Too expensive for fifth of world: Study brands EAT-Lancet diet biased

08 Nov 2019 --- The universal diet recommended by the EAT-Lancet Commission on Food, Planet, Health that aims to address both human and planetary wellbeing is too expensive for 1.58 billion people. This is according to a study from the International Food Policy Research Institute (IFPRI) and Friedman School of Nutrition Science and Policy at Tufts. The diet in question recommends a high intake of starches, legumes and nuts, unsaturated fats, fruits and vegetables. Notably, it also prescribes moderate consumption of dairy and relatively low consumption of meat, eggs, fish and sugar. The researchers are now calling for a food system with policies protecting health and environmental considerations, as well as increased corporate responsibilities.

“The underlying rationale for this diet is evidence mostly linking adult diets to non-communicable diseases such as diabetes, cardiovascular disease and cancers. It should be acknowledged that that evidence is imperfect, somewhat controversial, and quite biased towards older adults in wealthier countries, rather than younger children in poorer countries, who need animal-sourced foods,” Derek Headey, study co-author and Senior Research Fellow at the International Food Policy Research Institute, tells NutritionInsight.

The EAT-Lancet Commission had also suggested that the diet could ensure that future food systems can sustainably and nutritiously feed the estimated population of 10 billion people in 2050. However, it is predominantly people in sub-Saharan Africa and South Asia – some of the regions with the highest projected population growth rates – that would be unable to afford the estimated US$2.84 daily cost of the diet.

In low-income countries, this cost amounts to amounts to 89 percent of a household’s daily per capita income, which is more than people can actually spend on food. Conversely, in high-income countries, the diet would cost 6 percent of per capita income, which is often less than what people now spend on food.

The research team also found that the EAT-Lancet diet was 64 percent more costly than the lowest-cost combination of foods that would provide a balanced mix of 20 essential nutrients. The EAT-Lancet diet has higher quantities of animal-source foods and fruits and vegetables than the minimum required for nutrient adequacy, and much higher quantities than are now consumed in low-income countries.

Inadequate basic income is a major health constraint, notes Headley.A deliberate omission
The original EAT-Lancet reference diet did not take cost into consideration at all. Headey notes that this wasn’t necessarily an oversight. “If there’s no cheap substitute for a healthy food, there’s no cheap substitute. Our results show that the diet doesn’t necessarily cost a lot in absolute dollar terms, it’s just that lots of people are just amazingly poor.” 

“Specifically, the World Bank poverty line is US$1.90 per day. No-one at that level could afford the EAT-Lancet diet. There are also some who are not poor by the World Bank’s yardstick, but who still don’t have enough to afford the EAT-Lancet diet,” he continues.

In Africa south of the Sahara, nearly 57 percent of people earn less than the local cost of the EAT-Lancet diet. This is also the case in some of South Asia (38.4 percent), Middle East and North Africa (19.4 percent), East Asia and Pacific (15 percent), Latin America and Caribbean (11.6 percent), Europe and Central Asia (1.7 percent) and North America (1.2 percent).

Headley adds that at the consumer level, inadequate basic income is a major health constraint. “In low-income countries, the cheapest EAT-Lancet diet costs US$2.40 a day, but if you don’t have that fund, all the nutritional advice in the world will not allow you to consume the diet. However, as income rises, it becomes less of a constraint. In other words, there are a lot of obese people in the world who could afford to purchase a healthy diet, but choose not to,” he notes.

Calls for stronger regulation
Headey continues that to fight obesity in high income countries, it is necessary to improve knowledge and information and make it easier for food companies to sell healthy foods and harder for them to sell unhealthy foods. However, for poorer countries, incomes need to be raised through some combination of short-run cash and food transfers, and through catalyzing sustained pro-poor economic growth, including via agricultural investments.

Looking forward, Headey strongly recommends that the global food system is shaped by health and environmental considerations, as well as private sector responsibility. “We also need a much stronger regulatory environment for consumers. We need to think about ways to promote the production and trade of healthy foods. At the moment, many governments invest in or protect sectors that are producing pretty unhealthy foods. Sugar is one of the most protected agricultural sectors in the world.”

He continues that in many countries, public resources are heavily biased towards cereals, with relatively little support for fruits, vegetables and pulses. Therefore, agricultural and food strategies need to be much more aligned to achieving nutrition and health objectives.

This is not the first time the EAT-Lancet diet has been met with controversy. Earlier this year, The World Health Organization (WHO) withdrew its endorsement following concerns about the impact of the diet on people’s health and livelihoods.

By Katherine Durrell