Dire Diets! The Third World is slowly escaping poverty. But some regions are seeing bizarre new health trends, according to one woman researcher based in Beirut. By Jeremy Torr. 

Lebanon, 27 May 2012. There is a place on the border between Lebanon’s and Israel called Tyre, well known to anybody that studies either antiquity or the Christian bible – and to Hala Ghattas, a researcher into diet and health in under-developed regions. Tyre has been inhabited for millennia, and its cultural heritage has spread across the modern world in the shape of trading routes, special dyes and the art of navigation. Today, however, it is a shadow of its former self. Lots of tobacco farmers scratch a living in temporary-looking houses, under constant threat of military action across the still-tense border.

Thanks partly to the presence of minefields cutting into available arable and grazing land, only about half the population has enough to eat. According to Ghattas's recent study at the American University of Beirut, many families often spend a complete day without food, or go to bed hungry, and over a quarter of children under five are too short for their age—a classic symptom of malnutrition. But bizarrely, this malnutrition goes hand in hand with another common health problem in the area – obesity or being overweight.

According to Ghattas, the region suffers from a triple burden of malnutrition: energy deficiency, micronutrient deficiency and energy excess. This, it appears, is not uncommon in food insecure subpopulations including emerging countries in SE Asia, but nowhere as quickly as in the Arab world. Between 15% and 25% of Arab children under five are too short for their age and between 5% and 15% are underweight. Even though the quick and easy answer is that obesity exists principally among the regions' rich communities, with malnutrition and hunger among among the transient and poor. But the study reveals that obesity and malnutrition can exist in the same community and even in a single person.

Huge yet hungry

This seemingly direct contradiction is brought about by outside influences making a rapid and significant change in available foods and hence diet. “Significant reductions in fruits, vegetables, meat and dairy with increasing severity of food insecurity mean compromises in terms of food safety as well as dietary diversity,” notes Ghattas. “The way the body reacts to a changing diet means if a female is malnourished in the womb or during the first two years, her metabolism will change permanently.”

The adult woman's survival system will make sure she puts any surplus calories on as fat, no matter what she eats. If in later life her diet changes she is likely to put on weight – even as her children, who do not have the same mechanism yet embedded, become malnourished. In addition, the poor diet that often comes with food insecurity - lots of calories but not many micro-nutrients, such as iron or vitamins – can lead to typical malnourishment problems such as anaemia or blindness. As countries move from extreme poverty to middle-income status, this move from starvation rations to calorie-rich, nutrition-poor diets has become more common. They are simultaneously over- and underfed: too many calories, not enough micro-nutrients.

Conflict and migration

Ghattas says the problems can be helped by looking out for the issues that bring this peculiarly bad combination. “These include areas where food insecurity is impacted by conflict, changes of access to land, or even migration leaving less-capable bodies behind to farm traditional lands,” she notes. It also helps to look at issues such as education, gender and chronic disease which can all give predictors to the obesity/malnutrition syndrome. And lastly, recognising populations, or sections of any community, that manifest aspects such as low dietary diversity, stunting, and unusual overweight or obesity trends. She adds that programs that offer nutrition education, improved access to health care and education, especially ones that target women, are the best approaches.

In some areas she studies, Ghattas says that the level of inequality is so wide that the poorest 20% of the population accounts for 7% of all consumption, while the top 20% accounts for over 43% of food eaten. “No matter what food prices are, some people will always be able to access food and some will keep falling below a certain threshold; these are the food insecure,” she adds.

Hala Ghattas's research focuses on maternal and child nutrition and its interactions with immunity, morbidity and mortality. She has worked in The Gambia, Zanzibar and Cote d'Ivoire, and is based in Lebanon, conducting research on the prevalence and determinants of food insecurity and malnutrition in marginalised populations and those vulnerable to emergencies and those living in conflict-prone areas.

For more information see http://www.slideshare.net/fsaw2012/session-3-b-hala-ghattas

Photos : Internet, J. Torr