A plethora of nutrition actors from all corners of the globe gathered in Nepal on 4─7th November to share stories, exchange tips and regroup about what is in store for the future. Nine years into the Scaling Up Nutrition (SUN) Movement, the SUN stands at a crossroads in an era when nutrition issues are more complex and intertwined than ever. Go universal? Formalize its regional presence? Place its constituent global network secretariats under one roof? These are just some of the questions that the SUN Movement is facing as numbers of undernourished and overweight people rise and the data suggests that these are two sides of the same coin. Countries and the nutrition community are sorting out how to tackle what is referred to as the ‘triple burden’ ─ undernutrition, micronutrient deficiencies plus overweight and obesity ─ cognizant that policies and paradigms need to be recalibrated and new stakeholders need to be involved. Most agree that collaboration and partnership are central to this tall task and embraced the 2019 SUN Global Gathering as a space to focus on the ‘how’.

The UN [Nutrition] Network (UNN) Secretariat took a graceful dive into the triple burden theme, organizing a workshop on day 2 where it gave the floor to government speakers from Africa, Asia and Latin America alongside international experts. Attracting over 100 participants, the session was a prime opportunity to present a newly released World Bank Report on obesity, which highlights the Health and Economic Consequences of an Impending Global Challenge. The World Bank representative also spoke about the need to build the evidence base as part of fortifying efforts that address overweight and obesity, such as the formulation of obesity policy at the country level.

Mr. Victor Aguayo, Global Chief of UNICEF Nutrition Programme, spurred a rich session of ‘real talk’ about the path taken in three countries. Keynote speaker, Hon. Dr. Azucena Dayanghirang, Executive Director of National Nutrition Council in the Philippines, proudly spoke about the sweetened beverage tax levied on 19 December 2017 through greater fiscal reform. The tax, formulated with technical assistance from UN agencies such as WHO, has resulted in marked declines in the sales of these beverages, as high as 18.1 percent observed for powdered teas between January 2018 and February 2017. She went on to explain that, in parallel, the beverage industry made positive shifts, taking measures to reformulate products with regular sugar (indigenous to the nation) instead of high-fructose corn syrup, decreasing portion sizes as well as conducting awareness-raising campaigns on healthy diets. For her, “the UN Network is needed as a value technical assistance provider to SUN Focal Points and nutrition coordination mechanisms, empowering them to mobilize various development actors towards global nutrition targets and outcomes.”

Ms. Cecilia Gamboa, Costa Rica National Policy Coordinator for Food and Nutrition in the Ministry of Health and National SUN Focal Point, complemented, indicating that it was a combination of good policies, efficient programmes (e.g. fortification of staple foods) and community educational centres which enabled them to virtually eliminate levels of undernutrition in Costa Rica, including anaemia. At the same time, she cautioned that overweight and obesity levels are on the rise, and the urgency to act in that sphere. She sees the “need to reassess national policies and structures, position obesity in the political agenda, articulate sectors and ministries, change menus in schools, etc.” as concrete steps to take moving forward.

Kenya’s Gladys Mugambi, Head of the Nutrition and Dietetics Unit in the Ministry of Health, SUN Government Focal Point and member of the SUN Executive Committee, echoed that interventions need to be backed by sound policy work, regulatory and M&E frameworks and guidelines, all elements of nutrition governance. Taking the fortification example, one strategy applied in the Kenyan context was to establish an alliance for the formulation of standards and guidelines to get all producers on board. The “need to understand what people are actually eating” is also critically important says Dr. Patrizia Fracassi, Senior Nutrition and Food Systems Officer at FAO, who underscored that “food systems is not just about farmers and consumers, but everything in between.”

Participants further plunged into the topic during interactive group work, moderated by UNN-REACH facilitators, that elucidated recurring themes and bottlenecks. In some countries, the emphasis remains on efforts to address undernutrition despite notable levels of overweight and obesity. Taboos about double-duty actions, such as breastfeeding, particularly how it is perceived as having sexual undertones, were cited as barriers that need to be overcome. Promising experiences from Sierra Leone were shared about leveraging traditional and religious leaders to change nutrition behaviours and eating practices. Similarly, they spoke about how men are being engaged to address misconceptions that ‘fat children are healthy and fat adults wealthy’. Others talked about emerging and perennial challenges, such as food labelling fraud, capacity constraints in food labs for quality assurance and nutrition education gaps.

While there are common threads, it was clear from the discussions that no two situations are the same. There is no magic bullet. Participants agreed on the need to root action in robust situation analysis and adopt context-specific solutions, including different approaches for rural and urban settings. So, the magic will likely come from multi-pronged approaches that are tailored to the context. Participants also recognized the potential of nutrition communications strategies, food legislation/regulations and M&E.

As the direct link between children who are stunted and later becoming overweight gains clarity, countries are veering into this new nutrition territory, but it is anything but straight forward. Image regarding socioeconomic status, gender barriers, food culture and fiscal incentives all factor into the equation. Reflecting on the workshop, Mr. Laurent Michiels from the UNN Secretariat recognizes “that the way to success is not really clear for most countries.” For this reason, workshops of this sort are imperative to helping countries and the greater nutrition community learn from one another and to minimizing the likelihood that the mistakes are repeated. Every moment counts in the lead up to the final decade of the 2030 Agenda.

To learn more, view the workshop presentations below.

Costa Rica presentation by Ms. Cecilia Gamboa, Costa Rica National Policy Coordinator for Food and Nutrition in the Ministry of Health and National SUN Focal Point

Kenya presentation by Ms. Gladys Mugambi, Head of the Nutrition and Dietetics Unit in the Ministry of Health, SUN Government Focal Point and member of the SUN ExCom

FAO presentation by Dr. Patrizia Fracassi, Senior Nutrition and Food Systems Officer