Unlocking the Key to Global Health: Shifting the Focus from Personal Choices to Collective Solutions

The world is facing a pressing issue: by 2035, over half of the global population may grapple with overweight or obesity if current trends persist. Additionally, a staggering 1.3 billion people worldwide could have diabetes by 2050, with type 2 diabetes being the primary contributor, driven by changes in obesity and dietary habits. These trends carry significant health, social, and economic consequences, particularly for lower and middle-income countries, which are expected to bear the brunt of the impact. Notably, individuals with obesity and type 2 diabetes experienced worse outcomes during the COVID-19 pandemic.

In 2018, The BMJ introduced "Food for Thought," a collection aimed at addressing critical questions about maintaining a healthy diet and preventing disease. This collection revealed that nutrition science faces challenges due to weak research, commercial influences, and conflicting media messages. Five years later, these challenges persist, and rates of cardiometabolic diseases, closely tied to dietary factors, continue to rise.

These global challenges remind us that what, where, and how people eat is not solely a matter of personal choice. Approaches that put the onus on individual responsibility and providing information are insufficient, especially in light of the cost-of-living struggles experienced worldwide. The emphasis on personal choice often leads to feelings of shame among those who cannot access or afford healthier diets and shifts the responsibility away from policymakers and industries to enact meaningful changes in regulation, marketing, and addressing social inequalities. In this context, new medical treatments for individual weight loss, such as semaglutide, have become available, but concerns arise regarding their high cost, limited accessibility, and the uncertainties regarding long-term use.

The Food for Thought 2023 collection (accessible at www.bmj.com/food4thought23) centers on the role of nutrition in the development, prevention, and treatment of cardiometabolic diseases. One recurring theme is the need to focus on the broader social, political, and economic factors that shape the food environment and the choices available to individuals.

Addressing Imperfect Evidence:

The evidence base for interventions to enhance cardiometabolic health is growing and diversifying, but in some emerging fields, applied research is not yet robust and consistent enough to guide unified guidelines. For instance, conclusive recommendations on non-sugar sweeteners are hampered by insufficient evidence, especially regarding long-term effects. Clinical trials examining the influence of manipulating the gut microbiome on disease-specific outcomes remain sparse.

Diet and Nutrition-Related Policies:

Population-level interventions play a crucial role in combatting cardiometabolic diseases, but disputes about food group definitions can hinder policy action. Some foods, like ultra-processed ones, are suggested to be addictive, providing a new avenue for policy intervention. There's a call for public health measures to reduce people's exposure to and consumption of such foods.

Population-Level Drivers:

Population-level factors are discussed in the context of non-alcoholic fatty liver disease, emphasizing the role of diet in its development and prevention through dietary approaches like the Mediterranean diet. The benefits of a healthy diet in reducing COVID-19 risk and severity, particularly among disadvantaged communities, are highlighted. Early childhood also presents opportunities for obesity prevention, but this shouldn't lead to complacency regarding policy action.

In conclusion, the narrative needs to move beyond individual choices and focus on addressing the structural drivers of cardiometabolic diseases at the population level. The Food for Thought 2023 collection outlines priorities, uncertainties, and next steps for addressing the dietary factors contributing to obesity, diabetes, and other cardiometabolic diseases. It's a call for a collective effort to create a healthier world. 

References:

Articles:

• "Food for Thought 2023: Challenges of obesity and type 2 diabetes require more attention to food environment." BMJ.com, 2023. Accessed 7 November 2023.
• "Putting nutrition education on the table: development of a curriculum to meet future doctors' needs." BMJ Nutrition, Prevention & Health, 2022. Accessed 7 November 2023.
• "Effect of the amount and type of dietary fat on cardiometabolic risk factors and risk of developing type-2 diabetes, cardiovascular disease, and cancer: a systematic review." Food & Nutrition Research, 2023. Accessed 7 November 2023.
• "Cardiovascular Disease and Nutrition." IntechOpen, 2019. Accessed 7 November 2023.

Websites:

• "The Role of Nutrition in the Development, Prevention, and Treatment of Cardiometabolic Diseases." Accessed 7 November 2023.
• "Global Burden of Disease Study 2021." Accessed 7 November 2023.
• "World Obesity Atlas 2023." Accessed 7 November 2023.