Public health experts have called for a radical rethink of business models and food systems in order to tackle obesity, undernutrition and climate change. Governments must limit the political influence of powerful food and beverage corporations and prioritise the public good over commercial interests, according to a new report published by The Lancet Commission on Obesity in January. The report, which is the result of a three-year project led by 26 experts from 14 countries, says that three pandemics – obesity, undernutrition, and climate change – represent “The Global Syndemic”, with rising rates of obesity and greenhouse gas emissions, and stagnating rates of undernutrition. This syndemic “represents the paramount health challenge for humans, the environment, and our planet in the 21st century”. The authors argue that maligned economic incentives, lack of political leadership, and insufficient societal demand for change are preventing action. “At the moment economic incentives are driving us to over-produce and over-consume, leading to obesity and climate change,” said one of the Commissioners, Professor Corinna Hawkes from University of London. “At the same time many millions still do not have enough nutritious food, leading to undernutrition. It’s a warped system with an outdated economic model at its core,” she added.

The Commission identifies food and agriculture, transportation, urban design, and land use as the underlying drivers of “The Global Syndemic”. “Until now, undernutrition and obesity have been seen as polar opposites of either too few or too many calories,” said Commission co-chair Prof Boyd Swinburn of the University of Auckland. “In reality, they are both driven by the same unhealthy, inequitable food systems, underpinned by the same political economy that is single-focused on economic growth, and ignores the negative health and equity outcomes.” The authors write that food systems, for all their past successes in feeding human populations and improving their health and life expectancy, are now becoming more industrialised, globalised, and dominated by large actors capable of economies of scale and of maintaining long supply chains. Agricultural systems tend to favour energy-rich staple food production, without sufficient attention to nutrient-rich foods. Furthermore, ultra-processed foods are a key driver of the global obesity pandemic; nearly 2 billion people are overweight or obese. The food system is also driving severe environmental damage, contributing up to 29% of anthropogenic greenhouse-gas emissions and causing rapid deforestation, soil degradation, and massive biodiversity loss. The authors stress that a fundamental reorientation of food systems is required – “superficial repairs at the edges will not deliver the global outcomes needed for the 21st century.”

The Commission developed nine recommendations and more than 20 actions to tackle “The Global Syndemic”. They call for national and international governance levers to fully implement policy actions which have been agreed upon through international guidelines, resolutions and treaties. The authors propose a legally binding Framework Convention on Food Systems, similar to the UN conventions on tobacco and climate change, to support countries in drawing up sustainable and healthy food policies. Municipal governance and civil society engagement should also be strengthened to create pressure for policy action at all levels. The report also recommends to reduce the influence of large commercial interests in the public policy development process so that governments can implement policies in the public interest that benefit human health, the environment, and the planet. Governments should adopt and institutionalise clear, transparent, and robust guidelines on conflicts of interest. “Vested interests constitute a major source of policy inertia that prevents change to the existing systems. For example, national food producers and transnational ultra-processed food and beverage manufacturers often exert a disproportionate influence on legislators and the policy making process,” the report says.

Governments should also create sustainable and health-promoting business models to shift business outcomes away from a short-term profit-only focus. “To achieve this goal, first, national governments should eliminate or redirect subsidies away from products that contribute to The Global Syndemic towards production and consumption practices that are sustainable for human health, the environment and the planet.” Reducing subsidies to oil companies and large monocultural agricultural firms would allow subsidies to be directed towards innovations in clean energy and transportation and healthy, local food systems. In addition, economic systems need to be created that include the costs of ill-health, environmental degradation, and greenhouse-gas emissions in the costs of products.

Governments should also ensure information is readily available to consumers on the environmental footprints and health impacts of products. “People must be aware about the pros and cons of what they eat, and be encouraged to eat healthy food. Yet consumers often do not even know what they are consuming because labels do not provide understandable information,” writes José Graziano da Silva, Director-General of the UN Food and Agriculture Organization, in a comment. “Consumers must be empowered to make informed healthy dietary choices.” The authors expect that full disclosure would create a demand-driven pressure for businesses to shift to healthier and sustainable practices and products. “We need far-sighted policy makers and private sector leaders to drive forward actions that produce benefits for obesity, undernutrition, economy and sustainability,” says Prof Hawkes. (ab)