Malnutrition and Obesity: The Not So Unusual Combination

by Fiorenzo Conte

Malnutrition is the third cause of infant mortality and the third risk factor (i.e. it facilitates other diseases) worldwide. It is no wonder that malnutrition and the way to defeat this plague is the object of a heated debate. One simplisitc assumption underly many arguments about malnutrition: malnutrition is just the consequene of a lack of a diverse and sufficient diet. An article on The Economist explores the different factors that compose the nutrition puzzle so presenting a nuanced view of the matter. If it has the merit to shed light on one hand (e.g. it states clearly that it is not that there is not enough food to get around but is that it is unequally distributed globally) on the other it has the demerit to ignore what can be called the politics of undernourishment and malnutrition. This is clear in the following extract which presents an apparent puzzle: countries which have experienced a drastic economic and agricultural growth have  increased the number of people malnourished and obese at the same time.

Nutrition is also attracting attention because of some puzzling failures. In a few big countries, notably India and Egypt, malnutrition is much higher than either economic growth or improvements in farming would suggest it should be. India’s income per head grew more than fourfold between 1990 and 2010; yet the proportion of underweight children fell by only around a quarter. By contrast, Bangladesh is half as rich as India and its income per head rose only threefold during the same period; yet its share of underweight children dropped by a third and is now below India’s. Egypt’s agricultural value-added per person rose more than 20% in 1990-2007. Yet both malnutrition and obesity rose—an extremely unusual combination.

The failure to decrease the number of those malnourished despite improvements in agricultural outputs is defined as puzzling and the association between malnutrition and obesity is labeled as extremely unusual. This way of posing the issue has the consequence of presenting the problem as natural: it just happened. By so doing it obscures the social and political circumstances behind it. When one takes them into account it turns out that not only malnutrition and obesity can be associated but that the latter can cause the former. To understand how this happens it suffices to have a look at the example of Egypt.

A previous post presented professor Timothy Mitchel’s findings which point to the main culprits behind this phenomenon: social inequality and shifting consumption. To make a complex story short, the rise of an urban rich class determined a shift in consumption from staple food to meat. Their request, aligned also with the demand to accommodate the tourist industry’s needs, were accommodated by channeling more of the wheat produced in Egypt to feed animals. As a result the wheat for human consumption was to be imported. This increasing reliance on imported staple food ignited a vicious cycle whereby the trade deficit, consequence of the rising import of wheat, further aggravated the shift from a subsistence agriculture to an export oriented agriculture whose produces (e.g. grapes) catered mainly for the European markets. Needless to say the winners were the upper urban class who had access to the meat they wanted (thus becoming also more incline to obesity) whereas the losers were poor  (the majority of whom was landless) who remained vulnerable to the fluctuations of the international food market and therefore malnourished. This shift in production did not just naturally happened but it was facilitated by the interest of the US to find a market for the surplus wheat produced by its heavily subsidized farmers.

In sum, the Economist has the merit to illustrate that fixing malnutrition is no simple task because it requires a panoply of intertwined intervention; however it ignores those interventions which are needed to tackle to social determinant of malnutrition such more equal landholdings. And if these determinants are not taken into the equations the nutrition puzzle risk to remain unresolved.