Addressing China's Declining Health Culture

What if you could wave a magic wand and tell everyone how to eat?

That's exactly what Ms. Yuexin Yang, President of the Chinese Nutrition Society (CNS), did with the launch of a much overdue set of dietary guidelines for China in time for Nutrition Week, May 15-21. The new guidelines address the needs of a gigantic urbanizing population that is facing an obesity and diabetes epidemic, while also starting to incorporate sustainability concepts into the dietary agenda.

The China Nutrition Society conducts research about nutrition from around the world and adopts it to suit the current stage of development for China. For better or worse, the new guidelines are heavily influenced by the American food communication methods. A "food pagoda" imitating the food pyramid was introduced in 1997. This 2016 version introduces a new Yin-Yang plate that borrows from the United States' "My Plate" and is accompanied by a kid-friendly version of the pyramid in the shape of an abacus.

Since 1980, rapid urbanization and Westernization of China's diet have meant tectonic shifts in Chinese health. This generation growing up in concrete jungles have rarely seen real food growing in soil. China boasts the largest number of grocery stores in the world a short 20 years after the first supermarket opened in 1990. This generation has been raised on excessively processed food loaded with salt, sugar, fat and chemicals, such as fast food and sugary drinks.

Pastries and cakes have become a norm in a country that traditionally serves fruit, and where people don't bake.

The sad result is that China has the largest population living with obesity, according to a report by the Lancet Medical Journal. In a 35-year span, the rate of overweight Chinese children has skyrocketed from 5% to 20% -- as compared to the 17% of children aged 2--19 years in the United States. These outcomes, linked to changes in dietary habits, lead to costly economic burdens on China's health care system. Even though China has one-fifth of the world's population, it has a disproportionately large one-third of the world's diabetics.

To address this, the new dietary guidelines not only recommend daily exercise but also prescribe portion size recommendations for six different types of diets (pre-pregnancy, pregnant, nursing moms, infants, young children, elderly, and even vegetarian).

One weakness of such prescriptive methods is, however, the lack of ability to accurately measure what one eats across meals in a day, especially in a setting with shared dishes. Daily physical exercise is also suggested by the guideline.

The importance of dietary guidelines stretches much further than personal health alone. The consequences of the way we eat dramatically impacts water, land and energy resources. Surprising to most, food is also the single largest source of greenhouse-gas emissions [up to 30%]. Because China has a fifth of the world's population, the way Chinese people eat is a huge trigger point for climate change globally. Limiting red meat intake, reducing food waste, and improving agricultural efficiency can help China improve nutrition security but also help it meet its climate obligations internationally.

Although CNS doesn't specifically look at how diets affect environmental health, the new guidelines do support sustainability in three ways. (1) It emphasizes seasonal vegetables and fruits, which are more likely to be grown locally. Out-of-season foods take large amounts of resources to grow in hothouses and ship across the globe. (2) It discourages food waste. Researchers from Beijing and Stockholm suggest that approximately one fifth of food in China is wasted. This is equivalent to the water footprint of Canada or the total arable land of Mexico. A country such as the United Kingdom generates 10 percent of all emissions from food waste alone. And (3) it strongly advises the selection of fish or poultry over red meats. Lamb and beef are land-, water-, and emissions-intensive foods compared to the same nutritional value in plant-based foods.

The inclusion of sustainable concepts at all is quite remarkable given the large fight in the US over its 2015 dietary guidelines. Compared to the US Food and Drug Administration, CNS is a much smaller band of academics and nutritionists working with the Ministry of Health in Beijing. They have less food-industry pressures.

The key challenge for CNS is how to educate 1.4 billion people by translating these new guidelines into every mouthful. To do this, CNS is working with storytellers such as my non-profit JUCCCE, which launched the initiative "A New Way to Eat" in 2013 to teach Chinese kids to eat in a way that is good for them and good for the planet. The program playfully use games, kid-speak, and relatable "Food Hero" characters to show how eating well can keep you healthy.

To promote adoption of the guidelines, CNS is also heavily relying on social platforms such as WeChat, which now has over 500 million daily users -- more than the entire population of the U.S., Canada and Mexico combined.

Dietary guidelines are only a part of the journey to change an entire nation's eating habits. The Chinese population has shown itself to change behavior quite rapidly in response to food safety concerns, children's health needs, and opportunities to access a better quality of life. They eagerly seek the information to make better food choices. Food education is a great way to make Chinese individuals feel empowered to not only make a difference in their health, but also their world, with every bite they take.
