2016/12/01 by Barry M. Popkin · 323 citations
Agricultural and Biological Sciences · Environmental Science · Medicine · #Acceleration #Agriculture Sustainability and Environmental Impact #Biochemistry #Biology #Classical mechanics #Diet, Metabolism, and Disease #Dynamics (music) #Endocrinology #Food Industry and Aquatic Biology #Nutrition transition #Obesity #Physics #Transition (genetics)
paper · pdf · doi:10.1093/nutrit/nuw064
published in Nutrition Reviews 75(2), 73-82 (Oxford University Press)
openalex publication_date 2016/12/01 · openalex created_date 2025/10/10 · openalex updated_date 2026/08/06
Editor’s Note: In celebration of the 75th anniversary of Nutrition Reviews, the journal’s editors envisioned the publication of articles that examined the changing landscape of nutrition research and the food systems required to ensure sustainability of the global food supply that feeds the projected 9 billion people on earth. In this Perspective article, Dr. Popkin highlights the global nutrition transition that has been fueled by approximately 4 decades of research on food processing, preservation, and retail. This transition has also been influenced by changes in economic development and dramatic reductions in many communicable diseases (although new infectious agents have also been discovered) with a concomitant rise in chronic, non-communicable diseases that ultimately threaten the well-being of mankind. Whether research will allow scientists to reset the balance for our food supply remains unknown, but the editors of this journal believe that the forthcoming articles in 2017 and beyond will stimulate thought leaders to formulate solutions that will be our “moonshot” to ensure the production of quality food in a sustainable manner with minimal environmental impact to feed the growing population of the world. Naomi K. Fukagawa, MD, PhD Editor-in-Chief Over the past 2 decades a remarkable change in the way the world’s population shops and eats has occurred. Related to that has been a transformative change in the chain of food – from farm to fork – and the forces that control it. While most populations in the post World War II era consumed much of their diet in the form of home-cooked basic commodities – vegetable, tuber, or animal-source foods, this has shifted remarkably. Now it seems that the task of cooking has vanished from many households1 and the food consumed in much of the world is shifting from purchases made at local fresh markets to packaged and processed ready-to-eat or ready-to-heat food.2–4 The broader system that is defined by the activities, infrastructure, and people involved in feeding the global population (eg, the growing, processing, distribution, consumption, and disposal of foods) is referred to here as our “food system.” It includes the web of processes by which institutions, organizations, and individuals transform inputs into foods and individual ingredients into the food we consume (eg, seed, fertilizer, chemicals, and pharmaceuticals go into poultry which becomes chicken nuggets).5 All food systems interact with aspects of their environmental, societal, political, and economic contexts.6 A core element of all food systems is the “food supply chain” or “food value chain” through which food moves from farm to fork.7 Increasingly, environmental sustainability has become one of the major concerns related not only to our food system but also to our modern diet. In my opinion, it is clear that the modern diet must change, and with it our food system, if the human population is to reduce global emissions, cut water use, and enact many other agriculture-related changes that will foster a more sustainable food supply and a healthier population; however, there are key gaps in our knowledge, which are noted below. My opinions and ideas described herein were first realized while wandering through the modern retail stores of Asia and Africa – be they small convenience stores in villages, or large modern supermarkets, or mega-markets in larger cities. I later realized, the phenomenon I’d been observing had been documented by the agricultural economist Thomas Reardon,8–11 who was later joined by other agricultural economists as well as scholars from other disciplines as this present documentation shows. In my own research using 24-hour recall surveys in China in 2011 and Mexico in 2012, my colleagues and I found that large proportions of the foods consumed were packaged and processed. This knowledge allowed us to investigate the dietary intake side of this large growth of packaged and processed foods in the retail sector in other countries as well.4,12 The next major insight was gained by our work in the United States (and globally) aimed at understanding the enormity of the packaged/processed foods and beverages industry and the degree of processing under way. We found major shifts in the United States toward foods and beverages that were mainly ready-to-eat or ready-to-heat,2 marked differences in how various racial or ethnic groups purchased highly processed vs minimally processed foods and ingredients, and changing trends in the numbers of people who do and do not cook.3,13 This research has been accelerated globally by Carlos Monteiro and his team, who have highlighted the major roles that ultra-processed or highly processed foods have in modern diets.14,15 Finally, Thomas Reardon, Bart Minten, and others who have followed the food chain from the farm to the consumer in India, Bangladesh, and China showed that what farmers grow and to whom they sell is governed by the same economic actors as those seen in high-income countries like the United States for decades (eg, agribusinesses, retailers, food manufacturers, food service companies).25 They additionally highlighted a true transformation in how food is produced and handled throughout the global food system.25 The nutritional implications of the post World War II revolution in production and control of farming has led to a very different set of major actors affecting our diets. The implication of these changes is highly disputed. Some will say that processing has produced many positive improvements with minimal costs,16,17 while others will point out potential conflicts,18 and yet others will entirely disagree and feel that the modern processed food supply is a major cause of widespread poor health.14 No matter where the causal pathway lies, the world now faces far more obesity and diet-related noncommunicable diseases (NCDs) than in the past. Well over 2 billion individuals are overweight or obese, and most countries face higher mortality from these nutrition-related NCDs than from undernutrition and infectious diseases, which were the scourges of the past millennium. The modern agriculture system poses problems for the way countries must work to improve our diets. The text below takes us through the way our food system has rapidly changed and what this has done to our diet. The overview ends with a discussion of how some nations are attempting to meet their populations’ diet-related health challenges through regulation; however, since no country has reversed obesity rates to date, the global challenge remains immense. My purpose in writing this piece is to help the nutrition community understand (1) how rapidly the system underlying what we eat has shifted, (2) how these shifts are affecting human health across the world, and (3) how these changes have shifted the ways countries are attempting to encourage healthier diets using the policy options they have available to them. While the first self-service grocery market in the United States was Piggly Wiggly, the first major chain selling retail food nationally was the Greater Atlantic and Pacific Tea Company. At first, this chain sold only tea and coffee (before the 1900s), but over time it developed into the dominant full-service grocery store chain (the A&P) in North America.19,20 In Europe, stores such as Tesco in England and Ahold (which began as Albert Heijn) and Aldi in Germany emerged early in the 20th century.The density of European cities delayed the emergence of the larger supermarkets (and mega markets) and today’s mega-chains such as Walmart were mainly post–World War II phenomena. The two largest global companies, Carrefour and Walmart, started their major growth in the 1960s and 1970s, respectively.21 In the United States, the current dominance of the modern supermarket in the food system is very obvious.22,23 While small shops and other types of convenience stores abound and drug stores, gas stations, and other venues sell selected food and beverages, the bulk of purchases occur at grocery stores, supermarkets, and mega-markets for all racial and ethnic subpopulations.22,23 Reardon and others have documented the enormous growth of the retail food sector in Latin America. In 1990, only 15%–20% of all food purchases and food in-kind arrangements occurred at grocery stores, while fresh markets dominated the food purchases of the household, but this shifted dramatically during that decade. By 2000, 60% of the population’s share of pesos expended in cash and in kind for food went to supermarkets.24 Such changes have occurred much more recently in Asia.4,8,25–29 Reardon and others have defined 3 waves of food purchasing transformation in Asia, the first affecting Korea and Taiwan; the second reaching Indonesia, Malaysia, the Philippines, and Thailand; and the third, and most recent, affecting China and India.8,25 China’s transformation has not been dominated by Walmart and Carrefour, as seen in other parts of the world, but instead by chains from South Korea and Hong Kong and, most recently, by domestic clones of these stores.28,30 Yet, this major market looms large for all global food retailers. In Africa, growth in the retail sector has emanated more from South African chains that moved into urban centers on both sides of the continent.10,31 In 2 separate studies, my colleagues and I documented the components of the Mexican and Chinese diets that came from packaged and processed food. In both cases, we used 24-hour recall surveys – the 2012 National Nutrition Survey (ENSANUT) for Mexico and the 2011 China Health and Nutrition Survey for China.4,12 In each survey, we asked whether each food consumed came from a wrapped package or a container. In China in 2015, we went a step further and scanned the barcodes of all the food items in each household’s food storage facilities (unpublished data). Percentage of foods in China prepared at home, in restaurants, or prepackaged in 2011. Reproduced from Popkin (2014)4 with permission. Percentage of non-processed versus processed food consumed in Mexico in 2012. Reproduced from Popkin (2014)4 with permission. Having identified that consumption of packaged and processed foods has become more common, we now explore the more contentious question: What is the composition of this packaged and processed food, and is it healthful? There is a great deal of controversy about what people should eat. On one side are many who promote only so-called “real food,” encapsulated by Michael Pollan’s famous quotes: “Eat food, not too much, mostly plants”32 and “Don’t eat anything your great-grandmother wouldn’t recognize as food.” Scholars like Monteiro have promoted a similar diet, as seen in the Brazilian food guidelines.33 The Pan American Health Organization has adopted an approach to food labeling and diet promotion that is essentially based on Monteiro’s approach to food processing, with the idea of reducing what he called ultra-processed foods from the diet.34 The basic argument of Monteiro, Pollan, and many others is that we need to return to a diet based only on basic, unprocessed, or minimally processed food (such as flour and milk). For Brazil, a diet based on Monteiro’s philosophy would derive from a period in which the foods typically consumed were rice, beans, some fish and animal-source foods, and some fruit and vegetables. Is this realistic, or is this romanticism based on an earlier reality? Furthermore, within the modern food supply, which is highlighted below, can we turn back the clock and move to this type of diet, or do we need to work to get a more healthful supply of packaged and processed food while also promoting increased cooking and use of basic foods? The Global Food Research Program at the University of North Carolina is working with data sets of scanned food purchases for several countries. The segment on which my colleagues and I have focused particular attention is packaged and processed food for the United States. Jennifer Poti has essentially used product descriptions and ingredients to categorize 1.2 million unique packaged and processed foods from 2000 to 2012 into a food system quite comparable to Monteiro’s.2,3 In addition to noting the degree of processing, she also categorized food by convenience, in both cases based on detailed descriptors of each food and their ingredients. Both this system and Monteiro’s are different from the International Food Information Council approach, which has been adopted by the American Society for Nutrition and other organizations.16,17 These groups use a more simplistic way of categorizing foods and have not gone deeply into product composition or ingredients. Classifications system for degree of processing of food and beverage products. Data from Poti et al. (2015).2 Classification system for convenience of food and beverage products. Data from Poti et al. (2015).2 Trends in food and beverage CPG purchases by degree of processing. Data from Poti et al. (2015).2 Trends in food and beverage CPG purchases by level of convenience. Data from Poti et al. (2015).2 Most of the negative focus on food processing by journalists and scholars has focused on highly or ultra-processed food15,34,36,38 however, others are pushing for a greater shift from processed foods of all types toward real food, with the exception of classic methods of freezing, fermentation, and other types of minimal processing in order to preserve food and reduce food waste. Critical questions that are not addressed by these groups are the degree of processing, beyond minimal processing, that is necessary to save food from spoilage and waste, and if it is possible to transform a highly processed food supply into one that is both healthy and plentiful. In contrast, other organizations, including some that receive extensive food industry funding have been less critical of food processing.16,17 But there are many unanswered questions about the current and potential healthfulness of highly processed foods. 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