Positive Deviance and the Mediterranean Diet and Sustainability
Elliot M [email protected]
1
Sustainable Dietscase studies:
The Mediterranean Diet
School Interventions
Nutrition the fuel of a Nation
Well Fed Nation
Food Secure Nation
Healthy Nation
Productive, Resilient,
Sustainable Nation
Agriculture,Industry,
Human Capital
Nutrition, Food Security and Sustainability
Agriculture,Imports
Food Industry
Food Secure Nation
Food Loss
Food Waste
STABILITY
Well Fed Nation
Healthy Nation
Productive, Resilient, Sustainable Nation
Accessibility
Availability
Utilization
Household
Individual
National
TransportPhysical
Economic
Food Quality,Safety,
Sanitation &Health
SustainableDiets
SUSTAINABILITYEnvironment, Economy, Culture GENERATIONS
Availability
SUSTAINABILITYFOOD SECURITY
Socio-Cultural
Economy
Environment
Accessibility
Utilization
STABILITY
Natural Resources&
Climate
Person-Centered Global
after Berry et al. Public Health Nutrition, 2015
Sustainable Diets position Sustainability in the Food Security Pathway
SustainableDiets
SHORT
TERM
LONG
TERM
Positive Deviance and the Mediterranean Diet and Sustainability
Elliot M [email protected]
2
Poor People spend more proportionately on Food. This means less for health and education – thus increasing vulnerability
% of total household spending
Spen
din
g per p
erson
per w
eek on
foo
d $
Economist, 2013
Food insecurity , malnutrition andpoverty are deeply interrelated
UN Sustainable Development Goals 2015How many involved with Food Security?? Sustainable Development Goals 1 (adapted from FAO)
1. No Poverty – c80% of poor people live in rural areas
2. Zero Hunger – Enough food for all, but c800 million go hungry…
3. Good Health & Well-being – Good Health starts with Nutrition ( -9 months)
4. Quality Education – Nutritious food is critical for Learning
5. Gender Equality – Women produce ½ world’s food, but lack access to land
6. Clean Water & Sanitation – Sustainable agriculture and re-cycling addresses water scarcity
7. Affordable & Clean Energy – Modern food systems rely heavily on fossil fuels
8. Decent Work & Economic Growth – Agricultural growth in low-income economies can reduce poverty by half
9. Industry, Innovation & Infrastructure – Agriculture accounts for 25% of GDP in Developing Countries
Positive Deviance and the Mediterranean Diet and Sustainability
Elliot M [email protected]
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Sustainable Development Goals 2
10. Reduced Inequalities – Land reforms can give fairer access to rural land
11. Sustainable Cities and Commodities – Rural investment can deter unmanageable urbanization – 2/3 world population
12. Responsible Consumption & Production – 1/3 the food produced is lost or wasted
13. Climate Action – Agriculture is key to responding to climate change
14. Life below Water – Fish give 3bn people 20% of daily animal protein
15. Life on Land – Forests contain >80% of terrestrial biodiversity
16. Peace, Justice & Strong Institutions – Ending hunger can contribute to greater stability and peace
17. Partnerships for the Goals – To raise the voices of the hungry
ENVIRONMENTRegional
AVAILABILITYNational
ACCESSIBILITYHousehold
UTILIZATIONIndividual
STABILITY
SUSTAINABLE FOOD (SECURE) SYSTEMS & SD GOALS
Multi-Stakeholders: Government, Local Authorities, Farmers, Industry, NGOs,Academia, Civil Society … Consumers
THE CHALLENGE:How to MEASURE and MONITOR!!
Food Secure Vulnerability
Utilization
Stability
Individual
Household
National
“Short term”
Accessibility
Availability
Sustainable Food Systems and the SDG Goals
Waste
Loss
PhysicalEconomic
Aqua cultureAgricultural Production
Imports
Quality / SafetyQuantity
Health
SUSTAINABILITY GENERATIONS
“Long Term”
National Policyafter Berry et al, 2015, 2017
SDG 3Health &
Well-being SDG 6Clean water & Sanitation
SDG 12Responsible
Production & Consumption
SDG 15Life on Land
SDG 1No Poverty
SDG 14Life Below
Water
SDG 2Zero
Hunger
SDG 7Affordable & Clean Energy
SDG 13Climate Action
SDG 5Gender Equality
Example of a National Sustainable Food System : The “HOW”
1. Make Food System Sustainable along the entire food chain – from Production to Consumption; reduce food losses and waste
2. Strengthen Agriculture towards the best Sustainable practices
3. Protect the Right of All to healthful, nutritious & adequate food – Food Security
4. Monitor the safety of the food supply to be environmentally friendly and free of pathogens and pesticides
5. Legislate the Food Industry to produce minimally processed foods, with less added sugars, salt and additives. Incentives to produce healthy foods. Production & Marketing must be honest and transparent. No junk food marketing to children
6. School and Community Education on healthy life styles, nutrition, cooking (Mediterranean diet pattern), and EXERCISE
7. Promote access of healthy foods in restaurants & public places
Eating is not a list of do’s and don’ts but rather a pleasurable, tasty experience. Traditional and cultural preferences in food choices should be respected.
FAO, CIHEAM Technical Workshop, 2017
Positive Deviance and the Mediterranean Diet and Sustainability
Elliot M [email protected]
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Why the Mediterranean Diet???: the ONLY diet with scientific evidence for health benefits
• Decreased Overall Mortality (-9%)
• Decreased Cardiovascular Mortality (-9%)
• Decreased Incidence & Mortality Cancer (-6%)
• Decreased incidence Parkinson’s disease (-13%)
• Decreased Incidence Alzheimer's disease (-13%)
Sofi F, Cesari F, Abbate R, Gensini GF, Casini A. Adherence to Mediterranean diet and health status: meta-analysis. BMJ. 2008; 337:a1344
Bach-Faig A, Berry EM, Lairon D et al. Mediterranean Diet Pyramid Today. Science and Cultural Updates. Public Health Nutrition. 14 (12A): 2274-2284, 2011 Berry et al. Mediterranean diet pyramid today. Science and cultural updates. Public Health Nutrition 2011; 14: 2274-84.
Every Main Meal
Every Week
CulturalElements
MODERATION
Every Day
BiodiversitySeasonalityTraditional
Eco-FriendlyProducts
EVERY MAIN MEAL contains basic elements:
Cereals: 1-2s, preferably whole grain (processing removes fiber
and nutrients such as Mg, Fe, vitamins).
Vegetables: ≥2s, at least 1 serving consumed raw.
Fruit: 1-2s, as dessert.
Olive oil: central, principal source of lipids.
Emphasis on variety in colors & textures.
The pyramid “core” – plant-origin foods – for prevention of many chronic diseases and for weight control.
Berry et al. Mediterranean diet pyramid today. Science and cultural updates. Public Health Nutrition 2011; 14: 2274-84.
Food Pyramid vs Environment Pyramid
Barilla CFN
Positive Deviance and the Mediterranean Diet and Sustainability
Elliot M [email protected]
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Food Loss & Waste by Region
LOSS
WASTE
HIGHER IMPACT
• Healthy Diet, Healthy Caloric Intake, BUT
• Moderate Meat
• High in Dairy
• High in Fruit and Vegetables grown in GREEN HOUSE or AIR FREIGHTED
• High in Fruit and Vegetables grown in water stressed regions
LOWER IMPACT
• Healthy Diet, Healthy Caloric Intake,AND
• Low Meat
• Moderate Dairy
• High in Legumes and Pulses
• High in SEASONAL Fruit and Vegetables
Same Changes in Eating Patterns may have variable Environmental Impacts
Homo sapiens
Who-ever you are
Where-ever you live
What-ever you eat
The main storage fatty acid in
the human body
is
OLEIC ACID
Olive Oil, Almonds, Avocado
Berry, 1997
Oleic Acid is the link between the Socio-Biology and Culture of the
Mediterranean Diet
Mediterranean DietAVAILABLE
Mediterranean FoodEATEN
“Bottle Neck”ECONOMIC
SOCIO-CULTURAL
ChallengesToo Many Food Choices
Food PricesNO Time For Cooking
Women's Roles…EDUCATION
Positive Deviance and the Mediterranean Diet and Sustainability
Elliot M [email protected]
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These 10 Corporations Control Almost Everything We Buy
Industrial Corporations prioritise PROFIT, not public health
Select the Mediterranean country with the least
Obesity (in women >15 yrs) = FRANCE
Select the Mediterranean country with the
highest Global Nutrition Index = FRANCE (#2)
Determine the Diet & Lifestyle
Discover the Population Behavior
Design & Do CULTURALLY APPROPRIATE
interventions… BUT not so SIMPLE….
Situation is Dynamic, especially with problem of
Childhood Obesity… where HOLLAND is “best”…
Q: How could we apply PD to improving
Compliance to the Mediterranean Diet…???
Challenges for Adherence to MeDiet
1. Standardized Methodology for assessment (Sofi et al., 2013; Milà-Villarroelet al., 2011).
2. Cooking Skills transmission of culinary and traditional eating habits necessary to achieve a sustainable MEDIET : an indicator for example number of "traditional dishes" prepared/week?
3. Time constraints prevent spending too much on preparation & cooking meals. Working Women…
4. Demographic transition – family structure has downsized, less youngsters and more elderly
5. Economic changes from 1960s…Not all foods from the MEDIET pyramid are affordable
Possible Solutions to Improve Adherence to MEDIET
Updating the MEDIET and LIFESTYLE (MEDAL) to stimulate interest of the young in it as a contemporary, accessible, “fashionable” and sustainable healthy lifestyle. ROLE MODELS
More Education in schools, in nutrition, cooking skills and exercise, with easy, quick meal choices within the MEDIET
Social networking & web-based communication and information
Bringing more market produce into supermarkets –health aisles…
Effective labelling for consumers of principal foods groups of the MEDIET
Positive Deviance and the Mediterranean Diet and Sustainability
Elliot M [email protected]
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Promoting the Mediterranean Diet
Lifestyle:Interventions in Kindergartens &Junior Schools
Ronit Jakobovich, Asia Levita & Elliot M Berry in preparation, 2015
Maha Nubani PhD 2015. M Donchin, Ziad Abdeen & E M Berry
Changing Behaviours in EARLY CHILDHOOD – relevance for preventing Obesity and promoting the Mediterranean lifestyle
1890 Kindergarten CHILDREN aged 4-6 years
74 KINDERGARTEN TEACHERS
52 hour training Program
Intervention group: 1048 Children
42 Kindergarten teachers
Control group: 842 Children32 Kindergarten teachers
Evaluation after 9 months Intervention
Changes in Eating Habits
44
26
59
41
34
27
35
26
0
10
20
30
40
50
60
70
FRUITS VEGS
Pre Int Post Int
N Intervention 1048Control 842
19
39
7
74
18
47
19
45
0
10
20
30
40
50
60
70
80
SWEETS WATER
PRE INT POST INT
If a child can say to himself /herself:
“If I eat healthy food and do my physical exercises, then I’ll stay healthy”
Then, we have achieved our goal…
Conclusion:
It is possible to change behaviours towards a Mediterranean Lifestyle –
even in Kindergartens
Positive Deviance and the Mediterranean Diet and Sustainability
Elliot M [email protected]
8
An Intervention Program for Promoting Healthy Eating & Physical Activity among Palestinian Girls in Grades 4 & 5
Needs Assessment in 7 Intervention & 7 Control Schools
897 Pupils,
373 Teachers &
744 Mothers 2 Interventions of 10 months
Maha Nubani PhD 2015. M Donchin, Ziad Abdeen & E M Berry
Changes in Behavior: Nutrition and Activity
38.5
29.8
53.1 54.7
34.6
25.5
31.7
21
0
10
20
30
40
50
60
BREAKFAST F & V
PRE INT POST INT
16.5
34.7
61.2
28.9
13.6
31.9
13.1
30
0
10
20
30
40
50
60
70
PA TV
PRE INT POST INT
S
At 2 years follow-up, the programme is still running in 6 / 7 of the intervention schools, is being implemented in 5 / 7 of the control schools.
Additionally, several other schools are requesting to start the programme too…
SUSTAINABILITYof
PROJECT
Osnat KeidarFrom PhD Dissertation 2011
Health Promoting Schools - Improving Health & Hygiene in the Korogocho Slums of Nairobi, Kenya
They said it could not be done……
Positive Deviance and the Mediterranean Diet and Sustainability
Elliot M [email protected]
9
ToiletsBefore
After
Before After
Student BMI improved just through hand washing!!
*
*p<0.001
Education is THE number 1 Priority
Positive Deviance and the Mediterranean Diet and Sustainability
Elliot M [email protected]
10
Albert Einstein: "I fear the day when technology will outpace humanity. Then, the world will have a generation of idiots."
The curse of mobile phones…..
BUT…they are the future for Food Security!!! Survey Data, Health care and Farmer’s markets and more…
Berry’s ”E - Messages” for Public Health Nutrition by Sociotype
Individual / Health• EATING for ENJOYMENT • EXERCISERelationships• EMPOWERMENT• EQUITY, EQUALITYContext• EDUCATION• EMPLOYMENT• ECONOMICS• ENVIRONMENTAL ENGINEERING
David Ben GurionYotvata 1957
תצליחותתמידו תעיזו
Dare, Persist, Succeed
DO’s Fruits & vegetables –
5 portions daily –”colories”
“Biblico-Mediterranean” diet - Olive Oil
Sea Fish – twice a week
Spouse support & socialize (Family meals ENJOY!!)
Exercise –“Every step counts”
Practical Advice: 10 Lifestyle “Commandments”
DON’Ts
Smoke
Eat so much
Add salt (other spices OK)
Alcohol < 20-30 gm /day
Speed when driving
“Obesity is the price you pay for exceeding the feed limit…” - anonymous
“Is it on a disk?”
Positive Deviance and the Mediterranean Diet and Sustainability
Elliot M [email protected]
11
FOOD SECURITY (Public Health): Food should be AVAILABLE & ACCESSIBLE & ADEQUATE & ENJOYABLE
for ALL: MEDITERRANEAN LIFESTYLE
Four Final Thoughts:“Tell me your SOCIOTYPE” &
I will tell you How you COPE...
NUTRITION:“MODERATION in all things, including MODERATION”
(David Berry z”l)
SOCIOTYPE:...It is more important what comes OUT
of your mouth than what goes IN….. (Matthew 15.11)
COPING: (3-fold cord) How you cope is the life-long interaction between your
Genotype Phenotype [email protected]
Exercising at a RED Light
1 Hand squeeze
2 Isometric hand press
3 Stomach into Spine
4 Pelvic Floor - O Ring
CONCLUSIONS:FOOD SECURITY & INSECURITY
63
Life is in your hands….
“ Be the Change you wish to bring about”
M.K. Gandhi
Be a POSITIVE DEVIANT….
Positive Deviance and the Mediterranean Diet and Sustainability
Elliot M [email protected]
12
My Hero!“My inspiration are men and women whohave emerged throughout the globe, and whohave chosen the world as the theatre of theiroperations and who fight socio-economicconditions….who fight the suppression of thehuman voice, who fight disease, illiteracy,ignorance, poverty and hunger. Some areknown, others are not…”
Speech LSE, UK, 6th April 2000
Truth & Reconciliation Commission“The need for Understanding, but not for VengeanceA need for Reparation, but not Retaliation,A need for UBUNTU, but not for Victimization…”
Umuntu ngumuntu ngabantu
“What we need today, for the sake of survival of this planet, is long-term vision. Can governments whose very survival depends on immediate, extractive, short-term gain provide this?.....Our inability to live entirely in the present (like most animals do) combined with our inability to see very far into the future makes us strange in-between creatures, neither beast nor prophet. …We plunder the earth hoping that accumulating material surplus will make up for the profound, unfathomable thing that we have lost.”
Sustainability requires Vision AND Political Will …
Political Will + People’s Will = Sustainable Will
Isatou Jallow, Las Palmas, 2014
Born in The Gambia, former Chief of Women, Children & Gender Policy for the UN World Food Programme (WFP)
a major advocate for Gender Equality and the Empowerment of Women.
CONCLUSIONS:FOOD SECURITY
&INSECURITY
&SUSTAINABILITY
&SOCIOTYPE
=PUBLIC HEALTH NUTRITIONand be POSITIVE DEVIANTS
Food Security & Public Health Nutrition
A Well-Fed Nation
is a
Healthy Nation
is a
Productive Nation
Positive Deviance and the Mediterranean Diet and Sustainability
Elliot M [email protected]
13
Supplementary Reading List
1.Kafka: The Hunger Artist
2.Knut Hamsun: Hunger
3.Damon Runyon: A Little Piece of Pie
INDIVIDUAL / HEALTH:“Tell me what YOU eat and
I will tell you what YOU are”RELATIONSHIPS:“Tell me how a FAMILY eats and
I will tell you how it FUNCTIONS”
CONTEXT:“Tell me how a NATION eats and
I will tell you its VALUES”Do kids go to bed hungry??
= COPING with FOOD INSECURITY & SOCIAL JUSTICE& SUSTAINABILITY
The Sociotype & Coping with Food Insecurity
FOOD
CULTURE
↓↓
Jean Brillat-Savarin, 1825,
La Physiologie du Gout
“Tell me what YOU eat &
I will tell you who YOU are”
“Tell me how a FAMILY eats & I will
tell you how it
FUNCTIONS”
“Tell me how a NATION eats &
I will tell you its VALUES”
SOCIOTYPE▼
▼
Individual Health
Relationships
Context
Production: Where?
Washing-UpWaste, Re-Use,Activity
4. Post Meal:
3. THE MEAL: Which?, When?Where?, With whom?Quantity?, Duration?
1. Purchase: Where? How? What?How Often?
2. Preparation: Menu Planning, By Whom?, How?
The ANATOMY of a MEAL
Positive Deviance and the Mediterranean Diet and Sustainability
Elliot M [email protected]
14
Food Choices AestheticsSetting
TasteSmell
Price
Physiology: Hunger, Blood Sugar, Insulin
HabitsExperience
Determinants of Food Choices Food Culture: The Culinary Triangle: (Lévi Strauss & Leach)
Raw
RottenCooked
NatureCulture
Transformed
Normal
State of
Material
• Sushi (Raw),
• Smoked Salmon (Smoked),
• Chicken soup (Boiled),
• Mutton (Roast),
• Souffle (Cooked),
• Stilton / Gorgonzola Cheese (Rotten)
Air
SmokedWater
Boiled
Mediterranean Diet????
It is culturally unacceptable to lose
weight in Kumasi, Ghana….
… and other culture icons..
Pets of obese people are fatter than pets of lean
people….