Countries in East, South East and South Asia are facing all these issues to varying degrees, with obesity and diabetes major problems in China, Japan, Indonesia, Malaysia, the Philippines, Thailand and India.
All the aforementioned countries are struggling with anaemia in women of reproductive age, and childhood malnutrition is especially prevalent in Indonesia, Malaysia, the Philippines and India.
The annual report was published for the first time in 2014 by Nutrition for Growth (N4G), a partnership between the Japanese, UK and Brazilian governments that is supported by civil society organisations and philanthropic foundations.
At the first N4G summit in 2013, a Global N4G Compact was endorsed by 100 stakeholders — including governments, aid donors, civil society, the UN and businesses — who pledged over $4bn for nutrition-specific projects, and $19bn for nutrition-sensitive projects.
The report was created to track these commitments, as well as to provide comprehensive updates on the state of global nutrition.
Higher incomes, larger waistlines
All the countries experienced a rise in GDP per capita between 2014 and 2017, a factor that typically correlates with higher obesity rates.
While the incidence of diabetes and obesity between 2000 and 2015 grew in all seven countries, the increase was particularly steep in China, Malaysia and Thailand.
Within that period, the incidence of obesity among male children and teenagers aged five to 19 increased by 12.9% in China, 10% in Malaysia, and 10.5% in Thailand. This meant that of this demographic in 2015, 15.4% in China and Malaysia and 14.2% in Thailand were obese — the highest percentages among all seven countries.
While the figures for female children and teenagers in these three countries were markedly lower those for males, they were still the highest among the seven countries: 7.1% in China, 10.4% in Malaysia, and 8.7% in Thailand.
In adults aged 20 and above, the obesity rates rose by 8.6% to 13% among men and 9.1% to 17.9% among women in Malaysia, and 7.6% to 12.7% among women in Thailand. Once again, these were the highest obesity rates among all seven countries.
When it came to diabetes, men in China experienced the highest increase of 4% to 9.9% between 2000 and 2015. This rate of diabetes was second only to that in Malaysia, where 11.4% of men were reported as diabetic in 2015.
Among the seven countries, only Japanese women saw a decline in diabetes rates, from 5.6% to 5% within the same period.
You are what you eat
The limited availability of nutritious foods was one of the reasons for higher diabetes and obesity rates highlighted in the report.
In India and China, for instance, less than 25% of packaged foods carry a Health Star Rating of 3.5 or more, significantly lower than the 37% in Australia and New Zealand.
The report stated: "The results suggest a disparity between developed and emerging markets. On average across all nine markets (including the UK, US, Hong Kong, South Africa and Mexico), 31% of products have a Health Star Rating of 3.5 or more, meaning 69% of products did not meet the healthy threshold and are thus of relatively low nutritional quality."
In Indonesia and Malaysia, the rapidly rising volume of sugar consumption has been contributing to complications with diabetes and obesity.
Women and children
The incidence of anaemia in women of reproductive age was worryingly high across all seven countries, ranging from 14.9% in the Philippines to 51.5% in India. Pregnant women were the most severely affected, with the lowest incidence of anaemia in the Philippines at 30.3%, and the highest in India at 50.1%.
Malnutrition in children under five remained prevalent issues in Indonesia, Malaysia, the Philippines and especially India, which is home to the world's largest population of malnourished children (46.6 million stunted and 25.5 million wasted).
In 2013, 13.5% of children below five in Indonesia, 11.5% in Malaysia, 7.1% in the Philippines and 20.8% in India were considered wasted.
In 2015, 36.4% in Indonesia, 20.7% in Malaysia, 33.4% in the Philippines and 37.9% in India were considered stunted.
With the exception of Malaysia, however, these figures represented declines in the incidence of stunting in these countries between 2000 and 2015. Indonesia and India had shown the most improvement, with percentages of stunted children below five having dropped by 6% in the former and 16.3% in the latter.
In China, the incidence of stunting among children under five fell from 17.8% to 8.1% between 2000 and 2015. In Thailand, this figure dropped from 15.7% to 10.5%.
Indonesia, the Philippines and India had the highest rates of under-five mortality per 1,000 live births. 2017 data from the UN Inter-agency Group for Child Mortality Estimation 2018 showed that there were 25.4 deaths per 1,000 live births in Indonesia, 28.1 in the Philippines, and 39.4 in India.
However, as in the case of stunting in children under five, these figures represented gradual declines since 2014. Once again, Malaysia was the exception, with its rate of under-five mortality per 1,000 live births having seen a slow but steady increase since 2014, from 7.5 to 7.9.
Policy to prevent and protect
The improvements in childhood malnutrition in China could be partially attributed to government action to fight the problem.
Healthy China 2030, which was started in 2016, is the first national medium- to long-term strategic health plan, and "underlines the significant political will to enhance the health status of Chinese citizens".
This was followed in 2017 by a new National Nutrition Plan to 2030 that targets stunting, obesity, anaemia, breastfeeding, and folic acid deficiency among more vulnerable demographics.
The authors further stated: "The plan reinforces existing nutrition programmes benefitting infants, children, primary and middle school students, and pregnant women. It also proposes new interventions for people who are older, ill or living in poor areas.
"Given the historically unbalanced focus on rural populations, especially infants and children, another goal is to reduce the difference in height between urban and rural students."
The plan includes a healthy lifestyle campaign, nutrition monitoring, recommended dietary intakes and limits, nutrition labelling, and fortified food standards.
China has also taken a multi-sectoral approach, leading to changes in supply-side policy. The authors wrote: "The Food and Nutrition Development Outline 2014 — 2020 emphasises food quantity and quality equally, as well as innovation and the coordination of production and consumption.
"Meanwhile, agricultural policies are evolving — albeit slowly — to promote the evaluation of agricultural products’ quality and nutrition, as well as research on the impact of food processing, storage and transportation of nutrients."
In India, the government has developed a national nutrition strategy that draws on "district-specific nutrition profiles to enable diagnostic work and policy action to reduce inequalities and childhood stunting".
The national government also works closely with state governments to implement this strategy, and the FSSAI's continuous push for mandatory fortification of staples and essentials such as rice, wheat, salt, milk and edible oils plays a major role in efforts to lower the incidence of malnutrition in the country.
In Malaysia, the government has embarked on public-private partnerships with tech companies to develop apps designed to motivate the user to exercise, and facilitate better access to professionals such as personal trainers, nutritionists and healthcare workers.
Read the full report here.
