Healthier Diets Key To Reducing Obesity And NCDs: Says New WHO Report

A new WHO nutrition report highlights how healthier diets can combat obesity and leading noncommunicable diseases (NCDs) – suggesting that less consumption of free sugars, salt and saturated fat, particularly animal fat, will help reduce global trends of rising obesity, hypertension and cardiovascular disease.

But the report Essential Nutrition Actions – Mainstreaming Nutrition through the Life Course, steers clear of delivering recommendations on controversial policies that some nutrition advocates have said are needed to actually shift global diets to healthier foods – such as taxation of sugary drinks or graphic front-of-package labeling about unhealthy processed foods.

Graphic of a group of people eating food at a table
Photo: WHO

The report provides a broad compendium of guidance on nutrition and healthier diets at various stages of life, as well as in health emergencies. It brings together pre-existing WHO recommendations for combating obesity, hypertension and other NCDs, including advice to:

  • Reduce free sugars intake to less than 5% of total energy intake;
  • Limit salt intake to less than 5 grams a day;
  • Reduce fat intake to no more than 30% of total energy intake, saturated fats to less than 10% of total energy and transfatty acids to less than 1%;
  • Increase sodium intake to at least 3.5 grams a day;
  • Consume five portions of fruit and vegetables a day.

While recommending limited saturated fat intake, the report avoids reference to evidence about cancer risks from red meat and processed meat consumption, as reported in 2015 by WHO’s own International Agency for Research on Cancer (IARC). IARC described processed meat as “carcinogenic to humans” and red meat as “probably carcinogenic“.

Extensive guidance is, however, provided for well-tread health and nutrition strategies to address malnutrition and undernutrition, such as: vitamin and mineral supplementation of food staples; exclusive breastfeeding in the first six months of life; and safe drinking-water and sanitation to reduce diarrhoeal disease that can exacerbate  malnutrition; and breastfeeding in the first six months of life.

“Health services must integrate a stronger focus on ensuring optimum nutrition at each stage of a person’s life,” said a WHO press release, noting recent World Bank estimates that smarter investments in nutrition could save 3.7 million lives by 2025.

Diets Through the Life Course

In an interview on WHO’s Twitter channel, WHO’s Nutrition Director, Francesco Branca, director of WHO’s Nutrition Department, stressed the importance of fresh foods and plant-heavy diets at early childhood, adolescence and for older people.

“Good nutrition starts very early in life,” said Branca. In early childhood diets should be “mainly made of complex carbohydrates, not too much fat, particularly not the fat that comes from animal sources, and not too much  free sugars, the ones that you find in sugar sweetened beverages,” Branca added. Diets should also include “enough fruits and vegetables, five portions; as for animal foods, a little bit because we also have to be concerned about the impact that the diets we consume have on the environment,” he said.

An report last month by the Intergovernmental Panel on Climate Change (IPCC) put it more bluntly. The UN’s top body of climate scientists said shifting global diets away from red meat consumption and towards healthier plant-based alternatives is critical for combating climate change as well as halting land degradation so as to ensure long-term food system sustainability and food security.

Adolescents should reduce consumption sugar sweetened beverages and processed foods, Branca added. Adolescent girls, in particular, can benefit from folic acid and iron supplementation, which may also reduce health risks to their children, should they give birth.

Older people, in particular, should have “diets low in sodium, to protect from hypertension, and very rich in plant food, with adequate preparation. Sometime elderly do not have the opportunity to go out and do their shopping. We see a lot of elderly people who are malnourished,” he said.

For women, dietary consumption of phytoestrogens, from sources such as soy or flaxseed, may be helpful to combat menopausal symptoms as well as other NCDs. “People living in SE Asia consuming large sources of phytoestrogens through their lives seem to have an easier menopause,” Branca said. “Consumption of soy, flaxseed, may be important for prevention of cardiovascular disease and certain cancers.”  He noted that evidence of health benefits from food supplements, is not as robust.

Consumption of plant-based oils rich in unsaturated fats should be preferred throughout all life stages, Branca  noted, “because they have the least impact on our arteries” while consumption of industrially-processed trans-fats should be avoided altogether.

Fresh fruits and vegetables in Maldives market. Photo: WHO/V. Gupta-Smith

“You find some of these in prepackaged foods, we are trying as WHO to ask Industry to remove these toxic products from our foods, he said. In May, WHO Director General Dr Tedros Adhanom Ghebreyesus said that he had secured a commitment from leading food and beverage producers to phase out trans-fats by 2023. WHO estimates that consumption of industrial trans fat, commonly included in processed foods, leads to more than 500,000 deaths every year due to cardiovascular disease.

As for policy implications of the report, Branca said that it was important for governments to display leadership in “what the right diet is, informing consumers, creating and shaping the food environment.”  He noted that “some countries have established a tax on sugary sweetened beverages or clear packaging information,” although the report itself avoids mention of such  examples.

In its press release, WHO cited progress made over the past three decades in combating undernutrition, as reflected in a global decline in stunting (low height-for-age ratio) among children under 5 years old from 252.5 million children in 1990 to 149.0 million children in 2018. However, globally, the world now faces a “double burden” of malnutrition from inadequate food intake, as well as over consumption of unhealthy foods.

As a result, obesity is on the rise. Proportions of children considered overweight rose from 4.8% to 5.9% between 1990 and 2018, an increase of over 9 million children. Adult overweight and obesity are also rising in nearly every region and country of the world.  In 2016, some 1.3 billion people were considered overweight, of which 650 million (13% of the world’s population) were obese.

Obesity is a major risk factor for diabetes, says WHO, as well as for heart disease and stroke); musculoskeletal disorders such as osteoarthritis – a degenerative disease of the joints; and some cancers (including endometrial, breast, ovarian, prostate, liver, gallbladder, kidney, and colon).

Image Credits: WHO, WHO/V. Gupta-Smith.