Reverse thinking: Taking a healthy diet perspective towards food systems transformations

This peer review paper argues that taking a healthy diet perspective, instead of a narrower production-focused approach, in food system transformation is essential to reverse current trends towards unhealthy and unsustainable diets and address the persistent problems of undernutrition and micronutrient deficiencies and the rapid rises in overweight and obesity and related NCDs.

The paper goes into detail to distil complex approaches to food system, dividing the paper into three sections: 

• Consumption of a healthy diet: trends and gaps, including:

  • Defining a healthy and sustainably diet

  • Food system types and dietary gaps

  • Consumption of healthy and unhealthy foods per food systems type

• Food environments, consumer challenges and trade-offs for achieving healthy and sustainable diets, including:

  • Challenges in the food environment, such as physical, economic, convenience, and marketing and promotional aspects aspects of food environments.

  • Challenges in individual food choices for healthy diets.

• Food systems innovations toward healthy diets, including:

  • Consumer-oriented innovations toward healthy diets, such as leveraging social norms to motivate healthy diets; digital interventions and social media; mobile nutrition services (m-Nutrition); and social marketing by the private sector

  • Market oriented innovation pathways toward healthy diets, such as food labelling interventions; advertising regulation; changes in default options and changes to the physical environment; taxes and subsidies; 

To ensure that a healthy diet perspective is taken into consideration in food systems analyses, intervention design and policy development, the authors make the following recommendations in the Discussion section:

1. Food systems analysis contributes to a more in-depth understanding of the availability, accessibility and affordability of healthy diets in each food system type to inform decision-making regarding context-specific food systems policies and interventions.

2. Food systems analysis identifies potentially conflicting or synergistic objectives across, or trade-offs between, multiple food systems actors, drivers and outcomes. Whereas the healthy diets objective seems well aligned with attaining environmental sustainability of food systems, other trade-offs may exist between desired healthy diets among consumers, economic objectives of producers and social objectives of governments, which all need to be weighed and managed carefully.

3. Food systems analysis should include the formulation of questions that challenge intrinsic assumptions regarding the relationship between food system components. A specific intervention in one of the components may have unintended consequences in another. These assumptions and consequences should be well understood and made explicit. For example, if behaviour change interventions are successful in catalyzing demand for specific nutritious foods (e.g. fruits and vegetables) and supply cannot increase to meet this demand, prices would increase with potential negative effects on diets among the poor or other disadvantaged populations.

4. Research investments are made in LMICs for testing interventions that are impactful in one food system type and for adoption and effectiveness assessment in another food system, for example nudges to drive healthier consumer choices should be adapted to, and tested in, countries characterized by a rural, traditional and emerging food systems typology.