influence access to nutrition, how poor nutrition can keep people stuck in a cycle of poverty and disease, and what we can do about it.

Access to Food for All

Let’s try a thought experiment: imagine that oxygen wasn’t freely available in the atmosphere. That someone had figured out a way to extract it from the air, put it in canisters, and sell it.

And in order to breathe and stay alive, we had to pay to refill our canisters before they ran out.

What are the first words that come to mind when you consider that dystopian sci-fi scenario?

Far-fetched? Outrageous? Unacceptable?

Well, that’s exactly how we should feel about our current food system.

The way I see it, access to whole, healthy foods should be a basic human right. In tribal societies, which represent more than 99% of human history , food was all around for the taking (with some effort). To get roots or berries, you had to walk, keep your eyes peeled, and dig or pick. To eat an animal, you had to hunt or trap.

I’m not romanticizing the lives of hunter-gatherers (or of gatherer-hunters, as more and more researchers are starting to call them, recognizing that many such tribes got far more of their calories from gathering than from hunting ). Our ancestors often had to deal with food insecurity due to drought, pestilence, or even seasonal shortages. Life was often hard and dangerous, and life expectancies were far shorter, on average, than those in modern civilizations.

But the central feature I want to point out is that food access was universally shared. No chief or ruling class put the food “under lock and key.” Look around you; wherever you live, no other species has invented a system to deny access to free food. Squirrels don’t lock up oak trees and force other squirrels to pay for acorns. Hummingbirds squabble over flowers and feeders but don’t systematically deny entire classes of birds access to nectar. Sharks and whales swim through oceanic restaurants in which no bill is ever presented. Only humans have invented a social and economic system in which people may literally starve to death if they do not have access to enough money. 

The Cycle of Poverty & Food Inequality

In industrialized countries, poverty doesn’t always look like starvation. It can look like intermittent hunger. It can even look like excess. High rates of obesity occur when food access consists of calorically dense, nutritionally poor junk foods. As “gangsta gardener”  Ron Finley put it in his TED talk, in his South Central Los Angeles neighborhood, the drive-thru, fast food restaurants kill more people than the drive-by shootings.

The problem is not that we don’t have enough food in the world to feed everyone well. As Francis Moore Lappé points out , “The real cause of hunger is the powerlessness of the poor to gain access to the resources they need to feed themselves.”

This is a huge problem. Lack of access to healthy food, economic disenfranchisement, insufficient nutritional education , and unequal distribution of tools for preparing healthy meals, have created a gaping divide in the world. Those with the ability to procure and prepare nutritious food are healthier, less stressed, and better prepared to take advantage of opportunities for advancement.

But those without that ability are too often embedded in a vicious cycle, in which low-income individuals do not get the nutrition they need to fuel their own efforts to improve their lives. Thus poverty and inequality are perpetuated.

The gap isn’t random, either. Often poverty and food inequality are directly linked to race, gender, disability, and other demographic factors. Inequality of access to healthy food both arises from and reinforces class divides, racial inequality, and intergenerational cycles of poverty.

One example: folks with less money tend to spend a higher percentage of their money on food, than those with more. And statistically, the lower your income , the more likely you are to depend on cheaper, less nutritious food.

The Government Subsidy Problem

This isn’t because unhealthy, processed food is naturally cheaper than healthy, whole foods. It’s because, in many wealthier countries like the US, tens of billions of dollars of taxpayer money subsidize the mass production of gargantuan amounts of crops like corn, soy, and wheat.

These highly subsidized crops have two primary uses in the modern diet: as animal feed in factory farms, which brings down the price of industrial meat, and as ingredients in highly processed and nutrient-poor junk foods. This brings down the price of food-like products that provide cheap and tasty calories but are nutritionally horrendous.

Food subsidies are the primary reason why, over the last four decades , the price of processed foods and industrial meat has gone down 20-30%, while the price of fruits and vegetables has increased 40%.

When we subsidize junk food, we essentially force the economically poor to eat foods that are nutritional disasters. This makes it much harder for people who are born into families that are struggling financially to ever rise above poverty, and virtually ensures that cycles of intergenerational poverty will persist. And when a vastly disproportionate share of those who struggle financially are people of color, we’ve created one of the conditions that, in effect, perpetuate racial health inequality.

It may seem obvious, but the less healthfully you eat, the less likely you are to be healthy — and the more likely you are to suffer from debilitating illness, be unable to work, and fall into medical care-induced bankruptcy . And it’s hard to quantify the mental and emotional stress that comes from not knowing how or if you’re going to be able to feed yourself and your loved ones today.

Food Insecurity

There’s an epidemic of food insecurity today, even in the richest countries on earth. For example, 40% of US households below the poverty line are food insecure. In 2012, that number was a little less than 11 million households. By 2019, it had jumped to almost 14 million . The pandemic and lockdowns then proceeded to make a very bad situation much worse .

Food insecurity is largely tied to low income, of course, but there are other factors that can contribute. Income volatility, housing discrimination , changes in employment, and rising food prices are all associated with not having a reliable supply of food.

In neighborhoods known as “ food deserts ,” a host of interlocking conditions exist that perpetuate poverty, inequality, and food insecurity. For example, in many low-income urban and rural areas, it’s nearly impossible to find healthy food within walking distance. When supermarkets and healthy grocery stores aren’t present, inhabitants must make do with convenience stores, liquor stores, and gas station fare, or spend time and money traveling on public transit to get to supermarkets in other neighborhoods. And if they don’t have cars to carry their groceries home, they’re limited in the number of items they can purchase at one time, necessitating more frequent trips.

In this way, if the poorest and most vulnerable members of our society want healthy food, they must sacrifice time and money they could otherwise spend building up opportunities through work, education, or child care.

SNAP and Other Nutrition Programs

You might be thinking, “Hey, food insecurity is terrible, but that’s why most developed countries, at least, have food aid programs like food stamps. Don’t they solve the problem?”

They help, for sure, but don’t solve the problem.

It’s true that food aid programs are an essential lifeline for hundreds of millions of people. And in the US, the Supplemental Nutrition Assistance Program (SNAP) does exist to fill in the income gap when families and individuals can’t afford enough food. But the way it’s set up and administered severely dampens its effectiveness. The Center on Budget and Policy Priorities has determined that half of all SNAP recipients are still food insecure, despite receiving the aid.

How is this possible?

First, the amount of SNAP benefits are hardly enough to feed a person or family. Although “ the largest permanent increase to benefits ” was announced in the summer of 2021, the average SNAP benefit will still come to about $1.75 per person per meal — enough to purchase a box of highly processed mac and cheese, but not enough to add many veggies.

Second, many people who receive SNAP benefits work long hours, often at multiple jobs, often with difficult and long commutes between them. This means they do not have time to prepare healthy food from scratch. So they tend to do the rational thing: use the government benefit to purchase convenience foods.

Third, SNAP benefits are uniform throughout the US and don’t reflect local conditions. Since food is more expensive in big cities and other more costly areas, SNAP benefits don’t provide as much support, in net effect, to recipients living in those areas.

Also, people receiving SNAP may have limited access to markets and stores that accept SNAP. And those stores may not include healthy options. For example, SNAP recipients in Burlington County, North Carolina, have few options other than spending their credit at stores like Dollar General, Dave’s Mini Mart, along with Walgreens and Rite-Aid pharmacies. There they can get staples like white bread, peanut butter, and canned tuna, but will have a hard time finding fresh fruits and vegetables — and even inexpensive items like dried legumes.

Food banks can step in and fill the gap, but many of these don’t offer fresh produce either. Unlike a retail store with a robust inventory and distribution system, food banks can be very hit-or-miss when it comes to variety and quality. If you rely on a food bank, you’re pretty much at the mercy of whatever they have available and how many other people you have to share it with.

The Increasing Issue of Malnutrition

Food inequality leads to not only food insecurity, but also to disease, disability, and premature death. Indeed, when we look at the numbers, we see that a diet of poor quality food is more prevalent worldwide than starvation. Nearly two billion people worldwide are now overweight or obese, close to three times as many as are underfed and undernourished ( 690 million ).

Unlike starvation, which tends to occur in societies that lack basic resources, the malnutrition that stems from eating mostly high-calorie, low-nutrient foods is endemic in the modern “Western” world. Junk foods and fast foods, calorie-dense with little nutritional value, make up the majority of calories consumed in these societies. Kids in the US, for example, today get two-thirds of their total calories from ultra-processed foods. The skyrocketing rates of obesity and food-related illnesses testify to the prevalence of this dietary pattern.

While such malnutrition is not necessarily tied directly to poverty — wealthy people can live on fast food and junk food diets as well — it invariably leads to poorer health outcomes for those without disposable income. The cruel irony is that the malnourished who are monetarily poor typically lack the resources to buffer the health effects of their diets.

The Health Gap

While the rich and monetarily poor can both suffer from unhealthy diets, people of color and people in historically marginalized groups tend to face additional burdens of chronic disease from poor nutrition. This is largely because social and environmental factors linked to poverty often make things worse.

Diet-related disease is more common among people of color. For example, cancer, type 2 diabetes, asthma, and heart disease are up to twice as prevalent in Black, Hispanic, and Native American populations as in white ones. A representative sample of US adults aged 55 or older found that food-insecure women were more likely than average to experience lung disease and diabetes. And simply being a member of a minority group increased the odds, statistically, of being food insecure and having diabetes.

The unfortunate truth is, the very people who can least afford to get sick are getting sick the most. 

Food Inequality’s Impact on Children

Tragically, those who bear the worst brunt of food inequality, food insecurity, and malnutrition are children. They have easy access to junk food in schools, both from hallway vending machines and cafeterias. Unhealthy school lunches can lead to not just health and weight problems but to learning difficulties as well. It’s hard to feed children well on $1.30 per meal, so schools rely on prepackaged meals made with the lowest quality and most subsidized ingredients (factory farmed cow’s milk, white flour, sugar, etc.)

If a consortium of evil scientists were convened to design a diet intended to undermine learning and child development, they might feel mighty satisfied with the current system.

Outside of school, kids are still vulnerable. Fast food, junk food, and processed food manufacturers have learned that they can increase sales and profits by marketing directly to children through toys, characters, bright colors, and so on. Eric Schlosser reported in his 2001 book Fast Food Nation that 96% of American schoolchildren could recognize Ronald McDonald, putting him second in the fictional character Olympics. Only Santa Claus had higher brand recognition.

And for some reason, Ronald McDonald is portrayed as thinner than old Kris Kringle, who at least gets some exercise as VP of logistics at his polar toy factory. (Although, to be fair, the reindeer do the heavy lifting.)

Juvenile Delinquency

Poor diets can also raise rates of juvenile delinquency . The good news there, of course, is that feeding kids can dramatically reduce antisocial behaior, like my dad, Food Revolution Network President, John Robbins, has pointed out :

“A series of studies in the 1980s removed chemical additives and reduced sugar in the diets of juvenile delinquents. Overall, 8,076 young people in 12 juvenile correctional facilities were involved. The result? Deviant behavior fell 47%.

In Virginia, 276 juvenile delinquents at a detention facility housing particularly hardened adolescents were put on the diet for two years. During that time, the incidence of theft dropped 77%, insubordination dropped 55%, and hyperactivity dropped 65%. In Los Angeles County probation detention halls, 1,382 youths were put on the diet. Again, the results were excellent. There was a 44% reduction in problem behavior and suicide attempts.  

These and other studies have found that when troubled youngsters are put on a healthy diet based on nutrient-dense foods like whole grains, vegetables, and fruits, and avoid sugar and artificial colors, flavors, and preservatives, the results are predictably outstanding.”

The Wealth Gap

A popular 1927 song proclaimed that “The Best Things in Life Are Free,” pointing to examples such as the moon, the stars, the flowers in spring, the robins that sing, and love.

The much more cynical Ogden Nash retorted, in his 1938 poem “The Terrible People”: “Certainly there are lots of things in life that money won’t buy, but it’s very funny — have you ever tried to buy them without money?”

After all, it’s hard to enjoy a nighttime stroll under the moon and stars, or a morning walk in a flower-covered meadow while birds serenade, when you’re worried about covering next month’s rent to avoid eviction, or giving your kids something more nutritious than Cheetos and Mountain Dew for dinner.

We’ve seen that the “wealth gap” contributes heavily to the “health gap” between the affluent and the impoverished. What’s particularly insidious is that this is a self-reinforcing, vicious cycle. Poor nutrition leads to health problems that further erode wealth and diminish the opportunities to rise out of poverty.

Race plays a big role here; African Americans are 260% more likely than whites to incur medical debt. Even after adjusting for the differences in health status, income, and insurance coverage, almost 60% of the gap is still attributable to race .

The Cycle of Poor Health & Poverty

The vicious cycle between poor health and poverty is an unwanted gift that keeps on giving. Medical debt degrades health and nutrition, both financially and in terms of stress. Those laboring under the burden of debt have higher blood pressure, worse self-reported health status, poorer mental health, and shorter life expectancy than those with less debt. And without access to healthier foods, chronic illnesses continue to progress, causing even more economic hardship.

As if that wasn’t bad enough, the curses of food inequality and insecurity often get passed down from generation to generation. Just as children of the wealthy inherit stocks, bonds, real estate, and connections, so do children of the economically poor tend to inherit poverty, health problems, and other social harms from their parents and grandparents.

One of the core principles of the “American Dream” is upward mobility — the belief that if you work hard, follow the rules, and do the right thing, you can achieve wealth and rise above your original station. The reality of intergenerational poverty undermines that aspiration for far too many people. And unequal access to healthy food is a huge contributor to this problem.

It reminds me of a 1961 Herblock newspaper cartoon showing a wealthy businessman berating a poor woman huddled on a stoop in a slum neighborhood: “If you had any initiative, you’d go out and inherit a department store.”

What We Must Do About Food Inequality

I share all this not to depress you, but to inspire you to take action. There are things each of us can do to contribute to a just and sustainable solution.

We must continue to raise awareness about the impact of food on health, wealth, and opportunity — especially in low-income communities — and advocate for a sustainable food system that provides healthy and affordable food for all.

When our society is willing to face the shameful reality of chronic malnutrition, we can mobilize the political will to tackle the problem. Think of how we come together to aid those in a disaster zone. How donations pour in to those devastated by a hurricane, or catastrophic flooding. When we see people as part of “our community,” we naturally reach out to help, and seek to dismantle barriers to well-being. We need to make the consequences of our broken food system as visible as the effects of a natural disaster. And we need to remember to, as Bruce Springsteen sings, “ take care of our own .”

Taxing Junk Food

One powerful and effective legislative solution is to change the tax code and subsidies programs to reflect the true societal costs of particular foods. For example, we could reduce government subsidies of commodities crops, such as corn, soy, and wheat. And we could support laws that discourage the selling, marketing, and consumption of harmful foods and beverages. High taxes on soda , for example, have proven to reduce demand in the cities where the law is in place.

Berkeley, California’s tax on sugar-sweetened beverages reduced soda consumption by 21% and increased water consumption by 63% in low-income neighborhoods, according to a 2021 study reported in the American Journal of Public Health . And the funds raised by the taxes can be used to further reduce the inequality of outcomes between rich and poor.

Bring Down the Price of Healthy Food

In addition to making soda and junk food more expensive and harder to access, we can be doing the opposite to healthy food: making it cheaper and more accessible. SNAP incentive programs can encourage the purchase of fresh fruits and vegetables by increasing the value of SNAP credits when applied toward these foods.

One wonderful example is the DoubleUp Bucks program promoted by Wholesome Wave . Participants in this program, which is now available in 25 US states ( check here to see which ones), get their SNAP credits doubled when spent on fresh produce. Participants can buy a dollar’s worth of broccoli for 50 cents, making it a financially wise as well as health-supporting choice. Despite the upcoming rule changes to SNAP, which will increase the total SNAP budget, such incentive programs will likely continue.

Protect Kids from Junk Food Marketing

Another common sense step is to ban the marketing of junk food to children . Kids don’t have the experience needed to evaluate the claims in junk food ads, and these ads often fuel conflict between kids — who may be unfairly influenced by the ads — and their parents and other caregivers.

That cereal with a full tablespoon of sugar in each cup is not “grrreat.” That soda full of sugar, phosphoric acid, caffeine, colorings, and chemical flavorings is not “the real thing.” The fast food meal that features a movie superhero toy will not make anyone “happy” for long. Let’s pass laws to protect children from sugar-coated lies that lead to unhealthy habits and outcomes.

Support Nutrition Education

We can also support the expansion of nutrition education programs, such as those presented by Food Revolution Network, to local community leaders, activists, and advocates.

Another strategy is to focus on teaching nutrition to young children. Kids who learn to try new foods and how to prepare healthy dishes, are far more likely to eat healthier into adulthood. And children who attend schools that have gardening programs have a whole new outlook on food once they’ve tasted a cherry tomato they’ve grown themselves.

Build Community Gardens

Community gardens are a powerful tool to bring nutrition, nutrition education, and even employment to underserved communities. There are several ways to support such efforts, either locally or online, which you can find out about here .

Support Produce Prescriptions

Finally, anyone in the medical field can start advocating for produce prescription programs. A doctor can write a prescription, not just for a medication, but for fresh fruits and vegetables (which, rather than treating symptoms, often address root causes of disease). The prescription allows the patient to receive the produce either at a drastically reduced cost (like an insurance copay) or for free. One example is Wholesome Wave’s National Produce Prescription Consortium .

Organizations Working Towards Food Equality & Opportunity

A number of organizations are tackling the issues of food inequality and insecurity head-on. Here are a few you may want to check out, and possibly support.

1. Wholesome Wave

Wholesome Wave’s mission is to fight nutrition insecurity. Since 2007, they’ve been partnering with community-based organizations to provide enough food, and the right food, for our most vulnerable citizens — regardless of race, ethnicity, age, gender, or income. (Food Revolution Network is grateful to be a major supporter of Wholesome Wave.)

2. Chef Ann Foundation

The Chef Ann Foundation teaches and empowers schools and school districts to cook fresh, whole-food meals to students from scratch. Through professional development and implementation grants, the foundation works through the considerable barriers to organizational change and helps schools transform their lunch programs from relying on cheap, institutional junk food into produce-heavy affairs.

3. Food Research and Action Center

The Food Research and Action Center, or FRAC, engages in research, advocacy, and legislative solutions to food inequality and insecurity. They also offer resources on their website for local activists, including communication toolkits and in-depth reports.

4. Seeds of Native Health

Seeds of Native Health seeks to eradicate food impoverishment among US Native American populations and improve the health of Indigenous peoples. Noting that 81% of Native American adults are overweight or obese, and their rates of diabetes are double the national average, the organization supports grassroots practitioners, researchers, and advocates aiming to restore traditional, healthful diets within Indigenous communities.

5. Prosperity Now

Prosperity Now seeks to close the racial wealth divide. Noting that for a disproportionate number of Americans of color, financial ruin is just “one crisis away,” the organization promotes strategies, programs, and laws that enable low-income and minority communities to start building wealth that they can pass on to future generations.

6. Center for Healthy Food Access

The Center for Healthy Food Access works on many fronts to contribute to a healthy food future for all. From lobbying to strengthen SNAP and other food assistance programs to improving the food and water quality in schools to working with hospitals and other healthcare systems to deploy healthy diets in the fight against chronic disease in underserved populations, they seek to provide everyone with access to healthy food and access to information to make healthy decisions.

Healthy, Ethical, & Sustainable Food for All

Most of us want to live in lands of opportunity, where hard work is rewarded, and people from any background can rise up and improve their lives and their community. As we’ve seen, however, food inequality and poor nutrition can prevent individuals and communities from enjoying the health, wealth, and opportunity that should be the birthright of every human. As a society, we fail unless we can offer access to healthy whole foods to all our people.

Dr. Martin Luther King famously said, “The arc of the moral universe is long, but it bends toward justice.” The truth is, it doesn’t bend all by itself. With increased awareness and advocacy, we’re starting to see positive efforts and real progress on these issues. And there’s so much more for us to do.

At Food Revolution Network, our mission is “healthy, ethical, and sustainable food for all.” Perhaps if we stand up and speak out, we can contribute to building a healthier and a brighter future for all of us — regardless of our race, economic status, or other demographic factors.

Tell us in the comments:

• How does food inequality and food insecurity show up where you live?
• What organizations fighting food inequality inspire you?
• What steps can you take to help reduce food inequality in and around your community?

Feature image: iStock.com/MarsBars

• Increasing Health & Opportunity for All: An Interview with Terry Mason, MD
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Ocean Robbins

CEO, Food Revolution Network

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Ielts writing task 2 sample 875 - today people have unhealthy diet and do not exercise, ielts writing task 2/ ielts essay:, today people have unhealthy diets and do not exercise. what do you think why it is so. what are the reasons suggest some solutions for solving this situation..

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• Int J Health Sci (Qassim)
• v.11(2); Apr-Jun 2017

Effect of diet on type 2 diabetes mellitus: A review

1 Faculty of Industrial Management, Universiti Malaysia Pahang, Lebuhraya Tun Razak, 26300 Gambang, Kuantan, Pahang, Malaysia

2 Department of Public Health & Community Medicine, College of Medicine, Majmaah University, Kingdom of Saudi Arabia

Tahir Ansari

3 Department of Family Medicine, College of Medicine, Majmaah University, Kingdom of Saudi Arabia

Nadeem Shafique Butt

4 Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia

Mohd Rashid Ab Hamid

Globally, type 2 diabetes mellitus (T2DM) is considered as one of the most common diseases. The etiology of T2DM is complex and is associated with irreversible risk factors such as age, genetic, race, and ethnicity and reversible factors such as diet, physical activity and smoking. The objectives of this review are to examine various studies to explore relationship of T2DM with different dietary habits/patterns and practices and its complications. Dietary habits and sedentary lifestyle are the major factors for rapidly rising incidence of DM among developing countries. In type 2 diabetics, recently, elevated HbA1c level has also been considered as one of the leading risk factors for developing microvascular and macrovascular complications. Improvement in the elevated HbA1c level can be achieved through diet management; thus, the patients could be prevented from developing the diabetes complications. Awareness about diabetes complications and consequent improvement in dietary knowledge, attitude, and practices lead to better control of the disease. The stakeholders (health-care providers, health facilities, agencies involved in diabetes care, etc.) should encourage patients to understand the importance of diet which may help in disease management, appropriate self-care and better quality of life.

Introduction

Diabetes mellitus (DM) was first recognized as a disease around 3000 years ago by the ancient Egyptians and Indians, illustrating some clinical features very similar to what we now know as diabetes. 1 DM is a combination of two words, “diabetes” Greek word derivative, means siphon - to pass through and the Latin word “mellitus” means honeyed or sweet. In 1776, excess sugar in blood and urine was first confirmed in Great Britain. 2 , 3 With the passage of time, a widespread knowledge of diabetes along with detailed etiology and pathogenesis has been achieved. DM is defined as “a metabolic disorder characterized by hyperglycemia resulting from either the deficiency in insulin secretion or the action of insulin.” The poorly controlled DM can lead to damage various organs, especially the eyes, kidney, nerves, and cardiovascular system. 4 DM can be of three major types, based on etiology and clinical features. These are DM type 1 (T1DM), DM type 2 (T2DM), and gestational DM (GDM). In T1DM, there is absolute insulin deficiency due to the destruction of β cells in the pancreas by a cellular mediated autoimmune process. In T2DM, there is insulin resistance and relative insulin deficiency. GDM is any degree of glucose intolerance that is recognized during pregnancy. DM can arise from other diseases or due to drugs such as genetic syndromes, surgery, malnutrition, infections, and corticosteroids intake. 5 - 7

T2DM factors which can be irreversible such as age, genetic, race, and ethnicity or revisable such as diet, physical activity and smoking. 8 , 9

Epidemiology

Globally, T2DM is at present one of the most common diseases and its levels are progressively on the rise. It has been evaluated that around 366 million people worldwide or 8.3% in the age group of 20-79 years had T2DM in 2011. This figure is expected to rise to 552 million (9.9%) by 2030. 10 This disease is associated with severe complications which affect patient’s health, productivity, and quality of life. More than 50% of people with diabetes die of cardiovascular disease (CVD) (primarily heart disease and stroke) and is a sole cause of end stage renal disease which requires either dialysis or kidney transplantation. It is also a major cause of blindness due to retinal damage in adult age group referred to as diabetic retinopathy (DR). People with T2DM have an increased risk of lower limb amputation that may be 25 times greater than those without the disease. This disease caused around 4.6 million deaths in the age-group of 20-79 years in 2011. 11

Physical Activity and Lifestyle

A large number of cross-sectional as well as prospective and retrospective studies have found significant association between physical inactivity and T2DM. 12 A prospective study was carried out among more than thousand nondiabetic individuals from the high-risk population of Pima Indians. During an average follow-up period of 6-year, it was found that the diabetes incidence rate remained higher in less active men and women from all BMI groups. 13 The existing evidence suggests a number of possible biological pathways for the protective effect of physical activity on the development of T2DM. First, it has been suggested that physical activity increases sensitivity to insulin. In a comprehensive report published by Health and Human Services, USA, 2015 reported that physical activity enormously improved abnormal glucose tolerance when caused by insulin resistance primarily than when it was caused by deficient amounts of circulating insulin. 14 Second, physical activity is likely to be most beneficial in preventing the progression of T2DM during the initial stages, before insulin therapy is required. The protective mechanism of physical activity appears to have a synergistic effect with insulin. During a single prolonged session of physical activity, contracting skeletal muscle enhances glucose uptake into the cells. This effect increases blood flow in the muscle and enhances glucose transport into the muscle cell. 15 Third, physical activity has also been found to reduce intra-abdominal fat, which is a known risk factor for insulin resistance. In certain other studies, physical activity has been inversely associated with intra-abdominal fat distribution and can reduce body fat stores. 16 Lifestyle and environmental factors are reported to be the main causes of extreme increase in the incidence of T2DM. 17

Patient’s Knowledge Regarding DM

Among the patients, diabetes awareness and management are still the major challenges faced by stakeholders worldwide. Poor knowledge related to diabetes is reported in many studies from the developing countries. 18 Some studies have suggested that the occurrence of diabetes is different in various ethnic groups. 19 Knowledge is a requirement to achieve better compliance with medical therapy. 20 According to a study conducted by Mohammadi 21 patient’s knowledge and self-care management regarding DM was not sufficient. Low awareness of DM affects the outcome of diabetes. Another study conducted in Slovakia by Magurová 22 compared two groups of patients (those who received diabetes education and those who did not). The results indicated that receiving diabetes education significantly increased awareness about the disease in patients ( p < 0.001). The study further concluded that having diabetes knowledge can notably improve patient’s quality of life and lessen the burden on their family. Dussa 23 conducted a cross-sectional study on assessment of diabetes awareness in India. The study concluded that level of diabetes awareness among patients and general population was low. Another study conducted in India by Shah 24 reported that 63% of T2DM patients did not know what DM is and the majority were also unaware about its complications.

According to the study conducted by Bani 25 in Saudi Arabia, majority of the patients 97.3% males and 93.1% females were unaware about the importance of monitoring diabetes, with no significant gender difference. Diabetes knowledge, attitude, and practice were also studied in Qatari type 2 diabetics. The patients’ knowledge regarding diabetes was very poor, and their knowledge regarding the effect of diabetes on feet was also not appreciable. 26 Results from a study conducted in Najran, Saudi Arabia 27 reported that almost half of the patients did not have adequate knowledge regarding diabetes disease. Males in this study had more knowledge regarding diabetes than female patients. Diabetes knowledge among self-reported diabetic female teachers was studied in Al-Khobar, Saudi Arabia. 28 The study concluded that diabetes knowledge among diabetic female teachers was very poor. It was further suggested that awareness and education about diabetes should be urgently given to sample patients. The knowledge of diabetes provides the information about eating attitude, workout, weight monitoring, blood glucose levels, and use of medication, eye care, foot care, and control of diabetes complications. 29

Relation between Diet and Type 2 DM

The role of diet in the etiology of T2DM was proposed by Indians as mentioned earlier, who observed that the disease was almost confined to rich people who consumed oil, flour, and sugar in excessive amounts. 30 During the First and Second World Wars, declines in the diabetes mortality rates were documented due to food shortage and famines in the involved countries such as Germany and other European countries. In Berlin, diabetes mortality rate declined from 23.1/100,000 in 1914 to 10.9 in 1919. In contrast, there was no change in diabetes mortality rate in other countries with no shortage of food at the same time period such as Japan and North American countries. 31 Whereas few studies have found strong association of T2DM with high intake of carbohydrates and fats. Many studies have reported a positive association between high intake of sugars and development of T2DM. 32 In a study, Ludwig 33 investigated more than 500 ethnically diverse schoolchildren for 19 months. It was found that for each additional serving of carbonated drinks consumed, frequency of obesity increased, after adjusting for different parameters such as dietary, demographic, anthropometric, and lifestyle.

A study was conducted which included the diabetic patients with differing degrees of glycemic control. There were no differences in the mean daily plasma glucose levels or diurnal glucose profiles. As with carbohydrates, the association between dietary fats and T2DM was also inconsistent. 34 Many of prospective studies have found relations between fat intake and subsequent risk of developing T2DM. In a diabetes study, conducted at San Louis Valley, a more than thousand subjects without a prior diagnosis of diabetes were prospectively investigated for 4 years. In that study, the researchers found an association between fat intake, T2DM and impaired glucose tolerance. 35 , 36 Another study observed the relationship of the various diet components among two groups of women, including fat, fiber plus sucrose, and the risk of T2DM. After adjustment, no associations were found between intakes of fat, sucrose, carbohydrate or fiber and risk of diabetes in both groups. 37

Recently, evidence suggested a link between the intake of soft drinks with obesity and diabetes, resulting from large amounts of high fructose corn syrup used in the manufacturing of soft drinks, which raises blood glucose levels and BMI to the dangerous levels. 38 It was also stated by Assy 39 that diet soft drinks contain glycated chemicals that markedly augment insulin resistance. Food intake has been strongly linked with obesity, not only related to the volume of food but also in terms of the composition and quality of diet. 40 High intake of red meat, sweets and fried foods, contribute to the increased the risk of insulin resistance and T2DM. 41 In contrast, an inverse correlation was observed between intake of vegetables and T2DM. Consumption of fruits and vegetables may protect the development of T2DM, as they are rich in nutrients, fiber and antioxidants which are considered as protective barrier against the diseases. 42 Recently, in Japanese women, a report revealed that elevated intake of white rice was associated with an increased risk of T2DM. 43 This demands an urgent need for changing lifestyle among general population and further increase the awareness of healthy diet patterns in all groups.

Dietary Knowledge of Type 2 Diabetics

American Diabetes Association has defined self-dietary management as the key step in providing the diabetics, the knowledge and skill in relation with treatment, nutritional aspects, medications and complications. A study showed that the dietary knowledge of the targeted group who were at high risk of developing T2DM was poor. Red meat and fried food were consumed more by males as compared to females. The percent of males to females in daily rice consumption was significantly high. 44

In recent times in Saudi Arabia, food choices, size of portions and sedentary lifestyle have increased dramatically that resulted in high risk of obesity. Unfortunately, many Saudis are becoming more obese because of the convenience of fast foods, and this adds to the scary diabetes statistics. 45 On the other hand, Saudis drink too many high-sugar drinks. In addition, Backman 46 reported dietary knowledge to be a significant factor that influences dietary behaviors. In another study conducted by Savoca and Miller 47 stated that patients’ food selection and dietary behaviors may be influenced by the strong knowledge about diabetic diet recommendations. Significant positive relationship was observed between knowledge regarding diabetic diet and the amount of calorie needs (r = 0.27, p < 0.05). 48 The study concluded that knowledge regarding diabetic diet is essential and is needed to achieve better dietary behaviors. Results of study conducted in Saudi Arabia 25 reported that more than half of the diabetic patients denied modifying their dietary pattern, reduction in weight and perform exercise.

National Center for Health Statistics reported that socioeconomic status plays an important role in the development of T2DM; where it was known as a disease of the rich. 49 On the contrary, the same reference reported that T2DM was more prevalent in lower income level and in those with less education. The differences may be due to the type of food consumed. Nutritionists advised that nutrition is very important in managing diabetes, not only type but also quantity of food which influences blood sugar. Meals should be consumed at regular times with low fat and high fiber contents including a limited amount of carbohydrates. It was observed that daily consumption of protein, fat and energy intake by Saudi residents were higher than what is recommended by the International Nutritional Organization. 50

Attitude of Type 2 Diabetics Toward Food

DM can be controlled through improvement in patient’s dietary knowledge, attitudes, and practices. These factors are considered as an integral part of comprehensive diabetes care. 51 Although the prevalence of DM is high in gulf countries, patients are still deficient in understanding the importance of diet in diabetes management. 52 Studies have shown that assessing patients’ dietary attitude may have a considerable benefit toward treatment compliance and decrease the occurrence rate of complications as well. 52 A study conducted in Egypt reported that the attitude of the patients toward food, compliance to treatment, food control with and without drug use and foot care was inadequate. 53 Another study presented that one-third of the diabetic patients were aware about the importance of diet planning, and limiting cholesterol intake to prevent CVD. Various studies have documented increased prevalence of eating disorders and eating disorder symptoms in T2DM patients. Most of these studies have discussed about the binge eating disorder, due to its strong correlation with obesity, a condition that leads to T2DM. 53 Furthermore, a study revealed that the weight gain among diabetic patients was associated with the eating disorder due to psychological distress. 54 In another study that examined eating disorder-related symptoms in T2DM patients, suggested that the dieting-bingeing sequence can be applied to diabetics, especially obese diabetic patients. 55 Unhealthy eating habits and physical inactivity are the leading causes of diabetes. Failure to follow a strict diet plan and workout, along with prescribed medication are leading causes of complications among patients of T2DM. 56 Previous studies 57 conducted in Saudi Arabia have reported that diabetic patients do not regard the advice given by their physicians regularly regarding diet planning, diet modification and exercise.

Dietary Practices of Type 2 Diabetics

Diabetic’s dietary practices are mainly influenced by cultural backgrounds. Concerning each of the dimensions of dietary practices, there were significant positive relationships between knowledge regarding diabetic diet and dietary practices. Knowledge was a salient factor related to dietary behaviors control. 46 Moreover, patients’ knowledge on a recommended diet indicates their understanding of dietary guidelines which influenced their food selection and eating patterns. 47 The association between dietary knowledge and dietary practices among T2DM patients in the previous studies were inconsistent. Another study revealed that there was no relationship between dietary knowledge and compliance of dietary practices. 58 On the other hand, the same study found that a high dietary knowledge score was associated with following dietary recommendations and knowledgeable patients performed self-management activities in a better way. Dietary knowledge significantly influences dietary practices. In Indonesia, a study was conducted to measure dietary practices among diabetic patients, which elaborated that the Indonesian people, preferred to consume high-fat foods which lead to an increased risk of CVD. 59 The trend of skipping breakfast has dramatically increased over the past 10 years in children, adolescents, and adults. 60 , 61 There is increasing evidence that skipping breakfast is related with overweight and other health issues. 62 In addition, frequent eating or snacking may also increase the body weight and risk of metabolic diseases. 63 , 64 Rimm 65 demarcated western and prudent dietary patterns. The prudent dietary pattern was characterized by increased consumption of fish, poultry, various vegetables and fruits whereas; the western dietary pattern was characterized by an increased consumption of processed and red meat, chips, dairy products, refined grains, and sweets and desserts. These patterns were previously associated with T2DM risk. The glycemic index is an indicator of the postprandial blood glucose response to food per gram of carbohydrate compared with a reference food such as white bread or glucose. Hence, the glycemic load represents both the quality and quantity of the carbohydrates consumed. 66 - 69 Another study conducted in Lebanon demonstrated direct correlation of the refined grains and desserts and fast food patterns with T2DM, however, in the same study an inverse correlation was observed between the traditional food pattern and T2DM among Lebanese adults. 70

Type 2 Diabetes Complications

DM is the fourth among the leading causes of global deaths due to complications. Annually, more than three million people die because of diabetes or its complications. Worldwide, this disease weighs down on health systems and also on patients and their families who have to face too much financial, social and emotional strains. Diabetic patients have an increased risk of developing complications such as stroke, myocardial infarction, and coronary artery disease. However, complications such as retinopathy, nephropathy, and neuropathy can have a distressing impact on patient’s quality of life and a significant increase in financial burden. The prevalence reported from studies conducted worldwide on the complications of T2DM showed varying rates. The prevalence of cataracts was 26-62%, retinopathy 17-50%, blindness 3%, nephropathy 17-28%, cardiovascular complications 10-22.5%, stroke 6-12%, neuropathy 19-42%, and foot problems 5-23%. Mortality from all causes was reported between 14% and 40%. 71 In a study, researchers found that 15.8% incidence of DR is in the developing countries. The prevalence of DR reported from Saudi Arabia, Sri Lanka, and Brazil was 30%, 31.3%, and 35.4%, respectively; while in Kashmir it was 27% and in South Africa it was 40%. The prevalence of DR 26.1% was observed among 3000 diabetic patients from Pakistan; it was significantly higher than that what was reported in India (18%) and in Malaysia (14.9%). 72 - 76 Studies conducted on diabetes complications in Saudi Arabia are very few and restricted. A 1992 study from Saudi Arabia showed that in T2DM patients; occurrence rate of cataract was 42.7%, neuropathy in 35.9% patients, retinopathy in 31.5% patients, hypertension in 25% patients, nephropathy in 17.8% patients, ischemic heart disease in 41.3% patients, stroke in 9.4% patients, and foot infections in 10.4% of the patients. However, this study reported complications for both types of diabetes. 77

Relation between Dietary Practices and Diabetes Complications

Interventional studies showed that high carbohydrate and high monounsaturated fat diets improve insulin sensitivity, whereas glucose disposal dietary measures comprise the first line intervention for control of dyslipidemia in diabetic patients. 78 Several dietary interventional studies recommended nutrition therapy and lifestyle changes as the initial treatment for dyslipidemia. 79 , 80 Metabolic control can be considered as the cornerstone in diabetes management and its complications. Acquiring HbA1c target minimizes the risk for developing microvascular complications and may also protect CVD, particularly in newly diagnosed patients. 81 Carbohydrate intake has a direct effect on postprandial glucose levels in people with diabetes and is the principal macronutrient of worry in glycemic management. 82 In addition, an individual’s food choices and energy balance have an effect on body weight, blood pressure, and lipid levels directly. Through the mutual efforts, health-care professionals can help their patients in achieving health goals by individualizing their nutrition interventions and continuing the support for changes. 83 - 85 A study suggested that intake of virgin olive oil diet in the Mediterranean area has a beneficial effect on the reduction of progression of T2DM retinopathy. 86 Dietary habits are essential elements of individual cardiovascular and metabolic risk. 87 Numerous health benefits have been observed to the Mediterranean diet over the last decades, which contains abundant intake of fruit and vegetables. The beneficial effects of using fish and olive oil have been reported to be associated with improved glucose metabolism and decreased risk of T2DM, obesity and CVD. 88

The review of various studies suggests that T2DM patients require reinforcement of DM education including dietary management through stakeholders (health-care providers, health facilities, etc.) to encourage them to understand the disease management better, for more appropriate self-care and better quality of life. The overall purpose of treating T2DM is to help the patients from developing early end-organ complications which can be achieved through proper dietary management. The success of dietary management requires that the health professionals should have an orientation about the cultural beliefs, thoughts, family, and communal networks of the patients. As diabetes is a disease which continues for the lifetime, proper therapy methods with special emphasis on diet should be given by the healthcare providers in a way to control the disease, reduce the symptoms, and prevent the appearance of the complications. The patients should also have good knowledge about the disease and diet, for this purpose, the health-care providers must inform the patients to make changes in their nutritional habits and food preparations. Active and effective dietary education may prevent the onset of diabetes and its complications.