Syndemic, a new word for nutritionists • Thinking Nutrition

This word has most likely not yet been used in Portugal in the context of nutrition, but in times of climate emergency and obesity epidemic, nutritionists and the general population will hear more and more about the concept of Global Syndemic.

This is a concept that aims to describe the interdependence between obesity, malnutrition, and climate change, but before presenting the definition, we will describe some of its fundamentals.

Climate change as an influencer of food consumption

The links between predictable climate change and alterations in food production began to appear in reports from the IPCC (The Intergovernmental Panel on Climate Change), the United Nations body responsible for assessing and monitoring climate change, very early on.

In 1990, the first report already included a chapter dedicated to the consequences of the foreseeable increase in temperature and reduction in rainfall on food production. Today we know, for example, that an increase in temperature (between 3 and 4 degrees) could create microclimates favorable to the development of microorganisms in food and vectors that come into contact with food.

For example, an increase in temperatures favors the proliferation of some potentially toxigenic fungal species, including aflatoxin-producing species , which have the potential for acute and chronic toxicity.

Another relevant aspect may be the impact on the nutritional composition of some foods. It is estimated that the increase in carbon dioxide levels in the atmosphere impacts the nutritional composition of rice , specifically reducing its protein content and some vitamins and minerals, namely iron, zinc, and B vitamins.

In general, it is also estimated that climate change could contribute to a 3% reduction in global food availability per person, a 4% reduction in the availability of fruits and vegetables, and a 0.7% reduction in the availability of red meat .

Food consumption as an influencer of climate change

In Portugal, the National Council for the Environment and Sustainable Development (CNADS), a body under the auspices of the Assembly of the Republic, also addressed this issue very early on.

In July 2007, the Working Group on Environment and Health (GTAS), in an Opinion on food and air quality at the environment/health interface, produced what we can consider the first structuring document for strategic thinking on food and the environment in Portugal .

Among other recommendations, it was already pointed out that there was a need to "Better understand the energy inputs throughout the life cycle of food products consumed by the population and other information that helps to assess the environmental impact of the production, transport and consumption of different food products."

In other words, the CNADS document warned that, in addition to climate change potentially altering food production, current dietary patterns could also be a strong driver of climate change. However, at the time, we still needed more information to confirm this new paradigm, and in this respect, the teams led by Professor João Lavinha, coordinator of GTAS, were usually very cautious and evidence-based. This information has since accumulated at both national and international levels. Beyond this information on the impact of food consumption patterns on ecosystems, where beef consumption is paradigmatic (methane emissions from cattle raised for meat consumption increased by 48% in Portugal between 1990 and 2017), information has also accumulated on the relationship between climate change and the populations that will be most affected, both in terms of access to food and their living conditions .

In other words, the population in the worst economic conditions, where food insecurity is most prevalent and where the likelihood of malnutrition is highest, will also be the most affected by climate change, potentially starting an irreversible vicious cycle for billions of human beings.

This issue, regarding the prevalence of food insecurity determined by the social and economic conditions of the national population, had already been described during the economic crisis of 2011-2014. At that time, it was detected that the groups of the national population where the levels of food insecurity were highest were also, in some cases, the groups with the highest proportion of overweight individuals .

If these populations are also the most affected by climate change, the situation in Portugal will replicate what is already observed in other regions. In other words, social and economic factors could exacerbate the already existing pandemic synergy between malnutrition and climate change.

The concept of Syndemic applied to the field of nutrition

Based on these premises, the Lancet Commission on Obesity, led by Professor Swinburn, published the report "The Global Syndemic of Obesity, Undernutrition and Climate Change" , which introduces the concept of a Global Syndemic.

The word Syndemic or “synergistic epidemic” was used for the first time in the context of this report, to try to explain the synergy between the epidemics of malnutrition (obesity and undernutrition) and climate change. Two global-scale problems of a complex nature, with common social causes and determinants, and with consequences for human and planetary health. Both the origin and the difficulties encountered in halting the progress of these different pandemics have common causes.

But the concept of syndemic had already been used by other authors in the context of public health. This concept was proposed by several anthropologists in the field of medicine, and in particular by researchers at the CDC, and later very well described in the seminal text by Merrill Singer and Scott Clair in 2008, entitled “Syndemics and Public Health: Reconceptualizing Disease in Bio-Social Context” .

The novelty of this concept in public health was to bring to the discussion not only temporal variables or the co-occurrence of two or more diseases or health problems, but also the influence of the social context and its determinants on the expression of diseases. In the present case, and in this new interpretation, the Lancet experts adapt the concept mostly used to define synergies in the area of infectious diseases, applying it to the reciprocal interaction between pandemic problems on a global scale, such as obesity, malnutrition, and climate change.

Furthermore, it should be noted that these epidemics have mutual consequences for human health and the health of the planet, with the added complexity of social factors being able to intensely influence this complex web of relationships and consequences.

What determines the emergence of a Global Syndemic?

Reflecting on the origin of this Global Syndemic, the current food system model can be identified as one of the main determinants common to the various dimensions of this syndemic.

Food systems, due to their current configuration, which promotes intensive agriculture, animal protein production, or the massive transport of food through road systems, end up favoring the existence of processed foods with high energy density and low nutritional value at low cost, which fuel the obesity and malnutrition pandemics, but also generate 25-30% of greenhouse gas (GHG) emissions.

If this model of food production, consumption, and transportation accelerates climate change, then these changes, should they occur, will ultimately increase the risk of malnutrition among the most vulnerable populations, those with the least resilience to extreme weather events such as droughts, floods, or sudden changes in the prices of basic food products.

Source: The Global Syndemic of Obesity, Malnutrition and Climate Change – report by The Lancet Commission

According to the authors of this report, there are also common factors that have contributed to ineffective action in solving this problem. No country in the world has managed to effectively combat the problem of obesity.

"Political inertia," or the lack of political leadership and governance to implement effective measures in this area, the low pressure from civil society for political action, and the strong opposition to political measures motivated by economic interests, are factors that justify a weak fight against this Global Syndemic.

What can we do?

By highlighting the problem through its classification and the creation of this new concept, the aim is to contribute to a different and strengthened approach to it. An approach that considers the need for structural changes in food systems and the implementation of actions capable of providing mutual benefits for at least two of the dimensions of the Global Syndemic (double or triple-win actions).

This means that measures can and should be coordinated to combat these three pandemics simultaneously, combating malnutrition (obesity and undernutrition), protecting the environment, and not contributing to social inequalities. In other words, contributing to an idea of environmental protection that does not further increase the exclusion of the poorest, if these dietary practices are more expensive, difficult to access, or require a high level of literacy. Without being exhaustive, and by way of example, we identify some possible good practices in this area: