Health consequences of the industrialised, globalised food system Kerin O’Dea, Director, Sansom Institute for Health Research, University of South Australia

The shape of things to come The cover of ‘The Economist’, December 13-19, 2003 The Age, 2006 Are we already there?

The Global Epidemic Obesity: The Global Epidemic WHO 1997 Obesity: The Global Epidemic WHO 1997

What has changed in the past 25 years? The social environment – increasingly ‘obesogenic’ ↑ sedentariness ↓ opportunities for exercise Central heating Urbanised living

What has changed in the past 25 years? The social environment – increasingly ‘obesogenic’ ↑ sedentariness ↓ opportunities for exercise Central heating Urbanised living Food supply, eating patterns  Portion sizes  Availability of energy dense snack foods and drinks  Free sugars in processed foods and drinks Sucrose, high fructose corn syrup

Average portion sizes in US takeaway outlets doubled between 1980 and 2000: 500 to 1200 calories Super Size meals can provide 2500 calories

Snack foods and sweetened drinks high in sugar and/or fat readily available in schools, workplaces, shopping centres, hospitals.

Low fat foods Low fat ‘fast foods’ are frequently high in refined carbohydrates – Sucrose, high fructose corn syrup Frequently marketed as ‘health foods’ – Muesli bars, ‘fruit’ bars May have more energy and higher energy density than unsweetened ‘full fat’ versions – Yoghurt

per 100g 425 KJ 1.4 g fat 16.5 g CHO per 100g 309 KJ 3.2 g fat 6.5 g CHO

How much sugar is in our foods?

The 21 st century food supply Highly processed – Breakfast cereals – high in free sugars – Snacks – can be ‘low fat’, but high energy – Promotion using unrelated ‘healthy’ images The illusion of variety Health claims Nutriceuticals – Enrichment with particular (popular) nutrients Fibre, omega-3 fats, folate, calcium, iron

“99% fruit ingredients” 72% sugars Image of fresh fruit Far higher energy density

“Nutritionism” Michael Pollan ‘The Omnivore’s Dilemma’ ‘In Defence of Food’ Processed, highly refined foods packed with additives – preservatives, stabilisers – popular selected nutrients - their source foods often unrecognisable! Fibre-enriched soft drinks Calcium-enriched fruit juice Iron and zinc enriched cereal products Creates an illusion of health Totally market-driven

The Michael Pollan solution When you walk down those many supermarket aisles filled with thousands of enticingly packaged processed foods

The Michael Pollan solution When you walk down those many supermarket aisles filled with thousands of enticingly packaged processed foods Don’t choose anything that your great great grandmother would not recognise!

The economics of industrialised food High fructose corn syrup and processed saturated fats are the cheapest source of energy available – Due to huge distortions in our industrial food system – Agricultural subsidies that help the food industry not the farmers

The economic arguments High fructose corn syrup and processed saturated fats are the cheapest source of energy available – Due to huge distortions in our industrial food system – Agricultural subsidies that help the food industry not the farmers Is this really what is driving the obesity epidemic? Consistent with poorer people being more obese Impact on type 2 diabetes and CVD?

The economic arguments High fructose corn syrup and processed saturated fats are the cheapest source of energy available – Due to huge distortions in our industrial food system – Agricultural subsidies that help the food industry not the farmers Is this really what is driving the obesity epidemic? – Consistent with poorer people being more obese Impact on type 2 diabetes and CVD? Uneven impact across society

Fresh fruit, vegetables Lean meat, fish Fats and oils Sugar flour Energy density (MJ/kg) $ per MJ Confectionary Poverty and the food supply Drewnowski and Darmon, AJCN, 2005

Impact of the food supply on risk of cardiovascular and related chronic diseas Impact of the food supply on risk of cardiovascular and related chronic diseases Disadvantaged sectors of society carry particularly heavy burden Rural and remote Indigenous communities – epidemic of obesity, and premature type 2 diabetes and related conditions including CVD, renal failure