The Lancet Commission on Obesity has the potential to help solve our global nutrition crisis, but its first report offers a dangerously flawed analysis of the so-called ‘Global Syndemic.’
Climate change, and malnutrition in all its forms, including obesity micronutrient deficiency, and undernutrition, are among the most serious threats to global health. They are also central to the realization of human rights, including the right to adequate food, and the right to health. The underlying causes of malnutrition are complex and multidimensional and the lack of access to nutritious food is often a key indicator of socioeconomic inequality, which undermines the right to adequate food. Climate change further erodes this right, while current food systems and industrial agricultural accelerate the disproportionate impacts of climate change on the most vulnerable. As hunger and malnutrition continue to rise, it is necessary to better understand the way in which nutrition and climate change interact with each other and the right to food, and how a human rights-based approach to food security may help find a solution.
The Lancet Commission on Obesity’s first report on obesity, undernutrition, and climate change, published on 27 January, seemed to present the perfect opportunity to further this conversation. The Lancet Commission on Obesity is “a joint venture between World Obesity, Auckland University, George Washington University and The Lancet.” The Lancet was initially formed as an independent, international weekly general medical journal, but has evolved into one of the foremost institutions addressing the most urgent topics in society. The Lancet’s commissions have helped to contextual emerging scientific principles and influence decision-makers and the general public around the world. In fact, only one week prior to the Lancet Commission on Obesity’s report, the EAT-Lancet Commission had published a separate report that garnered significant attention for its recommending lower meat consumption as part of a sustainable diet.
The Lancet Commission on Obesity, will therefore inevitably help to strengthen accountability and implement meaningful change in the fields of public health and nutrition. Its first report, “The Global Syndemic of Obesity, Undernutrition, and Climate Change,” does include important information about undernutrition, obesity, and climate change. Where the report goes wrong, however, is in its attempt to characterize the interrelationship of these three phenomena.
To start, the Commission decides to coin a new phrase to describe an already complex nexus of obesity, undernutrition and climate change: a “Global Syndemic.” The report explains that the original concept of “syndemic” has been applied to a clustering of diseases on an individual level, and has been expanded to the field of epidemiology to refer to certain aspects of environmental health crises. Never before, however, has climate change, obesity, and undernutrition been categorized as a “syndemic.” Even William Dietz, a co-chair of the commission reportedly acknowledged that the Commission “just chanced on it—I didn’t know what a syndemic was.” This admission begs the question, “why create a new ‘buzzword’?” It may fly among the scientific community, but it will not help the general public to a better understand an already complex, multi-faceted issue. The report discusses, at length, the importance of civil society engagement in calling for solutions to obesity, undernutrition, and climate change. But introducing an unfamiliar term, the meaning and application of which, is subject ofdebate, only serves to distance the general public from this important discussion.
This term also seems to box the Commission into an uncomfortable corner. Pursuant to their definition of the term, the Commission explains that obesity, undernutrition, and climate change share a set of underlying drivers, including “food and agriculture.” Indeed, agricultural production is a leading source of GHGs, which causes climate change, and yes, export-oriented agricultural policies and subsidies for commodity crops used to feed animals and not people, make it more difficult for people to access nutritionally-adequate food. But to characterize “food and agriculture” is a driver of these “pandemics” is simply misleading. The neoliberal economic policies that have helped shape the modern industrialized agricultural system are problematic; but, the promotion of alternative agricultural models, such as agroecology, and the diversification of agriculture are not only mitigating climate change, but are contributing to the universal realization of the right to food. The report fails to even mention agroecology, let alone offer it as a viable solution to the “Global Syndemic.”
The other identified drivers, “transportation systems, urban design, and land use” are described as interconnected systems. The report discusses impacts of poor land-use planning, lack of reliable public transportation, and thus, increased car use, and urban neighborhoods that are not conducive to outdoor physical activity. This discussion is entirely irrelevant to rural, and non-urban areas, where agricultural workers, for example, who are among the world’s poorest, often live and work to produce food for urban consumption. The explanation of these drivers does little to explain their application outside of higher-income countries, and in fact, the report acknowledges that “food swamps” and “food deserts” resulting from poor urban design and land-use are rare in cities in low-income countries. Merely recognizing this blind-spot does little to improve the report’s lack of universality. The report also neglects to mention the large-scale land acquisitions devoted not to food production, but to the production of biofuel. Despite posing as a mitigative strategy to reduce GHG emissions, biofuel has adverse environmental impacts and poses significant threats to small-holder farmers, and indigenous populations without formal land rights.
The report is perhaps most tone-deaf in its over-simplified discussion of obesity. From the outset, the report associates “micronutrient deficiencies” only with “undernutrition,” and not “obesity,” despite the fact that all three forms of malnutrition interact with each other. In trying to describe obesity and climate change as mutually reinforcing, the Commission admittedly struggled. Recognizing that these interactions are “also numerous but less certain,” the report proceeds to outrageously suggest that (a) rising temperatures could contribute to obesity through reductions in physical activity; (b) a growing, and increasingly obese global population will require more food, the production of which will result in higher GHG emissions; and (c) obese populations rely more on vehicle transportation that contributes to GHG emissions. To their credit, the authors recognize that this latter claim is problematic, not only because the added contribution of GHGs is relatively small, but also because it places blame on people with obesity for climate change. And yet, all three arguments remain in the report.
To be clear, obesity, undernutrition, and climate change are, unquestionably, interrelated, and the report strikes the right note when describing the effects of climate change on food systems, and how such effects impact the accessibility, availability, and adequacy of food. This is perhaps the most convincing explanation of the seriousness of undernutrition, an issue which plays second-fiddle to obesity throughout the report. But the report fails to effectively consider how human rights are not only relevant, but vital, to the discussion. The Commission explains that it “proposed the use of international human rights, and to apply the concept of a right to wellbeing, which encompasses the rights of children and the rights of all people to health, adequate food, culture, and healthy environments.” It doesn’t seem that this proposal was accepted by majority of the Commission’s members. The brief explanation of each of relevant human rights and passing references to human rights instruments appear out of place in a report that does not apply a human rights-based approach, amounting more to lip service than anything else.
The sought-after “double-duty” or “triple-duty” actions designed to simultaneously mitigate obesity, undernutrition, and climate change are not the equivalent of taking a holistic, human rights-based approach. Among the key recommendations is increasing demand for policy action by the public. The report fails to discuss widespread violation of the human right to freedom of association, which disproportionately impacts the most vulnerable populations and prevents inclusive decision-making and civil society engagement. The report encourages philanthropic investments to strengthen social advocacy and social lobbying of civil society, but does not discuss how the lack of social protections for populations that are most vulnerable to climate change, including women, agricultural workers, and migrants, perpetuates hunger, food insecurity, and malnutrition.
Nor does the report address the extraterritorial obligation of States to monitor the actions of transnational food and agricultural corporations. The report discusses at length the dangerous influence of “Big Food,” on consumption patterns, but it does not remind States and businesses to prevent, address, and remedy abuses, when this influence amounts to a human rights violation. The involvement of private-sector actors to address obesity, undernutrition, and climate change, is crucial and their contribution the “Global Syndemic” is tangible.
In light of these issues, is still paramount to recognize that States hold the primary obligation to respect, protect, and fulfil the right to food. This requires recognizing obesity, undernutrition, and climate change as interrelated issues and taking action accordingly. Unfortunately, the Lancet Commission on Obesity’s first report may not be the best resource for doing so. On the contrary, the report could be undermined by civil society, especially food sovereignty movements, subsistence farmers, and peasants’ organizations.
We have very little time to effectively address climate change, which is not only undermining the right to food, but the health and wellbeing of the global population. The “Global Syndemic” lens would have us change course to focus on obesity-reduction as a solution to climate change. Yes, obesity is a major problem, and efforts to combat malnutrition in all of its forms will help to promote policies that reduce GHG emissions. But despite the report’s suggestion, obesity cannot be the driving force behind our response to climate change and the threats it poses to human and planetary health.