You are what you eat. Most of us have heard this old and simple, yet quite apt phrase. It has become more important than ever to seriously reflect upon this saying as it underscores that the food we eat determines the state of our heath. Alarm bells have been ringing on the ever increasing rates of overweight/obesity and Non-communicable Diseases (NCDs.) According to the Global Burden Disease study by the World Health Organisation (WHO), 70 percent of all deaths are due to the NCDs, of which ischemic heart disease followed by stroke are the top two killers in the world. Diabetes and various forms of cancers are also among the main causes of death worldwide. Overweight and obesity enhance the risk of these killer diseases as they lead to adverse metabolic effects on blood pressure, cholesterol, triglycerides and insulin resistance. 

The NCDs are emerging as a leading cause of death in South Asia too. The on-going economic shifts, rapid urbanisation and globalisation have resulted in a phenomenon called ‘nutrition in transition’. A nutritionally poor diet comprising of refined carbohydrates, high saturated and trans fat, excess sugar and high salt intake combined with low intake of fruits and vegetables are constituting a deadly dietary cocktail that underlie these conditions. 

Appreciate tradition

Nepal is also mirroring the global and regional trends. According to the WHO estimates, more than half of all deaths in our country are also caused by the NCDs, most of which are occurring in people under 60 years. While Nepal has been grappling with high under nutrition and its consequences, the mounting NCD burden is also indicated by the Nepal Demographic and Health Survey 2016. Almost a quarter of men are suffering from high blood pressure and around a quarter of women are overweight or obese. Paradoxically, childhood under nutrition is also related to overweight, obesity and the NCDs later on in life. This dual burden of malnutrition exerts a huge pressure on the health system and dampens our economy by causing significant losses of productivity. These sobering facts warrant that good nutrition be promoted on all fronts as a preventive solution to curb the rising NCD epidemic.   

Both nutrition and NCDs are multifaceted issues with multi-sectoral responsibilities. Leaders, policy makers, experts and advocates gathered in Uruguay last month for a global NCD conference convened by the WHO. One key outcome of the conference has been an agreement for policy coherence across and between different sectors of the food system, from food production through to consumption. 

The agriculture sector has a tremendous role in the control and prevention of NCDs. Healthy and sustainable diets need to be provided to people throughout their lives by increasing the availability and accessibility of safe, sufficient, diversified and nutritious foods. As such, the nutritional value of traditional and indigenous crops cannot be undermined. They need to be revived and boosted. 

Efforts to tackle under nutrition ultimately helps to curb NCDs also. The established link between breastfeeding and NCDs is one example. Breast milk not only provides a range of physical and cognitive benefits throughout childhood, but also confers protection against NCDs later in life. The declining breastfeeding rates in Nepal are thus a concern as much for reducing under nutrition as for curbing the NCDs. 

Walk the talk

People need to have access to information to make informed decisions and choices. The health sector needs to significantly invest in effective communication for behaviour change to promote nutritious dietary habits among the public. Many doctors, nurses and other health workers are found not to have adequate knowledge on nutrition. Hence, nutrition ought to be strongly reflected and sufficiently covered in the pre as well as in service curricula of medical, nursing and other health related courses. The health service providers should embrace comprehensive nutrition counselling as an integral part of the NCD screening and treatment. Health institutions including hospitals and medical colleges should ‘walk the talk’ by ensuring that the foods available within their premises are healthy and nutritious. 

The education sector has a role in imparting knowledge about good nutrition through systematic inclusion in the curriculum. At the same time, the education institutions must also practice what they preach. Preschools, schools, colleges and universities have a moral responsibility to promote and provide nutritious foods in their meals and strongly deter unhealthy options within their premises. 

The private sector, including food industries, media and markets, has a social and ethical responsibility to produce, provide and promote foods that support a nutritious diet. Corporate houses should also embrace nutrition in their policies and practices ranging from adequate breastfeeding support to female employees to provisioning healthy meal services in the workplaces. 

The general public also has a responsibility to actively seek a better understanding of dietary implications and opt for healthier choices. Demand from consumers can put pressure on the retailers and wholesalers to provide nutrient dense options, thereby stimulating increased production and availability of such foods. 

There is a dangerous trend of normalisation and glorification of junk food. Children and adolescents are especially drawn to such food and this is bound to have catastrophic health consequences for the younger generation. Uncontrolled production and consumption of such foods needs to be curtailed by introducing policy measures such as high taxation and limitations in imports and sale. Aggressive marketing and promotion should also be brought within the legal purviews. 

Production and promotion of nutrient dense food varieties on the other hand deserve to be truly glorified, highly encouraged and even incentivised. There are plenty of nutrition wisdom in Nepali dietary tradition which need to be recognised and embraced. 

An enabling policy environment exists to prioritise nutrition actions to prevent NCDs. The 2030 Agenda for Sustainable Development includes NCD (target 3.4) which is a valuable opportunity to garner more attention. Several global and regional WHO policy frameworks on NCDs highlight nutrition as one of the key priorities. Nepal has also developed a Multi-sectoral Action Plan for the Prevention and Control of NCDs with promotion of good nutrition as a strategic approach. Implementation must gain momentum. Intra-sector, inter-sector as well as multi-sector synergies as envisioned by the plan need to be accelerated.  

The grave challenge posed by NCDs is nothing less than an impending pandemic. Good nutrition is urgently calling on policy makers, implementers, private sector, farmers, wholesalers, retailers and the general public to embrace it from all around. After all, we are what we eat and we need to eat well to be well. 

- Uprety is a nutritionist and can be reached at [email protected]