The Poverty of Affluence

BMJ, 2023: Summary of potential factors and mechanisms linking ultra-processed food consumption with adverse cardiometabolic outcomes

Analysis

Food is our joy and our medicine. So important is it that the second of the United Nations’ Sustainable Development Goals is to end hunger, achieve food security and improved nutrition and promote sustainable agriculture. The Universal Declaration of Human Rights, too, provides for “the right to a standard of living adequate for the health and well-being of himself and of his family, including food….” Access to safe, nutritious, affordable and diverse food that does not damage earth’s natural systems in its production, assembly, transportation, and management of waste to maintain health for both people and the planet is a more comprehensive goal.

There is an expectation that developed countries are better placed to ensure the right to access nutritious and safe food, and to guarantee fair distribution. The excesses of affluent societies, however, have imposed stresses on communities which are gradually becoming recognised. As with any crisis, there is a storm of elements that have burdened some wealthy nations with chronic diseases and mental dis-ease.

Industry-level disincentives have created a failure in the system – particularly in the U.S. – to question the state of knowledge as to what provides for health and wellbeing: A drive for profitability at the expense of society at large; distorted and incomplete scientific understanding about macro-nutrient and eating pattern recommendations; and the historical impact and market distortion of government subsidies on agricultural production. These failures have created food deserts in some nations where there may be fast food outlets on every corner but no ready access to affordable or good-quality fresh food.

The damage done by UPFs (Ultra Processed Foods) at the population level as reported in the British Medical Journal in 2023 manifests in rising rates of obesity. As a comparison, the prevalence of obesity in the U.S. is currently at 42% of the population.

The overweight population in China in 2023 was around 35%, with obesity at 14% of the adult population. Across almost all age groups in China the burden has shifted from underweight dominance in 1990 to overweight dominance in 2022 as cited in the Lancet in 2024.

Type two diabetes is another health outcome of urbanization, diet and sedentary trends: 12% of the U.S. population has diabetes, but China has the highest number of diabetics globally with the China Diabetes Market Report: 2024-2032 stating that in the last 30 years, from less than 1% of the population, the level has increased to 12%, a direction which presents a gold mine for the diabetes therapeutics and diagnostics industries! Other outcomes of increased uptake of UPFs are hypertension, inflammatory and vascular diseases, cardio-vascular mortality, several cancers, depression and anxiety which are all blowing out the size and costs of medical industries and are the causes of much social disruption and human suffering.

The world has much to learn from the experience of living on the SAD (the Standard American Diet). The proportion of UPFs in the average American adult diet is 58% and for the Brits is 57% as reported in 2023. We are slowly building an understanding in nutritional sciences what good and bad dietary choices are doing to our health.

The nascent studies on the microbiome prove to be offering important insight into the relationship between physical and mental health and traditional foods as medicine. Although strong evidence is mounting, there is so much we are still to unpack in terms of how the changes to the food-matrix during processing affect health outcomes. Yet, we still feed our populations with food-like substances our great-grandparents would not have recognised, because it is cheap and hits the manufactured and aggressively marketed taste-bud bliss-point. Like many addictive, attractive and conveniently available substances, once hooked it is hard to come off the UPF diet, and more so if the average citizen is unaware of the dangers.

The South China Morning Post recently reported on “Poor Man’s”  meal choices in response to Chinese consumer spending cut-backs – one behavioural indicator of lack-luster economic circumstances. This has flow-on effects as businesses respond with budget offerings. On the face of it, low-price deals provide consumer choice, but provision of such options will prompt suppliers to make cuts along the supply chain.

This is of concern particularly in erstwhile well-to-do urban Chinese populations such as the GBA that have become acclimatized to industrialised fast-food offerings.

Not only are the chronic health problems looming around the corner from the increased uptake of those pseudo-foods, but of additional concern, the oversight and detection of dangerous substances in the enhancers, emulsifiers and many other chemicals the average person cannot remember, let alone pronounce, that are being incorporated to modern industrialised foods will be made far more difficult in such a market.

The history of food scandals in China (such as the tragedy of melamine in Sanlu Group’s milk) continues today with the latest uproar over the case of cooking oil logistics negligence as reported in the Times July 12. This does not bode well in a market where the consumption of UPFs is growing.  Worse, global trends suggest that in tough economic times cheaper processed foods become the choice for poorer segments of the community.

Chinese urbanites are noticeably dumpier than populations of neighbouring countries. Statistical evidence supports this observation and warns against unhealthy eating and lifestyle habits. More meat-based, fat-laden, salty and sweet foods in a diet will transition food preferences away from traditional, less-processed meals to fast-food options – an easy choice for people under economic stress and emotional pressure in urban centers where such foods are ubiquitous. UPFs are the new urban comfort food, without the effort.

The relationship between UPFs and the risk of being overweight in China is not straight forward. A 2023 study in the journal “Nutrients” provides evidence for women and adults living in small and medium-sized cities being at higher risk from weight-related outcomes from UPF consumption than the rest of the population but that there is still a general effect which should not be ignored.

Indeed, the increase in weight gain, chronic diseases and consumption of UPFs in urban China suggests lessons can be learnt from the outcomes and responses to the Standard American Diet and what can be gained from adherence to more traditional diets both locally and in the region.

As opined by academics at the Academy of Global Food Economics and Policy at China Agricultural University in the China Daily early this week, shifting food production focus “from merely ensuring food grain security to achieving overall food security, nutritional health, and green and low-carbon development…as well as fruits and vegetables and aquatic products” will nudge the overall system of food production to providing that access to safe, nutritious, affordable and diverse food to all segments of our community even when times are tough – if our tastebuds allow us.