Editing IPCC:AR6/SRCCL/Chapter-5 (section)

==== 5.1.2.2 Food insecurity status and trends ====

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In addressing food security the dual aspects of malnutrition – under-nutrition and micro-nutrient deficiency, as well as over-consumption, overweight, and obesity – need to be considered (Figure 5.2 (g) and Table 5.2). The UN agencies’ State of Food Security and Nutrition 2018 report (FAO et al. 2018 <sup>[[#fn:r22|22]]</sup> ) and the Global Nutrition Report 2017 (Development Initiatives 2017 <sup>[[#fn:r23|23]]</sup> ) summarise the global data. The ''State of Food Security'' report’s estimate for undernourished people on a global basis is 821 million, up from 815 million the previous year and 784 million the year before that. Previous to 2014/2015 the prevalence of hunger had been declining over the last three decades. The proportion of young children (under five) who are stunted (low height-for-age), has been gradually declining, and was 22% in 2017 compared to 31% in 2012 (150.8 million, down from 165.2 million in 2012). In 2017, 50.5 million children (7.5%) under five were wasted (low weight-for-height). Since 2014, undernutrition has worsened, particularly in parts of Sub-Saharan Africa, south-eastern Asia and Western Asia, and recently Latin America. Deteriorations have been observed most notably in situations of conflict and conflict combined with droughts or floods (FAO et al. 2018 <sup>[[#fn:r24|24]]</sup> ).

Regarding micronutrient deficiencies known as ‘hidden hunger’, reporting suggests a prevalence of one in three people globally (FAO 2013a <sup>[[#fn:r25|25]]</sup> ; von Grebmer et al. 2014 <sup>[[#fn:r26|26]]</sup> ; Tulchinsky 2010 <sup>[[#fn:r27|27]]</sup> ) (Table 5.2). In the last decades, hidden hunger (measured through proxies targeting iron, vitamin A, and zinc deficiencies) worsened in Africa, while it mainly improved in the Asia and Pacific regions (Ruel-Bergeron et al. 2015 <sup>[[#fn:r28|28]]</sup> ). In 2016, 613 million women and girls aged 15 to 49 suffered from iron deficiency (Development Initiatives 2018 <sup>[[#fn:r29|29]]</sup> ); in 2013, 28.5% of the global population suffered from iodine deficiency; and in 2005, 33.3% of children under five and 15.3% of pregnant women suffered from vitamin A deficiency, and 17.3% of the global population suffered from zinc deficiency (HLPE 2017 <sup>[[#fn:r30|30]]</sup> ).

Globally, as the availability of inexpensive calories from commodity crops increases, so does per capita consumption of calorie-dense foods (Ng et al. 2014 <sup>[[#fn:r31|31]]</sup> ; NCD-RisC 2016a <sup>[[#fn:r32|32]]</sup> ; Abarca-Gómez et al. 2017 and Doak and Popkin 2017 <sup>[[#fn:r33|33]]</sup> ). As a result, in every region of the world, the prevalence of obesity (body mass index &gt;30 kg m <sup>–2</sup> ) and overweight (body mass index range between normality [18.5–24.9] and obesity) is increasing. There are now more obese adults in the world than underweight adults (Ng et al. 2014 <sup>[[#fn:r34|34]]</sup> ; NCD-RisC 2016a <sup>[[#fn:r35|35]]</sup> ; Abarca-Gómez et al. 2017 <sup>[[#fn:r36|36]]</sup> and Doak and Popkin 2017). In 2016, around two billion adults were overweight, including 678 million suffering from obesity (NCD-RisC 2016a <sup>[[#fn:r37|37]]</sup> ; Abarca-Gómez et al. 2017). The prevalence of overweight and obesity has been observed in all age groups.

Around 41 million children under five years and 340 million children and adolescents aged 5–19 years were suffering from overweight or obesity in 2016 (NCD-RisC 2016a <sup>[[#fn:r38|38]]</sup> ; FAO et al. 2017 <sup>[[#fn:r39|39]]</sup> ; WHO 2015 <sup>[[#fn:r40|40]]</sup> ). In many high-income countries, the rising trends in children and adolescents suffering from overweight or obesity have stagnated at high levels; however, these have accelerated in parts of Asia and have very slightly reduced in European and Central Asian lower and middle-income countries (Abarca-Gómez et al. 2017 <sup>[[#fn:r41|41]]</sup> ; Doak and Popkin 2017 <sup>[[#fn:r42|42]]</sup> ; Christmann et al. 2009 <sup>[[#fn:r43|43]]</sup> ).

There are associations between obesity and non-communicable diseases such as diabetes, dementia, inflammatory diseases (Saltiel and Olefsky 2017 <sup>[[#fn:r44|44]]</sup> ), cardiovascular disease (Ortega et al. 2016 <sup>[[#fn:r45|45]]</sup> ) and some cancers, for example, of the colon, kidney, and liver (Moley and Colditz 2016 <sup>[[#fn:r46|46]]</sup> ). There is a growing recognition of the rapid rise in overweight and obesity on a global basis and its associated health burden created through non-communicable diseases (NCD-RisC 2016a <sup>[[#fn:r47|47]]</sup> ; HLPE 2017 <sup>[[#fn:r48|48]]</sup> ).

Analyses reported in FAO et al. (2018) highlight the link between food insecurity, as measured by the FIES scale, and malnourishment ( ''medium agreement, robust evidence'' ). This varies by malnourishment measure as well as country (FAO et al. 2018 <sup>[[#fn:r49|49]]</sup> ). For example, there is limited evidence ( ''low agreement'' but multiple studies) that food insecurity and childhood wasting (i.e., or low weight for height) are closely related, but it is very likely ( ''high agreement, robust evidence'' ) that childhood stunting and food insecurity are related (FAO et al. 2018 <sup>[[#fn:r50|50]]</sup> ). With respect to adult obesity there is robust evidence, with ''medium agreement'' , that food insecurity, arising from poverty reducing access to nutritious diets, is related to the prevalence of obesity, especially in high-income countries and adult females. An additional meta-analysis (for studies in Europe and North America) also finds a negative relationship between income and obesity, with some support for an effect of obesity causing low income (as well as vice versa) (Kim and von dem Knesebeck 2018 <sup>[[#fn:r51|51]]</sup> ).

As discussed in Section 5.1.1.1, different methods of assessing food insecurity can provide differential pictures. Of particular note is the spatial distribution of food insecurity, especially in higher-income countries. FAO et al. (2018) <sup>[[#fn:r52|52]]</sup> reports FIES estimates of severe food insecurity in Africa, Asia and Latin America of 29.8%, 6.9% and 9.8% of the population, respectively, but of 1.4% of the population (i.e., about 20 million in total; pro rata &lt;5 million for US, &lt;1 million for UK) in Europe and North America. However, in the USA, USDA estimates 40 million people were exposed to varying degrees of food insecurity, from mild to severe (overall prevalence about 12%) (Coleman-Jensen et al. 2018 <sup>[[#fn:r53|53]]</sup> ). In the UK, estimates from 2017 and 2018 indicate about 4 million adults are moderately to severely food insecure (prevalence 8%) (End Hunger UK 2018; Bates et al. 2017 <sup>[[#fn:r54|54]]</sup> ). The UK food bank charity, the Trussell Trust, over a year in 2017/18, distributed 1,332,952 three-day emergency food parcels to people referred to the charity as being in food crisis. Furthermore, a 2003 study in the UK (Schenker 2003) <sup>[[#fn:r55|55]]</sup> estimated that 40% of adults, and 15% of children admitted to hospitals were malnourished, and that 70% of undernourishment in the UK was unreported.

In total, more than half the world’s population are underweight or overweight (NCD-RisC 2017a <sup>[[#fn:r56|56]]</sup> ), so their diets do not provide the conditions for ‘an active and healthy life’. This will be more compromised under the impacts of climate change by changing the availability, access, utilisation, and stability of diets of sufficient nutritional quality as shown in Table 5.2 and discussed in detail below (Section 5.2).

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'''Table 5.2'''

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'''Global prevalence of various forms of malnutrition.'''
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HLPE: High Level Panel of Experts on Food Security and Nutrition; SOFI: The State of Food Security and Nutrition in the World; GNR: Global Nutrition Report; MND: Micro nutrient deficiency (iron deficiency for year 2016, uses anaemia as a proxy (percentage of pregnant women whose haemoglobin level is less than 110 grams per litre at sea level and percentage of non-pregnant women whose haemoglobin level is less than 120 grams per litre at sea level).

* a Body mass index between 25 kg m <sup>–2</sup> and 29.9 kg m <sup>–2</sup> .
* b Body mass index greater than 30 kg m <sup>–2</sup> .
* c Prevalence of overweight/obesity among adults (age ≥18) in year 2016. Data from NCD Risc data source.
* d UNICEF WHO Joint Malnutrition.
* e In 2011.
* f Anaemia prevalence in girls and women aged 15 to 49.

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