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The Way We Eat Now
Bee Wilson


‘At no point in history have edible items been so easy to obtain. Humans have always gone out and gathered food, but never before has it been so simple for us to gather anything we want, whenever and wherever we want it, from sachets of squid ink to strawberries in winter.’‘It’s now becoming clear that the way that most people currently eat is not sustainable – either for the planet or for human health. If we want to stop getting swallowed up by our own food and to re-establish eating as something that gives us both joy and health, it makes sense to find out where we are right now, how we got here and what it is that we share.’Why does it no longer seem odd that we’re able to eat sushi in Italy and Neapolitan pizza in Dubai?What has happened to the food we eat to make this possible, and how have these blurred boundaries influenced cultural development, as well as national appetites?From bananas and grapes to ultra-processed snacks, we may not spend enough time thinking about the origins of the food we’re eating, or how their ingredients might have altered over time. In The Way We Eat Now, award-winning food writer Bee Wilson examines the current food climate, exploring how we have found ourselves here, and at what potential cost.The Way We Eat Now also introduces us to the countries and communities that are making revolutionary efforts towards improving their populations’ relationship with food, and considers how we too might re-establish a more balanced connection with what, as well as how, we eat.























Copyright (#ulink_5ea33d6e-af6a-5cb5-897b-4a959af50951)


4th Estate

An imprint of HarperCollinsPublishers

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London SE1 9GF

www.4thEstate.co.uk (http://www.4thEstate.co.uk)

First published in Great Britain by 4th Estate in 2019

Copyright © Bee Wilson 2019

Bee Wilson asserts the moral right to be identified as the author of this work.

Diagrams redrawn by Martin Brown

Cover photographs © Shutterstock

All reasonable efforts have been made by the author and the publisher to trace the copyright holders of the images and material quoted in this book. In the event that the author or publisher are contacted by any of the untraceable copyright holders after the publication of this book, the author and the publisher will endeavour to rectify the position accordingly.

A catalogue record for this book is available from the British Library.

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Source ISBN: 9780008240769

Ebook Edition © Jan 2019 ISBN: 9780008240776

Version: 2019-02-12




Dedication (#ulink_19e0fac6-41fc-56a0-8df7-ee7adfe724a6)


For Leo




Epigraph (#ulink_d7bc502e-3308-5062-a027-8926d4ec26bc)


‘Ever the eaters and drinkers, ever the upward and downward sun, ever the air and the ceaseless tides’

Walt Whitman, ‘Song of Myself’


Contents

Cover (#ue2251058-aa00-57d6-852a-2a6d843daf6d)

Title page (#u9745dc18-3f23-5c56-820f-d82a8468f59d)

Copyright (#ua2b4ff59-6d4f-550b-906a-6dd23ee7fae9)

Dedication (#ufc4d0a14-c443-5d4d-93fb-a00b4c0f65e2)

Epigraph (#u3758c699-141b-5754-8629-8d94749ccea9)

INTRODUCTION: The Gatherers and the Hunted (#uf810ee30-aeb6-5f10-91a9-829d44c012a9)

1: The Food Transition (#uc8c693e4-cdc4-5d8b-9d08-42b579e4ef08)

2: Mismatch (#uf1624efb-3b52-5b9b-bf3f-cdad56a205f6)

3: Edible Economics (#litres_trial_promo)

4: Out of Time (#litres_trial_promo)

5: The Changeable Eater (#litres_trial_promo)

6: Dinner Without Duty (#litres_trial_promo)

7: Eating by the Rules (#litres_trial_promo)

8: The Return to Cooking (#litres_trial_promo)

9: Crossing the Bridge (#litres_trial_promo)

EPILOGUE: New Food on Old Plates (#litres_trial_promo)

Footnotes (#litres_trial_promo)

References (#litres_trial_promo)

Bibliography (#litres_trial_promo)

Illustrations (#litres_trial_promo)

Index (#litres_trial_promo)

Acknowledgements (#litres_trial_promo)

About the Publisher (#litres_trial_promo)




INTRODUCTION: (#ulink_11e1b722-6dbf-5e60-b3e7-a3dcd8372b45)

The Gatherers and the Hunted (#ulink_11e1b722-6dbf-5e60-b3e7-a3dcd8372b45)


Pick a bunch of green grapes, wash it, and put one in your mouth. Feel the grape with your tongue, observe how cold and refreshing it is: the crisp flesh, and the jellylike interior with its mild, sweet flavour.

Eating grapes can feel like an old pleasure, untouched by change. The ancient Greeks and Romans loved to eat grapes, as well as to drink them in the form of wine. The Odyssey speaks of ‘a ripe and luscious vine, hung thick with grapes’. As you pull the next delicious grape from its stalk, you could easily be plucking it from a Dutch still life of the seventeenth century, where grapes are tumbled on a metal platter with oysters and half-peeled lemons.

But look closer at this bunch of green grapes, cold from the fridge, and you see that they are not unchanged after all. Like so many other foods, grapes have become a piece of engineering designed to please modern eaters. First of all, there are almost certainly no grape seeds for you to either chew or spit out (unless you are in certain places such as Spain or China, where seeded grapes are still part of the culture). Strains of seedless grapes have been cultivated for centuries, but it is only in the past two decades that seedless has become the norm, to spare us the dreadful inconvenience of pips.

Here’s another strange new thing about grapes: the mainstream ones in the supermarket such as Thompson Seedless and Crimson Flame are always sweet. Not bitter, not acidic, not foxy like a Concord grape, not excitingly aromatic like one of the Muscat varieties of Italy, but just plain sweet, like sugar. On biting into a grape, the ancients did not know if it would be ripe or sour. The same was true, in my experience, as late as the 1990s. It was like grape roulette: a truly sweet one was rare and therefore special.






These days, the sweetness of grapes is a sure bet, because in common with other modern fruits such as red grapefruit and Pink Lady apples, our grapes have been carefully bred and ripened to appeal to consumers reared on sugary foods. Fruit bred for sweetness does not necessarily have to be less nutritious, but modern de-bittered fruits tend to contain fewer of the phytonutrients which give fruits and vegetables many of their protective health benefits. Most of the phytonutrients in green grapes were in the seeds. A modern red or purple seedless grape will still be rich in phenolics – nutrients that reduce the risk of certain cancers – from the pigments in its skin. But green seedless grapes contain few of these phytonutrients at all. Such fruit still gives us energy, but not necessarily the health benefits we would expect.




The very fact that you are nibbling seedless grapes so casually is also new. I am old enough to remember a time when grapes – unless you were living in a grape-producing country – were a special and expensive treat. But now, millions of people on average incomes can afford to behave like the reclining Roman emperor of TV cliché, popping grapes into our mouths one by one. Globally, we both produce and consume twice as many grapes as we did in the year 2000. Grapes are an edible sign of rising prosperity, because fruit is one of the first little extras that people spend money on when they start to have disposable income. The year-round availability of grapes also speaks to huge changes in global agriculture. Fifty years ago, table grapes were a seasonal fruit, grown in just a few countries and only eaten at certain times of year. Today, they are cultivated globally and never out of season.




Almost everything about grapes has changed, and fast. And yet grapes are the least of our worries when it comes to food: just one tiny element in a much larger series of kaleidoscopic transformations in how and what we eat that have happened in recent years. These changes are written on the land, on our bodies and on our plates (insofar as we even eat off plates any more).

For most people across the world, life is getting better but diets are getting worse. This is the bittersweet dilemma of eating in our times. Unhealthy food, eaten in a hurry, seems to be the price we pay for living in liberated modern societies. Even grapes – so sweet, so convenient, so ubiquitous – are symptoms of a food supply that is out of control. Millions of us enjoy lives that are freer and more comfortable than those our grandparents lived, a freedom underpinned by the amazing decline in global hunger. You can measure this life improvement in many ways, whether by the growth of literacy and smartphone ownership, the spread of labour-saving devices such as dishwashers, or the rising number of countries where gay couples have the right to marry. Yet our free and comfortable lifestyles are undermined by the fact that our food is killing us, not through its lack but through its abundance – a hollow kind of abundance.




What we eat now is a greater cause of disease and death in the world than either tobacco or alcohol. In 2015 around 7 million people died from tobacco smoke and 3.3 million from causes related to alcohol, but 12 million deaths could be attributed to ‘dietary risks’ such as diets low in vegetables, nuts and seafood or diets high in processed meats and sugary drinks. This is paradoxical and sad, because good food – good in every sense, from flavour to nutrition – used to be the test by which we judged the quality of life. A good life without good food should be a logical impossibility.




Where humans used to live in fear of plague or tuberculosis, now the leading cause of mortality worldwide is diet.


Most of our problems with eating come down to the fact that we have not yet adapted to the new realities of plenty, either biologically or psychologically. Many of the old ways of thinking about diet no longer apply, but it isn’t clear yet what it would mean to adapt our appetites and routines to the new rhythms of life. We take our cues about what to eat from the world around us, which becomes a problem when our food supply starts to send us crazy signals about what is normal. ‘Everything in moderation’ doesn’t quite cut it in a world where the ‘everything’ for sale in the average supermarket has become so sugary and so immoderate. In today’s world, it can be hard to know how to eat for the best. Some binge; some restrict. Some put their faith in expensive ‘superfoods’ which promise to do things for the human body that mere food cannot. Others – this is how far things have gone – have lost faith in solid food altogether, choosing instead to consume one of the new meal replacement drinks: curious beige liquids which have become an aspirational form of nutrition.

To our grandparents, it would not have seemed credible for any hungry human to think that not eating was a better option than eating. But our grandparents never had to live and eat in such a bewildering food culture as ours.

At no point in history have edible items been so easy to obtain, and in many ways this is a glorious thing. Humans have always gone out and gathered food, but never before has it been so simple for us to gather anything we want, whenever we want it, from sachets of black squid ink to strawberries in winter. We can get sushi in Buenos Aires, sandwiches in Tokyo and Italian food everywhere. Not so long ago, to eat genuine Neapolitan pizza, a swollen-edged disk of dough cooked in a blistering oven, you had to go to Naples. Now, you can find Neapolitan pizza – made using the right dough blasted in an authentic pizza oven – as far afield as Seoul and Dubai. Thanks to the new home delivery apps such as Deliveroo and Seamless, we can have food from almost any cuisine on our doorstep in minutes.

The gatherers of the world never had it so good. In our hunter-gatherer past, if you wanted a taste of something sweeter than fruit, you called a group of brave comrades together and went on a long, perilous expedition, scrambling up rocks, hunting in crevices for wild sticky honey. Often, the honey hunters came back empty handed. Now, if you fancy a taste of something sweet, you head to the nearest shop with a little loose change. You do not come back empty handed.

The flipside of food being so easy to get is that it is also hard to escape.

We are the first generation to be hunted by what we eat. Since the birth of farming ten thousand years ago, most humans haven’t been hunters, but never before have we been so insistently pursued by our own food supply. The calories hunt us down even when we are not looking for them. They tempt us at the supermarket checkout and on the coffee shop counter. They sing to us in adverts when we switch on the TV. They track us down on social media with amusing videos that make us want even more. They sneak into our mouths as free samples. They console us for our pains, only to become the cause of fresh sorrows. They trick us by hiding in ‘healthy snacks’ for our children that are just as high in sugar as the ‘unhealthy’ alternatives.

Talking about what has gone wrong with modern eating is delicate, because food is a touchy subject. No one likes to feel judged about their food choices, which is one of the reasons why so many healthy eating initiatives fail. The foods that are destroying our health are often the ones to which we feel the deepest emotional connection because they are the stuff of childhood memories. Some say we should never speak of ‘junk food’ because it is a pejorative term to use about someone else’s pleasures. But when poor diets become the single greatest cause of death in the world, I think we are allowed to be pejorative – not about our fellow eaters but about the products that are making people so unwell.




The rise of obesity and diet-related disease around the world has happened hand in hand with the marketing of fast food and sugary sodas, of processed meats and branded snack foods. As things stand, our culture is far too critical of the individuals who eat junk foods and not critical enough about the corporations who profit from selling them. We spend a lot of time discussing unhealthy foods in terms of individual guilt and willpower and not enough looking at the morality of big food companies who have targeted some of the poorest consumers in the world with products that will make them sick, or the governments that allowed them to do so. A survey of more than three hundred international policymakers found that 90 per cent of them still believed that personal motivation – aka willpower – was a very strong cause of obesity.


This is absurd.

It makes no sense to presume that there has been a sudden collapse in willpower across all ages and ethnic groups and each sex since the 1960s. What has changed most since the sixties is not our collective willpower but the marketing and availability of energy-dense, nutrient-poor foods. Some of these changes are happening so rapidly it’s almost impossible to keep track. Sales of fast food grew by 30 per cent worldwide from 2011 to 2016 and sales of packaged food grew by 25 per cent. Somewhere in the world, a new branch of Domino’s Pizza opened every seven hours in 2016.




Compared to even five years ago, the quantities in which confectionery is marketed are obscene. Oversized chocolate bars are nothing new, but I was stunned recently at my nearest supermarket to see Snickers chocolate being sold not by the bar, not even by the supersized bar, but by the metre, consisting of ten bars joined together: 2,340 calories of chocolate, on special offer for £1. If that is not an incitement to overeat, I don’t know what is.

Encouraging us to buy more food than we intend or need is a large part of the business strategy of all the major food companies. Until the mid-1990s, Hank Cardello advised some of the biggest food producers in the world. Cardello reveals that the mantra of the packaged food companies was that ‘you could make Americans eat just about anything, so long as you sold it right’. When the Western appetite for packaged foods finally started to reach saturation point, the industry moved on to new markets overseas. In developing and middle-income countries, branded food now hunts people down even in the privacy of their own homes. Through direct sales, multinational food companies are aggressively targeting low-income customers in some of the world’s remotest villages.




It isn’t that food executives are evil people who actively set out to make their customers obese. But as Cardello has explained, for too long, the wellbeing of consumers simply didn’t figure in the calculations of the big food and beverage companies that he worked with. ‘All we thought about was market expansion and our own bottom line.’


Food and beverage manufacturers explicitly talk among themselves of ‘heavy users’ as representing their key clientele: when it comes to sugary drinks and sweets, 80 per cent of the product is bought by just 20 per cent of the customers. ‘Heavy user’ is industry speak for people suffering from binge-eating disorder.

Yet junk food is far from the only cause of obesity, whose roots are complex and multifaceted. Across the board, across all social classes, most of us eat and drink more than our grandparents did, whether we are cooking a leisurely dinner at home from fresh ingredients or grabbing a quick takeaway from a fast food chain. Plates are bigger than they were fifty years ago, our idea of a portion is inflated and wine glasses are vast. It’s become normal to punctuate the day with snacks and to quench our thirst with a series of calorific liquids, from green juice and detox shots to craft sodas. You can gain weight eating expensive organic artisanal apple tarts and huge mugs of milky coffee just as easily as you can eating cheap fried chicken and Coke. As the example of grapes shows, we don’t just eat more burgers and fries than our grandparents. We also eat more fruit and more granola bars; more avocado toast and more frozen yoghurt; more salad dressing and many, many more ‘guilt-free’ kale chips.

Almost every country in the world has experienced radical changes to its patterns of eating over the past five, ten and fifty years. For a long time, nutritionists have held up the ‘Mediterranean diet’ as a healthy model for people in all countries to follow. But recent reports from the World Health Organisation suggest that even in Spain, Italy and Crete, most children no longer eat anything like a ‘Mediterranean diet’ rich in olive oil and fish and tomatoes.


These Mediterranean children, who are, as of 2017, among the most overweight in Europe, now drink sugary colas and eat packaged snack foods and have lost the taste for fish and olive oil. In every continent, there has been a common set of changes from savoury foods to sweet ones, from meals to snacks, from small independent food shops to giant supermarkets, from dinners cooked at home to meals eaten out, or takeaways.

Close to 10 per cent of preschool children in developed countries such as Australia now suffer from some kind of food allergy, ranging from shellfish to eggs and nuts. These can be scary and confusing times in which to eat, made still scarier by the fact that there are so many ‘experts’ out there selling us fear of food and fad cures. Times of transition have always been a gift to confidence tricksters.


When everything seems to be changing and we can no longer rely on the truths of the past, we become vulnerable to hucksters. Some diet gurus tell us to beware all grains; others tell us that we should fear supposedly ‘acid-producing’ foods ranging from dairy to meat and coffee. These new diets are perhaps best seen as a dysfunctional response to a still more dysfunctional food supply: a false promise of purity in a toxic world. Meanwhile, eating disorders are on the rise across the world, among men as well as women.

Happiness at the table entails making your peace with food, and so it’s a worrying development that eating now is so often treated as an all-or-nothing game. Food has never been so angrily polarised into virtues and vices, elixirs and poisons. On a single street in a single town there will be some people eating giant burgers toppling with many layers of meat and sauces and others eating supposedly perfect meals of kale and seaweed with fermented kombucha to drink. There are gurus telling us to avoid gluten ‘just in case’ and others teaching us to be frightened of cheese. I worry that in many cases, our pursuit of the perfect meal has become the enemy of the good-enough meal. While we fixate on this or that wonder ingredient, the thing that seems to be in short supply now is the everyday, unglamorous home-cooked dinner.

Part of the problem is that we have lost our trust in our own senses to tell us what to eat. We wouldn’t be such easy prey for extreme diets if we could recognise food when it’s right underneath our noses. Humans seem to have become – both collectively and individually – very poor at identifying food when we see it, partly because so much of what our culture offers up for us to taste is so heavily packaged and disguised.

If we have lost knowledge about what we are actually eating, we have also lost the old norms regarding how to eat it. Sometimes this looks like freedom; sometimes like chaos. In 1958, survey data suggests, nearly three-quarters of British adults drank hot tea with the evening meal, because this was the expected way to behave. Now, such shared expectations about food have largely vanished. Who can say for certain when ‘lunch time’ is any more? This generation has lived through revolutionary changes not just in what we eat but how we eat it. Our appetites used to be held in place by a series of invisible threads, rituals which told us how to behave when we held a knife and fork. Now, the rituals are mostly gone; and so are the knives and forks.

The nutrient content of our meals is one thing that has radically changed; the psychology of eating is another. Much of our eating takes place in a new chaotic atmosphere in which we no longer have many rules to fall back on. The problem is partly that cooking at home from raw ingredients is no longer the unquestioned daily routine that it once was. One of the functions of traditional cuisines was to create a common understanding of what ingredients could and couldn’t be combined. Sometimes, these rules could feel restrictive and annoying, such as the Italian insistence that fish and cheese can never enhance each other (tell that to the person who has just enjoyed a delicious fish pie with cheddar cheese on top). But at least these culinary rules gave a sense of structure to our eating, whether you obeyed them or not. Now, many of us are eating with no structure to guide us, as the day passes in a blur of bizarre snacks. When I interviewed a product developer for a major UK supermarket in 2017, she said that the main way that British eating behaviour had changed over the past decade was that people had become so erratic and hard to categorise. In a single basket of food, shoppers oscillate wildly between vegan health foods such as oat milk and meat-heavy ‘dude food’ such as pizzas topped with pulled pork.

On an early evening train journey recently, I looked up at my fellow travellers and noticed, first, that almost everyone was eating or drinking and second, that they were all doing so in ways that might once have been considered deeply eccentric. One man had both a cappuccino and a can of fizzy drink from which he was taking alternate sips. A woman with headphones on was nibbling an apricot tart, produced from a cardboard patisserie box. She followed it with a high-protein snackpot of two hard-boiled eggs and some raw spinach. Sitting across from her was a man carrying a worn leather briefcase. He reached inside the case and produced a bottle of strawberry milkshake and a half-finished packet of chocolate-caramel sweets.

Like other modern eaters, these travellers were improvising their own food rules as they went along. The most surprising thing about this scene – which took place between Birmingham and London – is that it could have happened on a train between cities almost anywhere. As I first embarked on this book, my plan was to explore how people eat in very different ways around the world. But as I met people from different countries, I kept being struck that the things they told me about modern eating were, to a weird extent, the same. This is another paradox of our times. Most people can afford to eat a more varied diet than in the past, but our varied diets are varied in the same way. From Mumbai to Cape Town, from Milan to Nanjing, people told me they felt they had lived through huge changes in the way they ate, compared to their parents and certainly compared to their grandparents. They spoke of the erosion of traditional home cooking and the rise of McDonald’s and of eating in front of screens. They also spoke of the backlash against ultra-processed food and the way that certain ‘healthy’ foods (notably quinoa) had become a fetish of late. They spoke of weight-loss diets and the popularity of low-carb regimes. They spoke of feeling pressed for time to cook the things they wished they could cook.

We aspire to better food choices, yet the way we eat now is the product of vast impersonal forces that none of us asked for. The choices we make about food are largely predetermined by what’s available and by the limitations of our busy lives.

It might be possible to eat in a more balanced way, if only we didn’t have to work, or go to school, or save money, or travel by car, bus or train, or shop at a supermarket, or live in a city, or share a meal with children, or look at a screen, or get up early, or stay up late, or walk past a vending machine, or feel depressed, or be on medication, or have a food intolerance, or own an imperfectly stocked fridge. Who knows what wonders we might then eat for breakfast?

It’s now becoming abundantly clear that the way most of us currently eat is not sustainable – either for the planet or for human health. The signs that modern food is unsustainable are all around us, whether you want to measure the problem in soil erosion, in the fact that so many farmers cannot make a living from producing food, or in the rising numbers of children having all their teeth extracted because of their sugary diet. Food is the single greatest user of water as well as one of the greatest drivers of the loss of biodiversity. We cannot carry on eating as we are without causing irreparable harm to ourselves and to the environment. At some point, governments may be forced by climate change to reform food systems to become less wasteful and more in tune with the needs of human health. The hope is – as we’ll see – that some governments and cities are already taking action to create environments in which it is easier to feed ourselves in a way that is both healthy and joyous. In the meantime, many individual consumers have taken matters into their own hands and tried to devise their own strategies for escaping the worst excesses of modern food.

Our culture’s obsessive focus on a perfect physique has blinded us to the bigger question, which is what anyone of any size should eat to avoid being sickened by our unbalanced food supply. No one can eat themselves to perfect health, nor can we ward off death indefinitely, and the attempt to do so can drive a person crazy. Our responses to food are hugely individual. Life is deeply unfair and some people may eat every dark green leafy vegetable going and still get cancer. But even if food cannot cure or forestall every ill, it does not have to be the thing that kills us.

The greatest thing that we have lost from our eating today is a sense of balance, whether it’s the balance of meals across the day or the balance of nutrients on our plate. Some complain that modern nutrition is in a state of terminal confusion and that science knows nothing about what a person should aim to eat for better health. This is not quite true. A series of systematic reviews of the evidence by some of the world’s top nutrition scientists – the kind who are not funded by the sugary drink or bacon industries – have sifted through all the data and found robust causal evidence that regular portions of certain foods do significantly lower a person’s risk of chronic diseases, such as heart disease, diabetes and stroke.




It’s the balance and variety of what you eat that matters rather than any one ingredient, but there are certain foods you might want to throw into the mix, depending on your preferences, your beliefs, your digestion and whether you have a food intolerance. These protective foods are all relatively unprocessed and include nuts and seeds; beans and pulses; and fish, the oilier the better (canned sardines are an affordable alternative). Fermented foods such as yoghurt, kefir and kimchi seem to help us in all kinds of ways that we are only starting to understand, from gut health to reductions in the risk of diabetes. There are also numerous benefits to eating foods high in fibre, especially vegetables and fruits and wholegrains. You do not have to fork out for superfoods such as fashionable kale; any vegetables will do, as many different types as possible.

A good diet is founded less on absolutes than on the principle of ratio. Take protein. One of the missing links in the obesity crisis seems to be the falling ratio of protein to carbohydrate in our diets. This phenomenon – first documented in 2005 by biologists David Raubenheimer and Stephen Simpson – is known as the ‘protein leverage hypothesis’. In absolute terms, most people in rich countries get more than enough protein, much of it from meat. What has fallen, however, is the proportion of protein in our diets relative to carbohydrates and fats. Because our food system supplies us with a flood of cheap fats and refined carbohydrates (including sugars), the percentage of proteins available to the average person in the US has dropped from 14–15 per cent of total energy intake (which is OK for most people, assuming you are not a bodybuilder, but still on the low side) to 12.5 per cent. This leaves many of us hungry for protein even if we have more than enough calories. Raubenheimer and Simpson have observed this protein hunger at work in many animal species besides humans. When a cricket is short of protein, it will resort to cannibalism. Locusts will forage different food sources until they get the ideal protein balance. Humans are neither as wise as locusts nor as ruthless as crickets. When our food is low in protein, we try to extract the balance from carbohydrates, with the result that we overeat. If Raubenheimer and Simpson are right, then obesity is – among many other things – a symptom of protein hunger.

Protein leverage would also explain why low-carb diets work so well – at least in the short term – as a weight loss tool for many people in our current food environment. The low-carb diet works partly because it is higher in protein (and lower in sugar). But there are other, gentler adjustments you could make to get your ratios back on track short of swearing off bread for life. You could cut down on sugary drinks; add yoghurt or eggs to your breakfast; or go easy on carbs for just one meal a day. Or you could get more protein from green vegetables and pulses, which turn out to be much richer in amino acids than was once believed.




It isn’t that there is anything wrong with carbohydrate per se (unless you are suffering from diabetes). After all, humans have thrived on carbohydrate-rich diets in the past – and, as nutrition scholar David Katz remarks, carbs can mean anything ‘from lentils to lollipops’. Our nutrient-obsessed age wants to fit every food into a certain box, yet pulses such as lentils are 25 per cent carbohydrate and 25 per cent protein. Do we welcome the lentil as a protein or reject it as a carb? Perhaps, instead, we should simply find a lentil recipe that tempts us to eat it (spiked with cumin seed and enriched with butter works for me) and call it food, because it is.

We are now at a transition point with food where a critical mass of consumers seem to be ready to make another set of changes to replace the last and, out of this craziness, to create new ways of eating that actually make sense for modern life. Very little about how we eat now would have been considered normal a generation ago, but I take consolation in thinking that surely much of it won’t seem normal in the future either. From around the world, I have found hopeful signs that the pattern of our eating may be turning back again in a healthier and more joyful direction. In the final chapter, I celebrate some glimmers of a different food culture that is just emerging: one in which nutrition and flavour are finally joined up.

To reverse the damage being done by modern diets would require many other things to change about the world today, from the way we organise agriculture to the way we talk about vegetables. We would need to adjust our criteria of prosperity to make it less about money in the bank and more about access to good quality food. We would need different food markets and differently run cities. Through education or experience, we would also need to become people with different appetites, so that we no longer crave so much of the junk foods that sicken us. None of this looks easy at present, but nor is such change impossible. If the food changes we are living through now teach us anything, it is that humans are capable of altering almost everything about our eating in a single generation.





1: The Food Transition (#ulink_b18551cc-6a64-520a-bf04-8302679ff7e0)


There are two big stories to tell about food today and they could hardly be more different. One of these stories is something like a fairy tale; the other is closer to a horror story. Both, though, are equally true.




And they never went hungry again


The happy version of the story goes like this. Humans have never in history been fed as well as we are right now. As recently as the 1960s, you could go into almost any hospital in the developing world and find children suffering from kwashiorkor, a form of severe protein malnutrition which gives rise to swelling all over the body and a pot belly. Today kwashiorkor is mercifully rare in most countries (though it still afflicts millions of children in central Africa). Other diseases of deficiency such as scurvy, pellagra and beri-beri are – with a few exceptions – terrors of the past. The waning of hunger is one of the great miracles of modernity. And they never went hungry again is the happy ending of many fairy tales.




Until the twentieth century, the threat of famine was a universal aspect of human existence across the world. Harvests failed; populations starved; for anyone but the wealthy, food wasn’t to be relied on. Even in rich countries such as Britain and France, ordinary people lived with the daily spectre of going to sleep hungry and spent as much as half their income on basic staples such as grain and bread. In the rice-based economies of Asia, mass starvation regularly killed whole communities.

The decline of hunger is one of the great wonders of our time. In 1947, according to the Food and Agriculture Organisation (FAO) at the United Nations, half of all the people on the planet were chronically underfed. By 2015, that figure had dropped to one in nine – even though the overall population had risen astronomically during the same period. The number of people living in extreme poverty continues to decline dramatically. On any given day in 2017, the numbers affected by extreme poverty – defined as less than $1.90 a day per person to cover food, clothing and shelter, adjusted for inflation – declined by 250,000.




Absolute hunger is much rarer than it once was. In 2016, the Swedish historian Johan Norberg went so far as to argue – in his book Progress – that the problem of food had been solved. Advances in farming technology over the course of the twentieth century made massively more food available to vastly more people. A modern combine harvester can yield in six minutes what it once took twenty-five men a day to do and modern cold storage can prevent crops from rotting and being wasted after harvest.


More food is produced each year than ever before.

Perhaps the greatest changes of all came about through the invention in the 1910s of the Haber-Bosch process, a method for synthesising ammonia which made highly effective nitrogen fertilisers cheap to produce for the first time. Vaclav Smil, a Canadian expert on land use and food production, has calculated that as of 2002, 40 per cent of the world’s population owed their existence to the Haber-Bosch process. Yet how often do you hear anyone talking about Haber-Bosch? Without it, many of us might not be here today, yet it has far less name recognition than Häagen-Dazs, a fake, supposedly Danish label for a brand of ice cream dreamed up by a businessman in the Bronx in 1961. In a way, our ignorance about Haber-Bosch shows once more how lucky we are. We have reached the point where most of us can afford to think more about ice cream than survival.




It is said that Norman Borlaug, a plant agronomist who was awarded the Nobel Peace Prize in 1970, saved a billion lives from starvation with his invention of semi-dwarf, high-yield wheat varieties. Thanks to Borlaug’s miracle wheat – coupled with modern farming methods – yields of the crop nearly doubled in India and Pakistan from 1965 to 1970.

Many of us yearn for the good old days of food when it was normal to bake your own bread – or roll your own tortelloni, as the case may be; but no one would wish themselves back to a state of famine. We sometimes forget that for most of history, even in rich countries life expectancy was short and people were sometimes so deprived of food that they mixed tree bark into flour to make it go further. Even for those who did not suffer actual famine, the business of cooking and eating on an average family budget could lead to a pinched and frugal existence, especially in winter when – before refrigeration was available – meals centred on staple grains and salted meat with little that was green or crunchy, never mind spicy or particularly delicious.




Today, many of us have instant access to almost preposterous quantities of food, year round, of a freshness and variety our grandparents could not have imagined. In the city where I live, a three-minute walk from my home in any direction will take me to food shops with plentifully stocked shelves. I can stroll east and arrive at a Chinese supermarket, a butcher and a south Asian grocery which sells everything from fresh mint leaves and every spice under the sun to home-made falafels and samosas. To the north I will find a health food co-op offering local sourdoughs, ancient grains and organic apples; and a Hungarian deli selling any European cheese I can possibly name, as well as a few that I can’t. To the west and the south are four rival supermarkets, each heaving with fresh fruits and cereals, meat and fish, oils and vinegars, ginger and garlic.

Magical as it is, I’ve come to feel entitled to this abundance. On the rare occasions that I arrive at one of these many shops and the one specific thing I was expecting to buy has run out – no Parmesan left on a Sunday night! Outrageous! – I feel a mild consternation, because my expectation to eat exactly what I want at the precise moment I want to eat it has been scuppered.

In the developed world, many are living in a new Age of Delicious, liberated from the last vestiges of post-war austerity. The decline of hunger has been accompanied by a bright new dawn of flavour. Cooks are relearning the arts of pickling and fermenting, but this time we are doing it out of love not necessity. Never have so many cups of heavenly-tasting coffee been topped with so many variations on beautiful latte art. Clever home cooks have made food far more inventive and open than it was even ten years ago. Gone is the old food snobbery that said you couldn’t be a good cook if you hadn’t mastered half a dozen elaborate French sauces or a shellfish bisque. The internet has enabled recipe swapping on a scale and at a speed that is dizzying. Where our grandparents (in the Anglo-American world at any rate) sat down dutifully to plates of under-seasoned meat and two veg, we have developed unexpected new global palates: for spicy Turkish eggs sprinkled with sumac or vibrant salads of green mango and lime. Food has gone from being a scarce and often dull kind of fuel to an ever-present, flavoursome and often exotic experience, at least in big cities. Think how casually we eat ingredients such as Kalamata olives or couscous now, as if born to them.

Yet the omnipresence of food has created its own completely new difficulties. Widely available cheap food can look like a dream; or it can be a nightmare. It’s impossible to accept Norberg’s assertion that the problem of food has been solved when diet now causes so much death and disease in the world. The same food that has rescued us from hunger is also killing us.

As of 2006, for the first time the number of overweight and obese people in the world overtook the number who were underfed, in absolute terms. That year, 800 million individuals still did not have enough to eat but more than a billion were overweight or obese. To our hungry ancestors, having too much to eat might have looked like the gold at the end of the rainbow, but what these new calories are doing to our bodies is not a happy ending.




The problem isn’t just that some people are overfed and others are underfed, lacking enough basic calories to ward off gnawing hunger (though that remains a real and brutal problem). The new difficulty is that billions of people across the globe are simultaneously overfed and undernourished: rich in calories but poor in nutrients. Our new global diet is replete with sugar and refined carbohydrates yet lacking in crucial micronutrients such as iron and trace vitamins. Malnutrition is no longer just about hunger and stunting; it is also about obesity. The literal meaning of malnutrition is not hunger but bad feeding, which covers inadequate diets of many kinds. If governments have been slow in acting to tackle the ill health caused by modern diets, it may be because malnutrition does not look the way we expect it to.

Despite the decline in hunger, malnutrition in all its forms now affects one in three people on the planet. Plenty of countries – including China, Mexico, India, Egypt and South Africa – are suffering simultaneously from over-feeding and under-nutrition, with many people suffering from a surfeit of calories but a dearth of the crucial micronutrients and protein a body needs to stay healthy. As a result, not just in the West but across the world, people are suffering in growing numbers from diseases such as hypertension and stroke, type 2 diabetes and preventable forms of cancer. The lead cause of these diseases is what nutritionists call ‘suboptimal diet’ and what to the rest of us is simply ‘food’.




Our ancestors could not rely on there being enough food. Our own food fails us in different ways. We have markets heaving with bounty but too often, what is sold as ‘food’ fails in its basic task, which is to nourish us.

To walk into the average supermarket today is to be greeted not just by fresh whole ingredients, but by aisle upon aisle of salty oily snacks and frosted cereals, of ‘bread’ that has been neither proved nor fermented, of sweetened drinks of many hues and supposedly ‘healthy’ yoghurts that are more sugar than yoghurt. These huge changes to modern diets have gone hand in hand with other vast social transformations such as the spread of cars, electric food mixers and electronic screens of many kinds, which have left us far less active than earlier generations, gym membership or not. The mechanisation of farm work which created the food to feed billions also resulted in farmers (in common with most of the rest of us) leading increasingly sedentary lives.

In just a few decades, these alterations to how we eat have left unmistakable marks on human health. Take type 2 diabetes. The causes of this chronic condition, whose symptoms include fatigue, headaches and increased hunger and thirst, are still being debated by scientists, but there is clear evidence that – genetics aside – there is a higher risk of getting type 2 diabetes if you habitually consume a diet high in sugary drinks, refined carbohydrates and processed meats and low in wholegrains, vegetables and nuts.

In 2016, more than six hundred children in the UK were registered as living with type 2 diabetes. Yet as recently as 2000, not a single child in the country suffered from the condition.




So are we living in a food paradise or a food hell? It doesn’t seem possible to reconcile these competing stories about modern food. But in 2015, a group of scientists in the United States, the UK and Europe devised a systematic assessment of the world’s diet which showed that both stories are true: the world’s diet is getting better and worse at the same time.




Where the balance falls


The light is fading on a cold winter’s day. I am sitting in a café at the top of the Cambridge University graduate students’ union with Fumiaki Imamura, a 38-year-old scientist. He drinks black coffee; I drink English Breakfast tea. Imamura, who has a Beatles haircut and a bright purple tie, is originally from Tokyo but has spent the past fifteen years in the West, studying the links between diet and health. ‘There are so many myths about food,’ Imamura says. One of the myths he refers to is the notion that there is such a thing as a perfectly healthy diet.

Every single human community across the globe eats a mixture of the ‘healthy’ and the ‘unhealthy’, but the salient question is where the balance falls. Imamura’s research shows that most countries in the world are currently eating more healthy food than we ever did; but also more unhealthy food. Many of us have a split personality when it comes to food, but then this is hardly surprising given how schizophrenic our food supply has become. We have access to more fresh fruit nowadays than we ever did; plus more sugar-sweetened cereals and French fries.

Imamura is a nutritional epidemiologist, meaning that he studies outlines of diet across whole populations to arrive at a more accurate account of how food and health are related. He works in the MRC Epidemiology Unit on the Cambridge Biomedical Campus. Imamura is one player in a much larger research team which straddles multiple universities in the United States and Europe. The overall project is based at Tufts University in Boston and is led by Professor Dariush Mozaffarian, one of the leading scholars currently using big data to measure nutrition in countries worldwide.

In 2015, Imamura was the lead author on a paper in medical journal The Lancet which caused a stir in the world of nutrition science. This team of epidemiologists have been seeking to map the healthiness, or otherwise, of how people eat across the entire world, and how this changed in the twenty years between 1990 and 2010.




At this point, you might ask, what counts as a good quality diet? Some would define healthy food in positive terms: how many vegetables and portions of oily fish a person eats. Others define it more negatively, judging it by an absence of sugary drinks and junk food. Clearly, these are two very different ways of looking at the question. Most research on diet and health has lumped the two together, assuming that a high intake of ‘healthy’ fish will automatically go along with a low intake of ‘unhealthy’ salt, for example. But, alas, human beings are inconsistent creatures.

The Japanese, who are generally considered to eat an outstandingly ‘healthy’ diet as rich nations go, consume large amounts of both fish and salt: the one ‘healthy’ and the other ‘unhealthy’. They consume much refined polished white rice (‘unhealthy’) along with copious amounts of dark green vegetables (‘healthy’). Imamura himself still eats a diet centred on vegetables and fish, he tells me, but also a lot of salt in the form of soy sauce, even though as an epidemiologist he is aware that high sodium intake has been linked in numerous studies to high blood pressure. But he is conscious that no population in the world eats exactly the combination of healthy foods that nutritionists might recommend.

There have been many attempts to measure the healthiness of the world’s diet in the past but most studies have treated human eaters as more rational than we actually are. Previous studies have summed together high consumption of healthy foods and low consumption of unhealthy foods. What made Imamura’s paper so innovative – and so much closer to the way we actually behave around food – was that he and his fellow researchers studied healthy and unhealthy foods in two parallel datasets.

Imamura and his colleagues came up with a list of ten ‘healthy’ items: fruits, vegetables, fish, beans and legumes, nuts and seeds, wholegrains, milk, total polyunsaturated fatty acids (the kind of fat found in seed oils such as sunflower), plant omega 3s and dietary fibre. They created a separate list of ‘unhealthy’ items: sugary beverages, unprocessed red meats, processed meats, saturated fat, trans fat, cholesterol and sodium. (Imamura knows that some would quibble with the items on these lists. There is an ongoing debate among nutrition scientists about the healthiness or otherwise of saturated fats versus unsaturated fats. It looks as though the key question with saturated fat, as with other nutrients, is not whether it is unhealthy in absolute terms, but what you choose to eat instead of it. There is evidence that replacing saturated fats with processed carbohydrates can be harmful for heart health, whereas replacing it with olive oil or walnuts may have benefits.


But based on everything that the epidemiologists currently knew about patterns of diet and health outcomes, these lists were the best they could do.) The researchers then tried to map a pattern of how much of these healthy and unhealthy foods are eaten in any given country.

‘We don’t know very much about what people consume, actually,’ Imamura tells me, disarmingly, sipping his black coffee. ‘Assessment of diet is very difficult.’ Almost all the data we have on what people eat is based on market figures: what commodities come into the country, or how many packets of an item people buy in any given year. This data on supply and production is used as a proxy for what people actually eat. It is useful for mapping big changes in our diets over time – the rise of salmon and the fall of herring, say. Often, food supply data reveals big truths about what we eat that are invisible to us in the daily bustle of shopping and cooking. Much of what I’ll tell you about food in this book will come from market data because often it’s the only hard data available.

But this kind of market data has flaws: for one thing, it offers only a national average, and for another, it does not tell you what happens to the food after it enters the home. Did the consumer steam that bag of green beans and eat them with grilled sardines? Or leave it to rot at the back of the fridge?

Another method of measuring diets is to ask people what they eat, whether over a 24-hour period or in a seven-day diary. Imamura tells me he much prefers survey data to market data because it gives a more detailed picture of how consumers actually behave around food. The snag is that one of the ways we behave around food is that we lie about it: No, I never bought and ate those extra-cheesy nachos. Yes, I eat five fruits and vegetables a day, every day. We also forget things, like that Snickers bar we devoured in haste between meetings.

One way to get around this problem of accuracy is to measure biomarkers in the human body itself, like forensic scientists analysing a corpse. In recent years, epidemiologists have started searching for traces of our diets in blood serum, hair samples and even toenail clippings (toes are used instead of fingers because they are less exposed to outside environmental contamination). Toenail clippings are apparently the best way to measure levels of the mineral selenium in the body – a detail nutrition researchers are interested in, since low selenium correlates with type 2 diabetes and childhood obesity.

The most versatile and commonly used biomarker to determine dietary intake is urine. Unlike toenails, which take weeks to grow back, urine is – how to put this delicately? – endlessly renewable, and it reveals traces of more different foods than any other measure. We haven’t quite reached the point yet where a sample of your urine could tell a researcher that you ate spinach gnocchi for lunch and pumpkin risotto for dinner, but that day may not be far off. In the meantime, urine has most often been used to measure how much salt we eat. Imamura and his colleagues looked at 142 surveys that measured sodium levels in urine, providing data on salt consumption for the majority of adult humans on the planet.




At the time of writing, Imamura’s study is the most complete snapshot we have of diet quality on a truly global scale as it relates to patterns of ill health. In all, the researchers managed to find data to cover 88.7 per cent of the adult population of the whole world. From this, they built up a picture of what we eat from two different angles: on the one hand, how much healthy food countries eat and on the other hand, how much unhealthy food.

A person may enjoy eating a slice of fresh melon but also enjoy munching on greasy fried onion rings. Countries, too, have contradictory tastes. Since 1990, the planet’s consumption of ‘healthy’ items has undoubtedly been growing, but this does not mean that people necessarily have a healthy pattern of eating. Take fruit. Since 1990, world vegetable consumption has remained static but the world’s fruit intake seems to have gone up by an average of 5.3 grams per person per day. For people who can afford to buy it, fresh fruit, from grapes to watermelon, has become one of the world’s favourite snacks. Fruit is expensive and it’s one of the first things parents buy as a treat for their children when they start to have disposable income. The rise of fruit gives credence to the fairy story about modern food (setting aside the fact that modern fruit is often not as nutritious as fruit used to be). Out of 187 countries, all but twenty or so have increased their intake of healthy foods, especially foods such as fruit and unsalted nuts which are eaten between meals.




But Imamura’s paper also supports the food horror story. The data clearly shows that diets high in sugary drinks, trans fats and processed meats became much more common in the world between 1990 and 2010. In 2010, around half the countries in the world were eating a diet higher in unhealthy items than in 1990, often drastically higher. The prevalence of unhealthy items in our diets is increasing more rapidly than our consumption of healthy foods. But it is not increasing everywhere to the same extent.

The biggest surprise to come out of the data was that the highest-quality overall diets in the world are mostly to be found not in rich countries but in the continent of Africa, mostly in the less developed sub-Saharan regions. The ten countries with the healthiest diet patterns, listed in order with the healthiest first, came out as:

Chad

Mali

Cameroon

Guyana

Tunisia

Sierra Leone

Laos

Nigeria

Guatemala

French Guiana

Meanwhile, the ten countries with the least healthy diet patterns, listed in order from the bottom up, were:

Armenia

Hungary

Belgium

USA

Russia

Iceland

Latvia

Brazil

Colombia

Australia

The idea that healthy diets can only be attained by rich countries is one of the food myths, Imamura says. He found that the populations of Sierra Leone, Mali and Chad have diets that are closer to what is specified in health guidelines than those of Germany or Russia. Diets in sub-Saharan Africa are unusually low in unhealthy items and high in healthy ones. If you want to find the people who eat the most wholegrains, you will either have to look to the affluent Nordic countries where they still eat a lot of rye bread or to the poor countries of southern sub-Saharan Africa, where a range of nourishing grains such as sorghum, maize, millet and teff are made into healthy main dishes usually accompanied by some kind of stew, soup or relish. Sub-Saharan Africa also does very well on consumption of beans, pulses and vegetables. The average Zimbabwean eats 493.1 grams of vegetables a day, compared with just 65.1 grams for the average person in Switzerland.




It was Imamura’s conclusion about the high quality of African diets that ruffled feathers in the world of public health. What about African hunger and scarcity? Zimbabweans may eat more vegetables than the Swiss, but there is more to health than vegetables, given that life expectancy in Zimbabwe in 2015 was just fifty-nine years of age compared with eighty-three for the average Swiss person. Some scientists argue that the low score for unhealthy foods in some African and Asian countries is actually a sign of diets that are ‘poor’ in various ways. If the people of Cameroon consume low amounts of sugar and processed meat, it is partly because they are consuming low amounts of food all round.




Imamura does not deny, he tells me, that the quantity of food available is very low in some of the African countries, but adds, ‘That’s not the point of our study. We were looking at quality.’ His paper was predicated on the assumption that everyone in the world was consuming 2,000 calories a day. Imamura was well aware that is far from the case in sub-Saharan Africa, where the prevalence of malnourishment is around 24 per cent according to the Food and Agriculture Organisation. But he and his colleagues wanted to isolate the question of food quality from that of quantity. Traditional public health nutrition, he observes, was so fixated on the question of hunger that it paid too much attention to the quantity of food people had access to without considering whether the food itself was beneficial for human health.




Africa’s hunger can easily blind us to the sheer quality and variety of food that people enjoy in much of the continent. The findings of Imamura’s paper came as no surprise to Graeme Arendse, a South African journalist at the Chimurenga Chronic, a magazine celebrating pan-African culture. In 2017 Arendse helped put together a special food issue of the magazine which challenged the Western idea that African food was all about deprivation and suffering. On a sunny winter’s day, sitting in his offices in Cape Town above the pan-African market in the city centre, Arendse tells me that ‘this story of scarcity is not true’. Arendse sees traditional African food as deeply diverse, with much of it very healthy. A short walk from his office in Cape Town, Arendse can pick up a takeaway of fish and brown rice at a Malian place where he likes to go. Other days, when the mood hits, he goes to a different café to buy a bowl of Nigerian egusi soup made from melon seeds with seafood and bitter greens, for the same price as a fast food meal from McDonald’s.

Arendse worries that unless traditional African cuisine with its soups and stews of many kinds is celebrated more, it will lose out even more to the fast foods and convenience foods that he notices becoming so popular now in South Africa. On the bus into work, in just the past couple of years, he has started to see some commuters breakfasting on crisps and cans of cola. ‘I never saw that in the past.’

Dietary patterns are getting rapidly worse in much of Africa, including South Africa. In recent years, monied South Africans have abandoned the old dinners of mealy maize and have started to drink bottles of sparkling mineral water and to eat salads of roasted vegetables and feta cheese, and, yes, many kinds of avocado toast. But there has also been a colossal rise in the consumption of packaged snack foods and sugary drinks. The balance of what South Africans eat is tipping away from the old vegetables and stews of the rest of sub-Saharan Africa and towards a Westernised diet of fried chicken and burgers and oversized portions of pasta.




‘These young people have stretched their stomachs,’ observed an old black South African in 2016, startled by the way that children suddenly expected to eat fried foods and meat every day. Middle-income countries such as South Africa have experienced the full fairy tale and the full horror story of food at the same time. Rates of both under-nutrition and over-nutrition in South Africa exceeded 30 per cent of the population as of 2016. In the old days, South Africans ate many wild fruits and breakfasted on a thick maize or sorghum porridge, seasoned to taste with a few drops of vinegar. Now, breakfast is more likely to be nutrient-poor white industrial bread with margarine or jam. With escalating sugar consumption, tooth decay is rising in South Africa at an alarming rate.




Eating in South Africa, a parched land with relatively poor soil quality, has never been ‘heaven on earth’, as South African dietitian Mpho Tshukudu has written. There is no golden age of food to return to. But nor have South Africans ever had to face food dilemmas quite like the ones they face today on a daily basis. One mother in her forties who came to Tshukudu’s clinic recalled that as a child growing up in a rural village, she walked for miles and ate home-cooked foods every day, always with a vegetable or some kind of legume. She knew no one who was obese and never needed to visit a doctor. But now, this woman lived in the city with her husband and three children and they all ate a lot of takeaway food and were frequently unwell. Her nine-year-old daughter was already so big that, to her distress, she had to buy her clothes in the grown-up section of the store.




In some ways, South Africa’s new unhealthy pattern of eating is distinctive to the country itself, and to the injustice of the apartheid years. During apartheid, the state controlled who moved to towns and who stayed in the country and no black farmers were allowed to own land outside the ‘homelands’. Adults living in black townships often had long commutes to jobs in the white cities which left less time for cooking than in the past and as a result, some of the old traditional dishes died out.

But the most extreme and sudden changes to South African eating happened after the end of apartheid in the mid-1990s, during and after Nelson Mandela’s presidency, when thousands of black South Africans were lifted out of poverty for the first time. People were free to move to the cities; and they did. By many metrics, life got better and easier, but much of what people were eating now was less healthy than it had been before. As a newly open economy, the country was flooded with fast food and processed food from both home and abroad. From 2005 to 2010, the sales of processed snack bars in South Africa increased by more than 40 per cent.




New freedom and city living; new snacks and abundance; new obesity and type 2 diabetes: the patterns of both eating and health have shifted fast in South Africa since the 1990s. The speed at which diets are changing here is vertiginous, yet the pattern is a familiar one. It is almost as if South Africa – along with so many other countries in the world – is following a script for eating set by America fifty or so years ago.




Stage four


Growing up in 1950s Wisconsin, Barry Popkin drank only tap water and milk, except for a small glass of orange juice to start the day. His father drank tea and his mother had coffee. At the weekend, as he has explained in his 2009 book The World is Fat, his parents might take a glass of wine for a treat. No one in Popkin’s family drank sweetened lattes or sugary energy drinks and the adults would not have dreamed of drinking alcohol every day. There were no smoothies and no white chocolate mocha frappuccinos. Popkin – Professor of Nutrition at Chapel Hill University, North Carolina – has made it his life’s mission to study the reasons why our patterns of eating and drinking are so different from those of the past; and to figure out ways to save the best of the changes and move beyond the worst of them.




During the months when I was first researching this book, it felt as if all roads led to Barry Popkin. Whether I was looking for hard facts on snacking or sugar or statistics about how food had changed in China over the past decade, Popkin always seemed to have co-authored the definitive paper on the subject. He was also involved in working with governments to create better food policies in many countries including Mexico, Chile, Colombia and Brazil. His website showed a photo of a cheery-looking man in his seventies with a white beard, but this Popkin was so prolific, I was starting to doubt whether he really existed, or whether he was in fact a team of nutrition academics working out of a factory somewhere.

When I contacted Popkin to arrange a telephone interview, he emailed straight back and told me he was having a ‘horrendous’ week but could take my call at 9 a.m. EST precisely on Monday morning. A gruff-voiced man answered the phone and immediately started explaining how food had radically changed in recent years, not just for a few people but for billions across the world. He spoke with great authority about the marketing of crisps and convenience foods; about the rise of highly sweetened drinks and the fall of home cooking. ‘It’s a radical change,’ Popkin told me, ‘and it’s going to be a big battle to reverse it.’

Popkin’s interest in nutrition started, he has written, during a year in India in 1965–6 when he was an economics student living in shantytowns in Old Delhi. India was a shock because after his modest but comfortable American childhood, Popkin was exposed to the extremes of hunger first hand. Returning to the States determined to use economics to help improve the way people ate, he assumed that the great problem to be solved with respect to nutrition would always be hunger.




By the 1980s, however, Popkin had noticed that obesity had begun to replace hunger as the main nutritional problem in the Western world and he observed, aghast, as the same set of chronic diseases swept across the globe. He was one of the first experts in the field to argue that obesity was a global problem, not a phenomenon of the West. Popkin coined the phrase ‘nutrition transition’ to explain the changes he saw happening around the world as countries developed from poverty to riches. As a country becomes richer and more open to global markets, its population almost inexorably starts to eat differently, consuming more oil and meat and sugar and snack foods and fewer wholegrains and pulses. Wherever this diet was adopted, Popkin noticed, it brought with it easier lives as well as a host of diseases.




One way to think about human history is as a series of diet transitions, with each stage driven by changes in the economy and society, plus shifts in technology, climate and population. In the beginning, we were hunter-gatherers, eating a mostly low-fat diet of varied wild greens, berries and wild animals. During the Upper Paleolithic Period, which began about fifty thousand years ago, more than half of our food came from plants and the rest came from animals. In these societies, people were forced to collaborate to collect food. We had discovered fire but not cooking pots. Life expectancy was low – you were at risk of dying a violent death, if infectious diseases didn’t get you first. But the archaeological record suggests that (depending on where in the world they lived) the humans in this phase who survived into adulthood experienced mostly good health, with few nutritional deficiencies.

Stage two, starting around 20,000 BCE, was the agricultural age, which was characterised by a switch to staple cereals and a huge increase in population. Now we had clay cooking vessels and more sophisticated grindstones at our disposal. The hunter-gatherer diet of wild plants and meats gave way to diets based on staple cereals, whether it was the rice and millet of China or the barley of Mesopotamia. Farming bestowed huge benefits. It created food surpluses for the first time, which freed many people from the task of food gathering and gave rise to vast new civilisations such as that of the Indus Valley, where modern-day Pakistan lies. Grains were a very efficient way to generate calories from the land. Without agriculture there would have been no cities, no politics, no human civilisation as we know it.

The downside of farming, however, was that it gave people a less varied range of foods than before. Along with the adoption of staple cereals, phase two saw a rise of famine and a sudden increase in diet-related problems. With diets that were often inadequate both in quantity and quality, humans shrank in stature and suffered from a range of deficiency diseases. The difference in human health between the diets of stage one and stage two is the rationale behind the popular ‘Paleo diet’ in which modern dieters try to turn the clock back by ten thousand years or so and eat as if farming had never been invented.

Then again, to find a diet healthier than the one most people eat today, we don’t need to go back thousands of years. In Europe, we could go back a mere couple of hundred years to the third stage, which Popkin calls ‘receding famine’. During this period, advances in agriculture such as crop rotation and fertiliser led to a more varied and plentiful diet, with fewer starch-based staples and a bigger variety of vegetables along with animal protein. In stage three, the possibilities of cooking expanded, with new methods of drying and preserving and pickling. This period also witnessed a slow decline in mortality. Many of the old deficiency diseases – such as scurvy and beri beri – became less common as diets became more nourishing. On Popkin’s model, many sub-Saharan African countries are living through this stage now. This would explain why their diets compare so favourably, in Imamura’s paper, with those of the industrialised world.

But then comes stage four, which is where we are now. This era is different in quality from any of the other stages. Suddenly, the diet changes much more rapidly, with consequences for human health which are more extreme. The economy shifts away from manual labour and towards mechanisation, people move from the countryside to cities and they start to expend less energy. There are revolutions in food processing and marketing and people start to eat more fat, more meat and more sugar, with far less fibre. Stage four sees human life expectancy hit new highs with the decline of deficiency diseases and the breakthroughs of modern medicine. But it also sees populations suffering from diet-related chronic illness as never before. The ‘nutrition transition’ happened all over the Western world in the decades after the Second World War and is now happening even faster among low- and middle-income nations in the rest of the world. This transition explains why our food is sickening us now, through excess rather than hunger.

Stage four is a radical break with the past which represents a reinvention of food and what it means for human life. One of the greatest departures of stage four is the new homogeneity of food. As agriculture becomes a vast international form of trade, people start relying on the same small number of global crops, even when they live oceans and continents apart.

For centuries, eaters have marked high days and holidays with moreish fried foods such as fritters and doughnuts. Only in modern times, however, could a person buy a stackable carton of fried crisps made from a slurry of dried potatoes and wheat starch seasoned with barbecue flavouring and sit on a sofa eating them not for a celebration, not even out of hunger, but just out of a mild feeling of restless boredom. Only in stage four could another person – in the same mildly bored state – be eating exactly the same crisps at the exact same moment on another sofa somewhere halfway across the world.




The Global Standard Diet


The nutrition transition has not just taken place at the level of supply. It has also altered our personal hungers so that we become people who gravitate towards the same foods. Between the 1960s and today, people around the world stopped depending so much on their own particular foodstuffs, the ones that belonged to our own families and homeland, and started eating other, alien commodities, grown in faraway places. Soon, we were eating so many of these alien foods that they stopped tasting strange to us and starting tasting normal. We changed not only the dishes we ate but the basic composition of our diets.

Nations have adjusted their food habits many times before – after all, tomatoes are not native to Italy, nor tea to Britain – but the recent global homogenisation of taste is unprecedented. All at once, billions of eaters in disparate places have started eating from the same repertoire of ingredients. Never before has such dietary change happened on such a scale, and simultaneously across most of the planet. It is a switch so pervasive and so huge that we haven’t had time to react or even to notice exactly what has changed. It is as if the colour of the sky morphed from blue to green, but before we could protest that something was not right, our eyes adjusted and we carried on as normal.

In the past, it was a fundamental fact about human beings – and about food – that people ate different things in different places. It’s in our nature as omnivores to be skilled at adapting to varied food environments. If you ask someone ‘what’s food?’ you would expect to receive wildly different answers to the question whether you were in Lagos or in Paris. In the past ‘food’ was not one thing but many, varying according to local crops, local ingredients and local ideas and prejudices.

When I was a child in the 1980s, I remember grown-ups in Britain talking with horror about the fact that the Japanese liked to eat … raw fish! It seemed so improbable. From their tone of baffled revulsion, these Britons might as well have been contemplating swallowing live frogs. I never imagined that one day those same grown-ups, older and greyer, would stroll into a perfectly normal shop on the average British high street and casually pick up a tray of sushi for lunch. We now live in a clone-world where you can get pizza in Beijing and Chinese dumplings in Rome, and not even be startled by the incongruity.

At a cultural level, some of this change has been wonderful to see (and to eat). So many of the old barriers and prejudices that kept people from experiencing each other’s food have been ripped apart. Many Westerners who used to look with suspicion on anything too garlicky or spicy or strong will now happily eat Korean-spiced barbecue or fiery Thai curries.

But if our palates have widened in some ways, they have narrowed in others, particularly at the level of ingredients themselves. When ‘food’ becomes a common language across the whole planet it stops being food at all, as our ancestors would have understood it. No matter where on the planet we live, there’s a striking convergence going on in our eating habits.

In the early 2010s, a team of researchers led by Colin Khoury, an American plant diversity expert, set out to quantify how the world’s diet had changed over the past roughly fifty years from 1961 to 2009, using food supply data from the FAO. For every country about which they could gather evidence (152 of them, representing 98 per cent of the world’s population), they measured which crops were eaten and how many per capita calories and other nutrients each of the foods delivered. Overall, the researchers looked at fifty-three different foods, from oranges to rice, from sesame seeds to corn.




These researchers found that there had been massive changes in eating since the 1960s. Wherever in the world you happen to live, you will now have access to much the same menu of core ingredients as someone who lives a thousand miles away in any direction. Khoury’s team referred to this phenomenon as the Global Standard Diet.




I started scrolling through the data on the FAO website trying to ascertain how the ‘average’ global eater in the 1960s differed from the average eater today. Then I realised the very question I was asking was wrong. The whole point is that in the 1960s, there was no such thing as an average eater across most countries, just lots of specific and wildly divergent patterns of eating. Back then, there were maize eaters in Brazil and sorghum eaters in Sudan. There were steak and kidney pie enthusiasts in Britain and goulash devotees in Hungary. But it made little sense to ponder how a globally average person might eat because no such person existed.

It is only now that we can, following Khoury, speak of a Global Standard Eater, because it is only now that humans have come to eat in such startlingly similar ways. Perhaps the biggest change is in the quantities that we eat – around 500 calories on average more per day than our equivalents in the 1960s (from 2,237 calories in 1961 to 2,756 calories in 2009). The Global Standard Eater consumes a whole lot more of almost everything than most eaters of the past. From the 1960s, we started to eat more refined grains and more fat, we drank more alcohol and, quite simply, we ate much more food. The average eater consumes a lot of sugar and rice and very few pulses or beans. Our diets overall are becoming sweeter and oilier and meatier and we are highly dependent for our sustenance on foods that have been grown or produced far away from the place where we live, wherever that place might be. Khoury and his colleagues have calculated that more than two-thirds of national food supplies across the world are derived from crops that are foreign to the country where they are eaten.




One grey rainy spring morning I am talking with Colin Khoury over the phone. He is at his home in Colorado, where he works at the US National Seedbank. His background, he explains, is not in nutrition but in plant science. ‘I’m a diversity person,’ he says – one of the many biologists who believe that the future of the planet depends on maintaining the maximum biodiversity for healthy ecosystems. As he and his colleagues began to draw together all the data on the world’s food supply, Khoury was startled to see just how homogenous the global diet had become, with eaters tending towards a common mean.

In Denver, where Khoury lives, the breakfast burrito is a local favourite in diners and cafés, especially at weekends. This greasy and comforting wrap is made from flour tortillas stuffed with eggs, potatoes, green chillis, maybe cheese and some kind of meat – sometimes chorizo, sometimes bacon or steak. The sandwiches are an object of local pride, like the Philadelphia cheesesteak.

To those who love it, the Denver breakfast burrito is a distinctive thing. But in another sense, this ‘local’ American speciality is not local at all. The bacon and the eggs come from giant production lines in Iowa. The eggs are fried in soybean oil from Brazil. As for the wheat that makes the tortilla that binds the whole meal together, it is the same dusty refined white flour made from the same flavourless modern strain of wheat that goes into most breads in America, from bagels to sliced Wonderbread to hotdog buns. The ingredients may be shuffled differently, but the Denver breakfast burrito is built from much the same deck of cards as a New York hamburger and fries or a pepperoni pizza in the Philippines.

‘People are eating much more of the same crops,’ Khoury tells me. ‘We have all these local twists on food but underneath it is not a huge list of species.’ In a way, the leap into stage four is like the emergence of agriculture in stage two: a narrowing of the diet which brings new diseases in its wake.

When you strip away the packaging, the recipes and the brand names, most humans – from Rio to Cairo – are getting a sizeable majority of our energy from meat, sugar, refined wheat, rice and refined vegetable oil. The average global eater largely consumes certain staple items, most of which will have been internationally traded before they reach the shop or the plate. The average eater gets the bulk of his or her daily calories (1,576) from just six sources. These are:



1 animal foods

2 wheat

3 rice

4 sugar

5 maize

6 soybeans


Of these, animal foods and wheat each contribute around 500 calories, with a further 300 calories apiece coming from rice and sugar, 200 calories from maize and 76 calories from soybeans. Compared to these big six items, all the other food commodities pale into insignificance.




There has been a startling shift away from multiple traditional diets towards a single modern one, with the same sweet-salty flavours and the same triumvirate at its heart of rice, wheat and meat.

You can trace the effects of these homogenous diets all the way to the gut. Compared to the average affluent Westerner, a hunter-gatherer from the Hadza tribe in north-central Tanzania – subsisting on an ever-changing diversity of roots and berries and wild meats – has 40 per cent more microbiome diversity (the microbiome being the host of micro-organisms in the human gut). Having a less diverse gut microbiome has been linked with both obesity and type 2 diabetes.




It’s worth noting that in some countries the move towards a global average diet has been beneficial. ‘In some places,’ Khoury points out, ‘it actually means an increase in diversity,’ certainly compared to fifty years ago. Averaged out, the world’s diet is more balanced now than it was in 1960, if balance is defined as eating an even spread of different foods. Until recently, many countries in east Asia were dangerously dependent on the single staple of rice to feed themselves. Apart from being a monotonous way to live, such single-staple diets are precarious when the single crop happens to fail – as the Irish potato famine demonstrated in the nineteenth century. Thanks to the opening up of new global markets, east Asian countries such as Vietnam have now been able to diversify into wheat and potatoes, which bestows greater food security as well as more varied nutrients.

But in most places, the new global diet has involved a narrowing down of what people eat. Our world contains around seven thousand edible crops, yet 95 per cent of what we eat comes from just thirty of those crops. As omnivores, humans are designed to eat a varied diet, so there’s something strange and wrong when, as a species, we become so limited in our choice of foods.




It might surprise you to learn (it did me) that the most average place in the world, food-wise, is not the United States, which is actually pretty extreme in the composition of its diet. To take one example, Americans have access to around twice the global average calories from meat (around 1,000 calories as against 500). Americans also consume far more sugar and sweeteners than the global mean.

To find the most average eaters in the world, you need to look to some of the middle-income countries of the developing world, especially in Latin America. These countries seem to hold up a mirror to the way food consumption is now shifting to a global mean. Purely in terms of the crops consumed, one of the most average places in the world for food is Colombia. Here, the top four sources of calories used to be maize followed by animal products followed by sugar and rice. Now the order is changed. Top of the list of Colombian foods are animal products (518 calories) followed by sugar (404 calories), then maize (368 calories) and rice (334 calories). Compared with the 1960s, people in Colombia have access to far more wheat and sugar and more refined oils.




The idea that Colombians eat in anything like an average way would once have seemed laughable. Until recently, Colombians’ food habits were not merely different from those of Europe and the US, but distinct to the point of eccentricity from the rest of Latin America. There is nothing ‘average’ about a country where people eat milk soup with eggs for breakfast, garnished with spring onions and coriander leaf. Called changua, to those reared on it this soup is as soothing as congee or chicken soup. Another distinctive element of Colombian food was its unique and abundant range of tropical fruits.

On a trip to Spain in the spring of 2017, I got into conversation with the best-selling Colombian writer Héctor Abad (author of the magical and strange book Recipes for Sad Women). We strolled through the city of San Sebastián just before sunset and Abad told me of his love of old books and old ways. He recalled that when he first travelled from Colombia to Italy, he was astonished to find that Italians ate fruit at the end of the meal rather than at the start. In the Colombia of Abad’s youth, local fruit was the opening of every dinner for those who could afford it. The fruits of Colombia range from succulent pink guavas to guanábanas, which Abad later described to me in an email as ‘a fruit with the peel of a dinosaur, and the meat a sweet humid cotton that you can easily chew’.

When Abad was eight years old, in the 1960s, an American student called Keith came to visit his family. Keith ‘almost vomited’ when Héctor’s mother offered him changua soup for breakfast. Keith was also no fan of arepas, the Colombian corn bread which used to be ground and roasted and baked fresh every day. Keith complained that in the city of Medellín there was not one place to get a hamburger. Abad was a teenager before he first tasted ‘that strange and very caloric thing called pizza’.

These days, Abad and his wife still eat the good old foods of Colombian cuisine, or as many of them as they can find. They cook a lot of soups and fish or hearty dishes of meat, rice and vegetables. But such dishes are no longer the norm for Colombians. Abad is convinced that if Keith came back to Colombia now, he would have no problem finding foods just like the ones he ate back home in Los Angeles.

Abad has noticed that young Colombians no longer eat the way that he does and that the change has happened lightning fast – ‘maybe five years, maybe ten’, he tells me. He sees young Colombians abandon the old corn arepas for breakfast in favour of Westernised sliced wheat bread. He watches as they eat hamburgers and avoid the old rice and beans. He sees them sipping not fresh fruit juices but fizzy drinks, ranging from 7 Up to Colombiana – a local drink that Abad describes as ‘sweeter than syrup’. He feels sad that the country seems to have lost its pride in the old foods. Abad’s 94-year-old mother still makes changua for herself when she is ill, but he doesn’t know anyone else who does.

What’s happening in Colombia is happening in most other countries too. Children around the world are now eating weirdly similar food to each other. You wouldn’t expect a child in Portugal and a child in China to consume the same after-school snack. But a study conducted from 2011 to 2013 across twelve countries based on interviews with more than seven thousand nine- to eleven-year-olds found that there were very similar patterns of eating across all twelve. In particular, those children who had an ‘unhealthy’ pattern of eating tended to consume near-identical foods: packaged cookies and cereal bars, branded sweets, chocolates and crackers.




Whether the children were in Australia or India, Finland or Kenya, they knew and devoured much the same things, which had nothing to do with the traditional cuisine of their country or even whether they were rich or poor. The children ate French fries and drank fizzy drinks; they ate doughnuts and crisps, cakes and ice cream. The nine-year-old in Bangalore and his or her counterpart in Ottawa had access to the same fizzy drinks, the same breakfast cereals, many of the same bagged savoury snacks. Across all the countries, the more healthy-eating children also shared similar patterns (except for the fact that children in India drank whole milk whereas those in Finland and Portugal drank skimmed milk). Children of all countries who ate ‘healthily’ ate dark leafy vegetables, orange vegetables and beans; fish and cheese; and fruit, especially bananas.




If any single food illustrates the monotony of modern global diets, it is the banana. The Cavendish banana has found its way into kitchens around the world without having a great deal to recommend it as a fruit. Those soft yellow crescents have become an emblem of our food system’s lack of biodiversity. They are now not only the most popular fruit in the world but the tenth most consumed food of any kind.







The mythical banana kingdom of Iceland


The unlikeliest bananas in the world grow in Iceland, a couple of hundred miles from the Arctic Circle. Iceland is not, to put it mildly, an obvious location in which to grow tropical fruit. Winter days in this part of Scandinavia sometimes have just four hours of sunlight and temperatures regularly drop below freezing. But near the city of Hveragerði in the south of the country there is a lava field that produces enough geothermal heat to power greenhouses where Nordic bananas grow.




Home-grown Icelandic bananas are a magical proposition, one which seems to buck the trend for increasingly global, faceless modern food. Around the turn of the millennium, rumours circulated that Iceland had become ‘the largest banana republic in Europe’. Others spoke of Iceland attempting to become self-sufficient in the yellow-skinned soft fruits.




Sadly, the ‘mythical banana kingdom of Iceland’ turned out to be just that, a myth. Bananas may grow in Iceland – a fact which is amazing enough in itself – but that does not mean that they can be grown on a commercial scale. Back in the 1940s, when plant scientists first discovered that bananas could be grown in Iceland, there were experiments with banana farms all over the country, but they were never profitable. The growing season for Icelandic bananas is short, with harvests lasting only from April to June. Soon, the Icelandic banana entrepreneurs gave up and donated their remaining plants to the Agricultural University at Hveragerði. You won’t find a geothermal banana in any local shop because the university is a publicly funded body that is not allowed to sell anything for profit. The tiny crop of bananas produced each year – about a ton – are enjoyed as a free perk by teachers, students and visitors.




For the rest of their banana needs, Icelanders do exactly the same as people in all northern and western countries: they buy Cavendish bananas shipped in abundance from sunnier countries by a large multinational corporation. Most of the bananas in Icelandic supermarkets – and there are plenty of them – have the blue Chiquita label depicting a glamorous woman wearing a fruit-decorated Carmen Miranda hat (‘Miss Chiquita’). An American firm based in North Carolina, Chiquita is one of the largest global fruit brands, operating in seventy countries, selling bananas produced in South and Central America, with a large concentration coming from Guatemala and Mexico. So far from being a banana outlier, Iceland is in fact entirely typical in the way that it consumes bananas.

Banana bread is currently one of the most-eaten cakes in Reykjavik and modern Icelanders are also enthusiastic consumers of raw bananas eaten out of the hand to gain a quick boost of energy. By 2000, according to FAO data, Iceland imported 12.46 kilos of bananas per head, nearly four times as many as Russia.




Bananas are a quintessential modern food in that they are overwhelmingly grown in tropical regions but eaten in temperate regions. Bananas are grown in developing countries for the pleasure and nutrition of developed nations. Our dependence on bananas reflects the astonishing fact that it has become more common to eat foods grown from foreign crops than from your own country.

Those yellow fruits, once rare and specific to certain places, are now an ordinary presence in kitchens across the world, a foreign taste that is no longer foreign. To our grandparents, unless they lived in the tropics, the banana was exotic, a huge and unusual treat. Now, there’s nothing unusual or exotic about bananas, which tend to be the cheapest fruit in the supermarket.

Bananas have become an everyday food in Italy and Oman, in Germany and India. Wherever in the world you eat a banana, it is likely to be the same bland Cavendish variety which dominates the world export trade, even though they never taste very good. Cavendish account for 47 per cent of all bananas grown (and close to 100 per cent of all bananas eaten in China and the UK).

For a long time I was puzzled by bananas. Sometimes British people of the wartime generation would speak of how desperately they missed bananas during the war and how they yearned to eat these special fruits again when the war was over. I couldn’t fathom this because the Cavendish banana is nothing to crave. But the bananas of the wartime generation were different. Before the Cavendish, the dominant banana was the Gros Michel, which was said to taste much better. It was a rare example of an old fruit that was sweeter than modern produce; and not just sweeter, but creamier in texture, with a deep, winey and complex flavour. If you’ve ever eaten a banana-flavoured sweet – that deep, sweetly pungent aroma – it’s apparently much closer to the Gros Michel than to the Cavendish. The problem was that the Gros Michel was wiped out by Panama disease in the 1950s.




When casting around for a new strain of bananas that consumers would accept, the United Fruit Company, the American-owned company that controlled most of the world’s banana plantations, alighted on the Cavendish. It tasted nothing like the Gros Michel – growers at United Fruits noticed that the flavour was off and the texture was dry – but it looked the same, it transported easily and, crucially, it was resistant to Panama disease. Without having much to recommend it in terms of flavour or texture, the Cavendish became the banana to conquer the world, largely because it looked the way people expected a banana to look. (At the time of writing, the Cavendish has been hit by a new strain of Panama disease, which casts yet more doubt on the wisdom of the banana industry investing so heavily in just one strain.)




As a fruit engineered to be seedless, every Cavendish banana you buy is an exact genetic clone of every other banana. Bananas are the monoculture of all monocultures. There are more than a hundred varieties of bananas in existence – including red-skinned ones – but you wouldn’t know it from the selection on offer in most shops, where bananas come in just one variety. Except for plantain-eaters who eat them in cooked form, you seldom hear anyone talk about the virtues of different varieties of banana because the whole point is that you expect them to taste the same: not the most delicious thing you ever ate, but cheap, filling and fairly wholesome – compared to a bar of chocolate if not to other fruit. Bananas in the supermarket are mainly marketed not on variety or flavour but on size: small ‘child-sized’ bananas, larger ones for the rest of us.




List of British apple varieties beginning with the letter C (a partial list). Out of all these varieties (more than 150), the only one for sale in most British supermarkets is Cox’s Orange Pippin.

What is true of bananas is true to a lesser extent of other fruits. There are around six thousand British heritage apple varieties, ranging from tart to sweet, from soft to hard, from yellow to green to red. Yet commercial apple production in the UK now centres around just ten varieties, chosen for a reliable look and shape and a certain bland sweetness. This varietal simplification has consequences for our health. Different apple cultivars contain varying levels of phytochemicals: vitamins that have been linked to the prevention of certain types of cancer and cardiovascular disease. If we only ever eat one type of apple, we may not get the full health benefits of eating the fruit.




At least with apples, there is still a folk memory of diversity: of the enchanting old varieties that we have lost. This memory is kept alive by farmers’ markets in the autumn. But with bananas, we don’t even expect variety. The Cavendish is an archetypal modern food commodity. Whatever the season, it arrives hygienically zipped in its own biodegradable yellow packaging and it has desirable, healthy overtones. Assuming you get one at the right stage of ripeness, the flavour is as consistent as Coca-Cola. You will find them in the hot summers of Dubai and the freezing winters of Iceland.

Not so long ago, Iceland was a place where fresh fruit was rare. There was a time in the 1930s when Icelanders needed a doctor’s prescription to buy fresh fruit. You can see why Icelandic bananas seemed such a wonderful project to plant biologists of the 1940s. During the early twentieth century, fruit was only available to Icelanders in the summer when there were just three kinds of native berries: regular bilberries (Vaccininum myrtillus), bog bilberries (Vaccininum uliginosum) and crowberries (kroekiber), a type of small black berry growing on sprawling shrubs. The crowberry is mouth-puckeringly sour. Icelandic food writer Nanna Rögnvaldardóttir notes that it would not be considered a delicacy in any country that had access to sweeter tasting berries.

Crowberries used to be one of the inimitable tastes of Iceland, along with moss, seaweed, smoked offal, soured milk (skyr) and salt cod. For centuries, the people on this inhospitable island ate a diet unlike anywhere else in the world, determined by what was available. Grain was nearly impossible to grow and so, instead of a slice of bread, Icelanders sometimes ate dried fish spread with butter.




In a world before bananas (and all the changes that came with them), Icelanders were people who could appreciate tiny differences in the limited range of ingredients that they ate. In the old days in Iceland, people ate so much cod that they became intensely attuned to the variety of flavours and textures within a single fish, from cheeks to eyeballs. There are 109 words in Icelandic to describe the muscles in a cod’s head.




The culture that gave rise to this varied language of food has largely gone. Much of the food of Iceland is now the food of everywhere. Nanna Rögnvaldardóttir remembers a time when salt and pepper – and possibly cinnamon, for cakes – were the only spices you could find in Reykjavik. Now, Iceland – despite its cold climate – enjoys extra-virgin olive oil, sun-dried tomatoes and garlic in profusion.

Since the 1960s, an ever-increasing range of fruits has been imported into Iceland and there is no need to forage for sour crowberries unless you desperately want to for old times’ sake. A typical Icelander today gets 109 calories a day from fruit, compared with just 46 calories in 1960. At the publishing house where Rögnvaldardóttir now works, a consignment of fresh fruit is delivered to the office every day, about half of it bananas. But in all this variety, she can’t help feeling that something has been lost. ‘As virtually all our fruit is imported, we are rather ignorant of the seasons,’ she comments. Bananas are regarded with affection, she says, because they are relatively affordable and always there in the shops, even in winter. In some fundamental way, Icelanders do not know these new foods as intimately as they once knew cod and crowberries. The average Icelander eats 111 bananas every year. Yet to describe this endless feast of bananas, an Icelander has just one bland word: banani.

I can’t entirely lament the existence of the Cavendish banana, not least because I always have them in my kitchen, ready to feed to a hungry child or to slice onto morning porridge. Without the Cavendish, millions of poorer consumers would have little or no fresh fruit in their diets at all. They are a useful source of potassium, fibre and vitamin B6. But this monoculture of fruit is a symptom of our food culture’s wider obsession with cheapness and abundance over flavour. The salient fact about bananas – one of the most wasted foods in the typical home kitchen – is that there always seem to be too many of them to eat up before they turn brown.




A short history of eating too much


The immense volume of food in our lives is no fluke; it was planned for. In more ways than one, our food system goes back to the aftermath of the Second World War, when governments around the world became obsessed with making sure that their citizens had enough to eat, after the misery of war. In Europe and the US, farmers were paid subsidies for the sheer volume of food that they could produce. We are still living with this legacy of quantity over quality.

Before the war, most farmers had run small mixed farms based on the principle of crop rotation to maintain soil fertility and control pests. After the war, farmers started to specialise, in order to get the maximum yield possible from the land. Nitrogen was diverted from the old bomb factories to make fertiliser and tanks were repurposed as combine harvesters. Under the US Marshall Plan, which ran from 1947 to 1952 to help with post-war reconstruction in Europe, $13 billion was pumped into the economies of the continent. Much of it arrived in the form of animal feed or fertilisers. The era of plenty was beginning.




One of the paradoxes of the post-war food system was that it entailed the greatest expansion of agriculture the world had ever seen, even as there was a mass exodus of farmers from the land. By 1985, just 3 per cent of the American population were farmers, where a hundred years earlier it had been more than half of the population. But the new farms did not need so many farmers, thanks to huge efficiencies of machinery and fertiliser. Between 1950 and 1990, world output of wheat, corn and cereals more than tripled, with the US leading the way. Something had to be done with all this grain. Increasingly, it was fed to animals to fuel a rising meat market.




In this revolution of the land, we lost thousands of small farmers. But what we gained was a colossal supply of calories, which after all was exactly what governments had been hoping and planning to achieve after the war. The calories available to the average American increased from 3,100 per day in 1950 to around 3,900 by the year 2000 – around twice as much daily energy as most people need, depending on their activity levels. Put another way, to avoid over-eating in today’s food environment, most of us would need to reject half of our allotted calories. Every day. This is not impossible but nor is it easy, given that it is human nature to eat whatever’s available.




These changes went along with the increasing dominance of huge multinational food companies who found a way to take the surplus calories and ‘add value’ to them – which meant adding margins. The power accrued by these companies in the decades since the war is hard to overemphasise. By 2012, the revenue of Nestlé alone was $100 billion, twice as much as the GDP of Uganda (at $51 billion). It was these companies, more than the farmers themselves, who profited from the overproduction of subsidised crops in the West. If you break down the US food dollar now, only 10.5 per cent goes to farmers. A much bigger share (15.5 per cent) goes to those processing the food. By itself, the actual raw cereal in a box of cereal is almost worthless. What adds the value are the flavourings and sweeteners and crisping agents, the pictures on the box and the advertisements that make a child clamour for its parents to buy it.









Average energy use versus average energy need: this graph shows the vast rise in the oversupply of food in most countries since 1990.

In the early 1990s, European governments were still subsidising farmers to churn out mountains of food, surpluses of which often found their way onto the world market where they made it hard for producers from poorer countries to compete. In 1995, the World Trade Organisation was founded. Its aim was to end the unfair subsidies and remove trade restrictions, to give the developing world more of a level playing field. But the new liberalised global markets were not necessarily any fairer than the system that came before and they certainly did not result in better diets. The richer countries carried on subsidising their own local farmers but also benefited from relaxed subsidies overseas, enabling their farmers to enter new markets in the developing world. Meanwhile, rules on investing in the food markets of poorer countries were radically liberalised, which led to a huge wave of foreign investment from companies selling highly processed foods. This paved the way for the nutrition transition to happen in Asia and South America.




Western eaters have been living in the sugary abundance of stage four for decades. The difference now is that so many other, poorer countries are galloping to join us. In wealthy countries, the key decades of dietary change were the 1960s and 1970s, when people shifted en masse to diets higher in sugary drinks and highly processed foods. As far back as 1980, the average Canadian was already getting more than a thousand calories a day from animal products, chiefly meat, and more than three hundred calories each from oils and sugars. The great food revolution of our times is that people across the entire globe are starting to eat this type of oil-heavy, ultra-processed diet.




One of the frightening aspects of stage four is how fast it has happened. It took thousands of years to get from a hunter-gatherer society to one based on farming (from stage one to stage two). The effects of the Industrial Revolution in Europe and the US took only a couple of centuries (stage two to stage three). But the new shifts in the West away from home-cooked meals and tap water and on to packaged snacks and sugary drinks were speedier still, taking only a couple of decades. In Brazil and Mexico and China and India, the change is happening even faster, in the space of ten years or less. For South America, the peak decade of nutritional change was the 1990s. Over just eleven years, from 1988 to 1999, the number of overweight and obese people in Mexico nearly doubled, from 33.4 per cent of the population to 59.6 per cent.




Mexican diets have changed at tumultuous speed. After the North American Free Trade Agreement (NAFTA) was signed by the United States, Mexico and Canada in 1994, it spelled the end of subsidies for home-grown Mexican corn and the Mexican market was flooded with cheap yellow corn from the US which did not have the same qualities as the old corn, either in taste or nutrition. Traditional Mexican tortilla were made from locally adapted landrace corns of diverse species, each of which had its own distinct flavour and nutritional properties. Before it was cooked, the corn was ‘nixtamalised’: soaked in an alkaline solution which increases the nutritional properties of the grain. The old tortillas were eaten with beans, a culinary arrangement which also reflected agricultural practice. Traditionally, in Mexico, corn and beans were intercropped, to enrich the soil. Now, corn and beans are not necessarily seen together either in the soil or on the plate in Mexico. Refried beans have been edged out by ultra-processed foods, whose sales expanded at a rate of 5–10 per cent a year from 1995 to 2003.




As in South Africa, the pattern of eating in Mexico has changed, radically and fast. We are not talking here about the occasional fizzy drink or a Friday night plate of fried chicken but a near total transformation of the food supply, which has gone hand in hand with disastrous changes to the population’s health since the 1990s. From 1999 to 2004, 7-Eleven doubled its number of stores in Mexico. There are Mexican towns where running water is sporadic and Coca-Cola is more readily available than bottled water. Meanwhile, the prevalence of overweight and obesity among people in Mexico rose 78 per cent from 1988 to 1998 and by 2006, more than 8 per cent of Mexicans were suffering from type 2 diabetes.









A changing plate of food in China and Egypt in 1961 and 2009.

A similarly tragic nutrition transition is currently playing out in Brazil, where much of the population is both malnourished and obese. Throughout Brazil there are ‘dual burden households’ where some family members (usually the children) are underweight and stunted and others (usually the mothers) are obese.


Many adolescent girls in Brazil are both anaemic and obese, suggesting that their diets, though plentiful, are low in crucial micronutrients, especially iron.




To Americans, junk food is nothing new. Cracker Jack, a sticky packaged confection made from popcorn, syrup and peanuts, was first sold in Chicago in 1896. The difference now is the sheer global reach of branded processed items, which have succeeded in travelling to some of the remotest villages in Africa and South America. From the late 1990s onwards, the multinational food companies worked hard to get their products into even the tiniest village food stores in Africa. As soon as electricity reached a given region, Coca-Cola would be there, offering free coolers and kiosks to shopkeepers who would stock their products. But now, food companies have taken this marketing a stage further, employing travelling salespeople to bring branded processed foods right into individual homes.




In 2017, reporters from the New York Times followed some of the women who act as door-to-door salespeople for Nestlé in Brazil. Items such as chocolate pudding, sugary yoghurts and heavily processed cereals are sold door-to-door to consumers who may believe they are doing the best for their families by buying these products, which often boast that they are fortified with vitamins and minerals. In the poorer regions of Brazil, door-to-door sales enable multinational food companies to reach households they could never otherwise have penetrated.




A report on the Nestlé website in 2012 boasted about door-to-door sales as a form of ‘community engagement’ because the foods being sold were fortified with vitamins. What the report doesn’t mention is that these fortified foods contain excessive amounts of sugar and refined starch and are displacing other, more nourishing foods from the Brazilian diet. The company currently had 7,000 saleswomen going door-to-door in Brazil, but aimed to expand this number to 10,000. Nestlé claimed that the initiative brought a sense of ‘independence’ as well as valuable income to the female sellers. Needless to relate, the company said nothing about the fact that most of these women – like their customers – were now grappling with diet-related ill health. A reporter for the New York Times spoke to Celene da Silva, a 29-year-old seller for Nestlé, who weighs more than 200 lb and has high blood pressure. She drinks Coca-Cola at every meal.




This is a story not just about the food industry but about social change. The rise of the big multinational food companies in Brazil and elsewhere is part of a bigger picture which includes rising incomes, changing patterns of work, urbanisation, electronic kitchen gadgets and a growth in TV, computer and mobile phone ownership. Mass media is one of the drivers of the nutrition transition that we often forget about. In China in 1989, only 63 per cent of households owned a TV set and of these, half owned a black and white set. By 2006, 98 per cent of Chinese households owned a TV, and almost all of them showed a full colour picture. TV watching not only encourages people to be less active than ever before, but it also allows direct marketing of novel processed foods, particularly to children. Almost all the food advertised in the world on TV is what nutritionists call ‘noncore’: inessential, sugary or salty snack foods rather than those served for a main meal. The aim of the adverts is to create a preference for these unhealthy foods in children which, the manufacturers hope, will last a lifetime.




It’s not that electronic entertainment or labour-saving kitchens and city life are bad in themselves – to the contrary. Speaking for myself, I would hate to go back to a life before Spotify – never mind before refrigeration and colour TV. So many of the social changes that have gone along with the nutrition transition have enabled people to lead fuller, easier, more comfortable lives. In the spring of 2018, when I visited Nanjing, one of the biggest cities in China, I walked on ground that would have been farmland ten years ago, full of workers doing back-breaking labour in the fields. Now, these neighbourhoods were full of glitzy high-rise malls where young people whose grandparents had lived their youth in toil and hunger sat in air-conditioned branches of Starbucks nibbling fluffy cakes flavoured with green matcha tea. Older Nanjing residents who would once have struggled to afford exotic fruit such as durian or lychees more than once or twice a year could now buy these fruits every week, and carry them home on a super-fast metro train.

In a way, the modern global food industry is a miraculous achievement. It can grow anything, transport anything, sell anything (so long as that anything can be neatly packaged and placed on a supermarket shelf). The system can produce fresh green beans and perishable meat in a far-flung corner of one country and distribute them, still in an apparently fresh state, to hungry eaters anywhere on the planet in a matter of days. For those with the cash to buy them, there are summer fruits in winter and sweet cups of piping-hot chocolate topped with whipped cream all the year round. Where our ancestors worried intensely about the safety of dairy products, we can now buy fresh refrigerated cold milk, mostly free of pathogens, whenever we feel like it.

The food transformations of stage four are unlike anything else the world has seen. Sometimes, I look at my three children and think how extraordinarily fortunate much of this generation is, never having to doubt whether there are things to eat in the shops. Fresh fruit is almost like running water to them. When stuff in our refrigerator runs out, we know there is plenty more where it came from. My children have never known empty shelves or rationing. Nor have I, come to that.

Needless to say, it still isn’t possible for all children, everywhere, to rely on this diet of abundance, even now. The terrible food shortages in present-day Venezuela are a bleak reminder that we cannot necessarily count on this era of plenty lasting for ever. It’s also the case that many children, even in rich countries, are not sharing in the plenty to the same extent, with one in five American children suffering from food insecurity. Stage four has seen the emergence of new forms of social and economic inequality around food. Some children have never tasted a strawberry, except for the fake strawberry flavour in a fast food milkshake. Others – from wealthier families – are given organic oats and farmers’ market berries for breakfast. The gap in quality between the diet of the poorest and that of the richest is wide and widening. The poorest families in America may not look hungry in the way that Victorian orphans looked hungry but they eat fewer dark green vegetables, fewer wholegrains and fewer nuts.




The great question held out by stage four is whether it is possible to enjoy the advantages of modern eating without the downsides. The post-war food system succeeded in delivering a vast surplus of calories. What it has not delivered thus far – at least not in most countries – is food for the masses that won’t make people unwell.




Bending the curve


Experts in development studies talk about ‘bending the curve’ of the nutrition transition, meaning changing its direction to a healthier pattern of eating. In an ideal world, we would be able to enjoy the convenience, variety and pleasure of modern food without the chronic illness that so often seems to be its corollary. Can the curve be bent away from junk food and towards vegetables? If so, where has this ever happened?

One country – South Korea – comes up again and again when we consider these questions. South Korea managed to pass from stage three to stage four of the nutrition transition in lightning time without experiencing anything like the same consequences of a changing diet seen in Brazil and Mexico and South Africa. Almost alone in the world, South Korea bent the curve.

From the early 1960s to the mid-1990s, the South Korean economy was completely transformed. Between 1962 and 1996, per capita GNP increased an astonishing seventeenfold. Meanwhile, life expectancy had increased from 52.4 for Korean males in 1960 to 82.16 in 2015. As elsewhere, this growing wealth went along with demographic changes, as populations rapidly moved away from the countryside and into cities. South Koreans acquired TVs and microwaves and electric rice cookers. In 1988, the city of Seoul hosted the Olympic Games and became exposed to international influences as never before.

As we might expect, these economic and social changes went along with huge adjustments to the South Korean diet. Household food consumption surveys suggest that Korean meat eating increased tenfold between 1969 and 1995 – not exactly a trivial change. Previously, a dish such as spicy bulgogi – made from shredded beef marinated in soy sauce and sesame oil – might have been a special meal. Now, with rising incomes and falling food prices, it was an everyday midweek supper for middle-class families. Meanwhile, the consumption of cereals (majoring on rice) plummeted from 558 grams per person in 1969 to 308 grams in 1995.

Given how rapidly South Korea moved from poverty to wealth and became exposed to new world markets, you would expect the country to have moved equally rapidly to an obesogenic diet high in sugar, new fats and packaged foods. But compared to people in other rapidly developing nations, Koreans retained their traditional diet to a much greater extent. When researchers examined the data for South Korea from the 1960s to the 1990s, they were startled to find that South Korean fat consumption was still reletively low. In 1996, the typical South Korean ate less fat than the average Chinese person, even though the GNP of South Korea was at that time fourteen times higher than China’s.


Meanwhile, levels of obesity in South Korea were also markedly lower than would have been expected from the nation’s level of economic development. As of 1998, just 1.7 per cent of men and 3 per cent of women in South Korea were obese.




The area where South Korea bends the curve most of all is in vegetable consumption. In 1969, the average South Korean ate 271 grams of vegetables, fresh and processed, every day. In 1995, despite all the other changes to Korean society – from the strange vogue for bubble tea to the invention of K-pop, a fusion of Western and Asian pop music – the amount of vegetables Koreans ate had actually gone up slightly, to 286 grams. The city-dwelling Koreans of the 1990s led completely different lives from Korean villagers in the 1950s, yet they continued to eat their greens. The example of Korea shows that it is possible to be a modern person who is not disgusted by cabbage.




How did South Korea manage to retain its vegetable-eating ways, despite all the other transformations and pressures of modern life? Part of the explanation is cultural. South Koreans see vegetables as something delicious rather than merely healthy, as we all too often see them in the West. Koreans enjoy a greater variety of flavoursome vegetables than most eaters in other countries, from bean sprouts to spinach. In rural Korea, it has been estimated that as many as three hundred different vegetables are eaten, each prized for its distinctive flavour and texture. King of all vegetable dishes in Korea is kimchi, a kind of fermented and highly spiced cabbage, which is not just a condiment but a staple food, the most consumed single item in the diet after rice, as of 2002.




If Korea was helped by its vegetable-loving food culture, it also benefited from a range of government initiatives which consciously set out to soften the blow of the nutrition transition. In contrast to other developing countries, South Korea made a more concerted effort to protect its own cooking against the new globalised diet. From the 1980s onwards the Rural Living Science Institute trained thousands of workers to provide free cooking workshops educating families in how to make traditional dishes such as steamed rice, fermented soybean foods and kimchi.


In addition, there were mass media campaigns to promote local foods, with TV programmes emphasising the higher quality of local food and the benefits of supporting home-grown produce and local farmers. When most children in the 1980s switched on the TV, they would be greeted by adverts for sweets and treats, fizzy drinks and cereals. When Korean children watched TV, they might instead be fed with government-endorsed messages on the benefits of locally grown food.




Fast forward to the present day, and the average South Korean diet is no longer quite as healthy as it was in the 1990s. When Popkin returned to look again at the data on Korean diets in 2009, he found that consumption of both alcohol and soft drinks was on the rise. From the late 1990s to 2009, the Korean government put a decade of effort into promoting the consumption of wholegrains, yet the average person only ate around sixteen calories more of wholegrains than before. The message this time was less effective. The prevalence of obesity, diabetes and heart disease in South Korea were also much higher in 2009 than ten years earlier.









Vegetable consumption in Republic of Korea, 1969–2009, grams per person per day.

Yet Koreans still eat far more vegetables than people in most other wealthy countries and kimchi is as popular as it has ever been. This is all the more remarkable considering that the price of cabbage – the main ingredient in kimchi – rose by 60 per cent between the 1970s and 2009. The average South Korean diet might not be perfect – what human diet ever has been? – but South Korea remains as remarkable proof that it is possible to attain some kind of golden midway point between the wholesome but too-scarce diets of the past and the plentiful but unhealthy diets of the present.




What South Korea shows is that the curve of the nutrition transition can be bent, at least slightly, with the right interventions from government. This offers hope to the developing countries of sub-Saharan Africa. Perhaps they, too, will be able to retain the best aspects of their vegetable-centric and varied diets while enjoying lives of greater comfort, wealth and ease.

At the time of writing, however, it is doubtful whether the governments of other developing countries will follow the South Korean route in actively trying to fight the onslaught of packaged foods. The more common approach seems to be for governments not so much to fight the nutrition transition but to try to make it curve faster, to gain from the profits of multinational food companies.

In August 2017, I was in Copenhagen for the World Food Summit, a two-day conference aimed at finding better ways for the world to feed itself. One of the speakers was Harsimrat Kaur Badal, the Minister for Processed Foods in India’s government (I never knew such a job existed). Badal stood up and gave a passionate speech lamenting the Indian attachment to freshly cooked food made from fresh vegetables. India, she said, was a country where most people still ate three home-cooked meals a day. The audience of Danish and international food writers, chefs and representatives from the food industry let out a mild sigh of envy. Oh for the fresh-cooked food of India! But the minister was trying to explain to us that this fresh and delicious food was actually a very bad and wasteful thing. ‘We only process 10 per cent of the food we produce in India,’ she lamented. She compared this to the countries of Western Europe, where around 60 per cent of food is processed. The minister made the point – quite reasonably – that the middle classes in India wanted to eat the same foods that were available to people with money in the rest of the world. She also pointed out that India wastes $40 billion worth of food every year, mostly because of inefficient distribution networks. ‘Food waste is morally wrong.’ The answer, she suggested, was foreign direct investment (FDI) in processed food.

India was a gigantic business opportunity, the minister explained. It was a market of 1.4 billion people, whose potential as consumers of processed food was still largely untapped. ‘I invite you all to come and partner with my country,’ she announced. ‘We want you to teach us your Danish technology and knowhow.’ In return, she offered India’s amazing ingredients and a ‘platform’ of customers ripe for the picking.

Is this really the route that the governments of India and other developing countries want to take through the nutrition transition? India is a country with a long-standing love of vegetables, which has the potential to experience something like the South Korean version of stage four, rather than the health-destroying version seen almost everywhere else. Rising incomes in India are a wonderful and life-changing thing, on so many levels. But already, as India welcomes more ultra-processed food into its diet, the country is seeing an alarming rise in type 2 diabetes and insulin resistance. Is there a way for India to enjoy life beyond hunger without having to suffer the diseases of affluence?




What we ate next


Based on everything we know about history, stage four will not be the final phase of the nutrition transition, but no one can say for sure what future diets will look like. One thing that seems certain is that after fifty years or more of over-consumption there will have to be some kind of shrinking back in the amount of calories populations consume. What remains to be seen is whether this reduction will be forced upon us by climate change and failing harvests, or whether we can take control of our own food destiny and start to eat within the limits of what our bodies need and what the land can bear. Barry Popkin is among those who predict that with the right policies the latter can happen and we will leave behind stage four for stage five, a phase of life that he has christened ‘behavioural change’.

Stage five – if it ever fully comes into being – is where the hope lies. During this phase, most people would still be affluent and live in cities, but the cities would take on different characteristics, with more opportunities for physical exercise and more accessible and affordable fresh produce. This stage would be characterised by people eating more vegetables and fruits and experiencing a rapid decline in degenerative diseases. During this phase, greater knowledge of the links between diet and health would lead people to eat better diets. Phase five is where we would all like to be living and eating: a comfortable life with neither hunger nor disease, with delicious food but not an excess of it.

There are little glimmers that stage five may be emerging – not everywhere and for all people, but in enough places that it starts to look a bit like the future. One of those places is Denmark.

‘So much has happened in twenty years. It is unbelievable how exciting it is to be a cook right now!’ exclaims Trine Hahnemann, a caterer and cookbook author based in Copenhagen. I meet Hahnemann at the same World Food Summit in the summer of 2017 where I hear the Indian Minister for Processed Food speak. Hahnemann takes me to a wine bar in one of Copenhagen’s many beautiful old townhouses where we drink Grüner Veltliner white wine from elegant Scandinavian glasses with long stems and flattened bulbs. She tells me how she sees good food as central to the quality of life in general.

As a Dane, Hahnemann’s experience of modern food is completely different from that of her middle-class equivalent in Mumbai or Delhi. Denmark passed from stage three to stage four of the nutrition transition in the 1950s and 60s. Now, it is heading somewhere altogether more flavoursome and interesting. If stage five exists anywhere, it is surely in Copenhagen, where the majority of adults cycle to work and the food culture centres on dishes which are healthy, sustainable and delicious. As in South Korea, Denmark benefits from a government that takes the quality of its citizens’ diet seriously. In 2004, Denmark placed a blanket ban on trans fats in foods for sale, a move that played a part in reducing the country’s rates of heart disease.




When Trine Hahnemann was a child, no one in her Copenhagen school had heard of garlic. She remembers how long it took for houmous to be accepted by conservative Danish tastebuds. ‘Yet now,’ she remarks, ‘you couldn’t go to any food store and not find houmous. That’s in thirty years. That’s diversity.’ A mere ten years ago, there was no Vietnamese food to be found in Copenhagen, whereas now there is a passion for pho, a spicy Vietnamese broth heady with green herbs and vegetables. Yet the Danes have also retained their love of healthy traditional foods such as dense dark rye bread.

As someone who caters for government-funded work canteens, Hahnemann has seen first-hand how the Danish government makes healthy and sustainable eating a priority for everyone in society, rich and poor. As of 2016, a new law came in requiring that any food served in a public institution – from a school to a hospital – must be 60 per cent organic. Hahnemann finds that the Danes she cooks for are remarkably receptive to vegetables and flavourings which would once have been seen as threatening. If a big batch of cauliflower arrives from her suppliers, she may serve it three days in a row: day one with a brown butter sauce, day two as Indian pakoras and day three Italian-style with capers.

Despite Hahnemann’s love of vegetables, not everything she cooks and eats would be defined by a nutritionist as strictly ‘healthy’. Like most Danes, she adores cake and always keeps a sponge cake in her freezer in case friends drop by and she wants to rustle up a quick rhubarb and chocolate layer cake, filled with a rich rhubarb cream and topped with chocolate ganache. ‘Life without cakes would be a bit too sinister,’ Hahnemann writes in one of her cookbooks, adding that she believes cake to be good for mental health. Just as the Japanese-style diet eaten by Fumiaki Imamura is a mix of ‘healthy’ and ‘unhealthy’, so is the modern Danish diet. But the balance, in both cases, is tipped towards the healthy.




Not every country can be like Denmark, which benefits from a tiny population, substantial wealth and low levels of social inequality. It would be difficult to replicate exactly the way that the Danes eat anywhere else. The question, however, is whether other countries could shift to a phase where the typical diet is abundant but no longer damages the health of millions.

There are small but growing signs that many people around the world are moving in something like a Danish direction with food. Fumiaki Imamura’s data shows that the quantity of healthy food being eaten in the more affluent countries of the world – in Europe, North America and Australasia – is actually going up, while consumption of unhealthy foods slowly starts to level off. This chimes with the behaviour around food we can observe all around us, with many consumers consciously reacting against what they see as a toxic food supply and searching for new ways of eating. Who would ever have predicted the day when kale and beetroot would become objects of affection in the West? Food preferences can change in a remarkably short space of time.

The hope held out by stage five is that the two stories of modern food could merge into one, single story: a cheerier and more consistent one. We abolish hunger, eat our greens, make water the default drink, discover delicious things like houmous, have the occasional slice of cake for our mental health and live happily ever after. With the right food policies – which would include a combination of different farming policies, better food education and tighter regulation of unhealthy foods and drinks – we might yet reach stage five. For this to happen, governments would have to reset the trajectory of food policy away from the post-war agenda of quantity at all costs. There are tiny signs that this is happening, for example in the sugar taxes that have been enacted in various countries, but the true potential of food policy to improve our diet has yet to be tested. As the authors of one briefing paper on future diets from 2014 remarked, ‘policies on diets have been so timid to date that we simply do not know what might be achieved by a determined drive to reduce the consumption of calories, and particularly the consumption of fat, salt and sugar’.




In the meantime, for those of us still in the middle of stage four, it can be hard to know how to live and eat for the best. We are beset on all sides by extremes – from fad diets on the one hand to junk food on the other – and it can feel almost impossible to steer our own path through the madness and choose a variety of foods that give us both pleasure and health.

It would be a start if we could at least name the food in front of us and notice what it is that we are putting in our mouths. Half the time, we do not even seem to recognise the ways in which our food has changed.

Colin Khoury, the diversity expert who identified the Global Standard Diet, told me about a dinner table game he plays at his home in Denver. Khoury lives with his wife and disabled brother and all three play the game every evening when they eat. It’s a kind of secular grace. Before taking the first mouthful, the three of them compete to name the species and botanical family of all the foods they are about to eat. In Latin. If they are eating burritos, for example, one of the Khourys might start by saying thanks for Triticum aestivum (wheat, in the tortilla), in the grass family (Poaceae). Then another person another might say, ‘Persea americana, avocado, in the laurel family (Lauraceae).’ They keep going until no one at the table can name any more ingredients. And then, the three of them eat. ‘It’s kind of a silly exercise,’ says Khoury, ‘but for me it’s a chance to pull it apart enough to be recognisant of what’s in a meal.’ Khoury’s dinner table game is a small but eloquent gesture against a world converging on the same unbalanced diet.

Personally, my Latin is not good enough to play this game. But I like Khoury’s idea of picking apart the components of food on a plate as a way of paying attention to what you are actually eating. This is what omnivores have always done: we look at a range of items and say ‘this is edible’ and ‘this isn’t’. None of us can escape living and eating in the global market of stage four. You can’t increase the variety of your daily food intake simply by naming it. But if we are going to tip the balance of our diets back in a better direction, it helps if you can at least say what it is that you are eating.

One of the problems with modern eating is that we stopped trusting our own senses to tell us what to eat. We may not be hunter-gatherers, nor even farmers. But every human is still an eater, and we still have senses that can tell us useful things about what to put in our mouths, if only we pay attention. You are under no obligation to eat something just because a packet tells you it is ‘all-natural’ or ‘protein-boosted’ or supposedly marvellous in some other way. Despite all the transformations of stage four, some things remain constant in our eating lives. Food is only food when a human says it is, and that human is you.





2: Mismatch (#ulink_8095c3fd-1604-548e-96fe-287865b8714a)


‘Sometimes we need to step backwards.’ Thus begins one of the many voices on the internet suggesting that our eating would be healthier and happier if only we could travel in time and eat a bit more like our great-grandmothers. This particular article – from the Institute for the Psychology of Eating – goes on to recommend ‘ancestral eating’ as the solution to many of the health problems of modern times.

What, you may ask, is ancestral eating? Apparently, it means sticking as closely as possible to the diet of your great-grandparents, wherever they happen to have lived. If your ancestors came from Greece, ancestral eating might entail full-fat yoghurt, wild greens, grass-fed meat and olive oil; if your family came from Japan, it might include fish, seaweed, fermented vegetables and ‘heirloom’ grains.




Nostalgia for the tastes of our childhood has always been a powerful emotion. In our modern food environment, many of us invoke the wisdom of our grandparents as a way out of the craziness and ill health of modern diets. The inspiration for much of this way of thinking comes from the food writer Michael Pollan, who memorably advised that a good rule of thumb for healthy eating was ‘Don’t eat anything your great-grandmother wouldn’t recognise as food.’

The urge to turn back the clock on modern diets is understandable. So many aspects of our diets have worsened in recent decades. In all regions and in all countries, diets rich in coarse grains, legumes and other vegetables are disappearing as a mainstream way of eating and, as we saw in Chapter 1, there has been a great loss of biodiversity. It’s true that almost anyone in the modern world would be nutritionally better off eating more olive oil, more vegetables, more fish, more lentils, more wholegrains.




Yet there are significant problems with thinking that the solution to poor diets is to go backwards. For one thing, our great-grandmothers often suffered terribly for the food they made, as they toiled to grind enough grain to keep their families alive. Until recently, it was common for women in much of the world to suffer from severe arthritis in their upper bodies, caused by the hours they put in at the grindstone, and rolling dough for such staples as chapattis and tortillas.

Moreover, not all great-grandmothers were eating an ideal diet. Many of our recent ancestors, as we’ve seen, were eating an extremely monotonous diet of grains and teetering on the brink of hunger. True, your great-grandmother wouldn’t recognise ‘sports drinks’ or popcorn fried chicken or any of the myriad other new highly processed foods, but she also might not recognise many of the wholesome new foods that contribute to health: raw kale salad and overnight oats and pumpkin seeds. Some great-grandmothers, moreover, were eating an early twentieth-century version of junk food. In 1910 a public health campaigner in New York City watched school children buying hotdogs dyed with violently pink food colouring and frosted cupcakes. It’s simply not true that our great-grandmothers would only recognise meat that was organic or grass-fed.

There is yet another difficulty with calling on the wisdom of our great-grandparents to save us from the worst excesses of modern food. This way of thinking ignores the fact that we are already living and eating with one foot in the past. Many of our most profound problems with eating stem from our inability fully to adapt to the new realities of the nutrition transition. In many ways, we already are eating according to the wisdom of our great-grandmothers, whose physiology and attitudes to eating were forged by the constant threat of scarcity.

What we eat may have radically changed in our lifetimes, but our food culture has not changed quickly enough to keep pace. We may, sadly, have forgotten the recipes of our great-grandmothers. Most of us have lost their home-spun knowledge of how to bottle fruits for the winter, not to mention their brilliance with a carving knife. But what we have not forgotten is their excitement at a laden table. We are living in a world of perpetual feast but with genes, minds and culture that are still formed by the memory of a scarce food supply. This is part of what it means to live through the vertiginous changes of stage four. We haven’t yet developed the new strategies for living that would enable us to navigate our way through this forest of seeming plenty to a way of eating that gives us both health and pleasure.

Think about some of the eating strategies that would have made sense in an era of scarce food. For one thing, you would value energy-dense foods such as meat and sugar very highly and gorge on them when they came your way – just as many of us still do. You would leave a clean plate and when food was accessible, you would grab it while you could.




Development experts speak of ‘mismatch’ in explaining the clashes between the new food reality and the persistence of a human biology and culture adapted to earlier times. Instead of looking backwards to some imagined past which we can never reclaim, we need to look forwards and have yet another change of taste.

Our food system is currently full of mismatches. Some of these mismatches are cultural, as we fail to adapt to the new realities of eating in an age of abundance. Our food culture remains far too misty-eyed about sugary foods, for example. We haven’t adjusted emotionally to the fact that sugar is no longer a rare and special celebration food, worthy of devotion. Nor have we yet modified our attitudes towards those who are overweight and obese, to reflect the fact that these people are now in the majority.

Perhaps the most tragic mismatches are biological, as bodies formed for an environment of scarcity have not adapted to cope with the strange and bountiful new world we now find ourselves eating in.




The thin-fat baby


It was 1971 and Dr Chittaranjan Yajnik was a young medical student training at Sassoon General Hospital, Pune, a big city in the west of India. Yajnik was given the task of measuring the body mass index (BMI) of diabetic patients. This should have been a routine job, little more than number crunching. The main challenge was that Yajnik could not afford a calculator, so he laboriously wrote down the patients’ weight in pounds and height in feet in a log table and used his paper notes to calculate in his head the BMI in kilograms per metre squared.




After taking measurements for the first ten patients, Yajnik noticed something was not right about his numbers. His medical textbooks had taught him that type 2 diabetes was a disease mostly suffered by the old and the obese. But the first ten diabetic patients that Yajnik measured in the hospital at Pune were all young and thin, with low BMIs. If his measurements were correct, then the textbook must be wrong, or at least incomplete, in its definition of type 2 diabetes as an offshoot of old age and obesity. Yajnik tried to raise the problem with his medical supervisor but was told that this was no time to be challenging medical orthodoxy – he should just focus on passing his exams.




Yajnik could not put the puzzle of diabetes in India out of his mind. After some years studying Western diabetes in Oxford, England, he returned to Pune as a fully qualified medical researcher, by which point diabetes was on the rise in his home country. In the early 1990s, Yajnik began a study following mothers and their babies in six rural villages near Pune – the Pune Maternal Nutrition Study. The data he started to gather confirmed his hunch that diabetes in India had a very different face from the supposedly classical type 2 diabetes in the textbooks. Yajnik took detailed birth measurements of more than six hundred Indian babies and compared them with a cohort of white Caucasian babies born in Southampton in the UK. Compared to the UK babies, the Indian babies were smaller and lighter. Yet when Yajnik used calipers to measure the thickness of the babies’ skinfolds, he found that the small Pune babies were actually fatter than the Southampton babies – they were surprisingly ‘adipose’, especially around the centre of the body. Yajnik coined the phrase ‘the thin-fat Indian baby’ to describe this phenomenon. Even at birth, these Indian babies had higher rates of pre-diabetes hormones in their bodies than their British equivalents. The babies may have looked thin but their body composition was actually fat.




We speak of conditions such as heart disease and type 2 diabetes as ‘non-communicable diseases’ or NCDs. You can’t catch an NCD from another person in the way that you would catch a common cold by standing next to someone who is sneezing. But what Yajnik discovered is that babies can actually ‘catch’ a predisposition towards diabetes from their mother in the womb, via the diet she eats. The babies of mothers who were undernourished during pregnancy had ‘fat-preserving tendencies’ – passed on as a survival mechanism.




It used to be believed that India’s diabetes epidemic was mainly due to ‘thrifty’ genes, endowed over many generations on populations that suffered from patchy and inadequate food supplies. Thanks to decades of malnourishment, these populations were poorly adapted to eat a rich modern diet. Yajnik’s breakthrough was to show that the time frame of maladaptation was much shorter. He speaks not of a thrifty gene but a ‘thrifty phenotype’: the interaction of genes with the environment over a single generation. Depending on the environment in which it develops, a given gene may give rise to different phenotypes. The ‘thin-fat’ baby represents a mismatch of biological environments. These babies grew inside their malnourished mothers with phenotypes for hunger but – thanks to the huge changes in India’s food supply between the 1970s and the 1990s – found themselves eating an unexpectedly plentiful diet.




When Yajnik first observed the ‘thin-fat’ baby in the 1990s, this was a radically new way of thinking about the interaction of nutrition and health. It took six years for Yajnik to have his first paper on the subject accepted for publication because the mainstream medical establishment was so sceptical of this idea ‘coming from an obscure Indian in an obscure place’, as he puts it. The idea of the ‘thin-fat’ baby only started to gain acceptance when Yajnik published a paper in 2004 revealing that he was a ‘thin-fat’ Indian himself.




This 2004 paper – which he called the ‘The Y-Y paradox’ – included a now-famous photograph of Yajnik side by side with his friend and colleague John Yudkin, a British scientist: two slim middle-aged men in white shirts. The paper explained that Yajnik and Yudkin had near-identical body mass index readings of 22 kg/m


. A BMI of anything between 18.5 and 24.9 is considered healthy in the UK: not underweight and not overweight. Yajnik and Yudkin were both well within this healthy range. But X-ray imagery showed that Yajnik – the thin-fat Indian – had more than twice the body fat percentage of his friend. Yudkin’s body fat was 9.1 per cent whereas Yajnik’s, despite his slim appearance, was 21.2 per cent. Further research has confirmed that the adult Indian population in general has lower muscle mass and higher body fat than white Caucasians or African Americans.




The story of the thin-fat babies of India is the story of the nutrition transition written on human bodies. Thanks to the new science of epigenetics, we now know that a pregnant woman’s body sends signals to her unborn child about the kind of food environment he or she will be born into. An underweight pregnant woman who eats a scarce diet is signalling to her child that food will always be scarce, which triggers a series of changes in the baby’s body, some hormonal and some physiological. For example, Yajnik found that a lack of vitamin B12 in the mother’s diet resulted in babies who were more likely to be insulin resistant.

Thin-fat babies are graphic evidence of a society in a state of dietary flux, with a shift from starvation to abundance in a generation. These Indian babies were born to mothers who lived and ate not so long ago, but the circumstances of their lives feel like another universe. There was seldom enough food, especially fats and protein, and people had to walk many miles just to get fresh water. When these women became pregnant, their babies’ bodies were metabolically programmed before birth – with their ample deposits of abdominal fat – to survive in circumstances that were harsh and lean. But the babies grew up eating in a very different and more affluent environment: a world of improved buses and electricity and labour-saving farm machinery, of cheap cooking oil and rising incomes. Millions of people in Indian cities – a new and rising middle class – have scooters where once they had only bicycles or feet. Diabetes is the worm in the apple of this new Indian prosperity.

The problems of babies born into a rapidly changing food environment are compounded by the way they are fed during the early years of life. The memory of scarcity still informs the strategies mothers use to feed babies, not just in India but everywhere in the developing world. Many of the thin-fat babies will have been fattened up in their first two years by emergency food aid. In the old India, the most urgent nutrition problem was outright hunger and overfeeding a child seemed to be the last thing anyone should worry about. This hungry India still exists to a shocking extent, with 38 per cent of all children under five so short of food that it will impair their future development, according to the Global Nutrition Report. If the alternative is to starve, rapid weight gain in the first two years of a child’s life can be a miracle. But it’s now known that this rapid growth in children who were previously malnourished may have unintended long-term consequences. Rapid growth is a risk factor for obesity and elevated blood pressure in later childhood and diabetes in adulthood. There is gathering evidence that high intake of protein and vegetable oils during the early years of feeding may result in a higher risk of obesity later in life.




Given India’s vast population, it is perhaps not so surprising that the country currently has more patients with type 2 diabetes than any other in the world. The more startling fact is that people with diabetes form such a high percentage of that population. Already, in large cities such as Chennai, around two-thirds of the adult population is either diabetic or pre-diabetic.




What can be done to correct the nutritional mismatch suffered by the thin-fat babies? Those working with malnourished babies in developing countries have started to talk of ‘optimal’ nutrition: the kind of childhood diet that will provide all the essential micronutrients and promote growth while minimising excess weight gain. Yajnik and his colleagues are currently working on a project giving a cohort of adolescent girls vitamin supplements which should, in theory, mean that in pregnancy their bodies will send the message to their unborn children that a world of plenty awaits them. The aim of the project is to get the bodies of the mothers to communicate more accurately with their unborn children about what food is like in modern India and thus to reduce the risk to future generations of developing NCDs. Only time will tell if these hopes come to fruition. The epigenetic messages in our bodies cannot be rewritten straight away.

Spare a thought for the grown-up thin-fat babies of the 1980s and 1990s, many of whom are now diabetics living in modern India. Through no fault of their own, these people are stuck while young with a disease they will spend a lifetime trying to manage. Living with type 2 diabetes means living on a diet that is directly at odds with the prevailing food supply. In food markets awash in lavish amounts of refined carbohydrates, they must teach themselves to be sparing with sugar and white rice. They must try to limit their calorie intake in a world that offers them ever-larger portions.

The dilemmas faced by the thin-fat Indian are an extreme version of the problems facing millions of others in the modern world. We are all affected to some degree by a series of biological clashes between the basic instincts of our bodies and the environments in which we live, and taken together, these clashes seem almost designed to make us fat. Every human baby has an inbuilt preference for sweetness, which didn’t matter too much in the days when sugar was a luxury, but which becomes a problem in a world of cheap sweeteners. We also have a natural inclination to conserve energy, which served us well as physically active hunter-gatherers and farmers but doesn’t pan out so well in cities full of cars. Many of the human instincts that evolved to help us survive have now become a liability. Yet another example is the fact that, in human biology, hunger and thirst are two separate mechanisms, which means we can drink almost any amount of sugary drinks without deriving much satisfaction from them.




The thirst conundrum


Where do you draw the line between a drink and a snack? These days, it can be hard to tell. If you eat a serving of chocolate ice cream, it counts as dessert and gives you approximately 200 calories. But if you take the same chocolate ice cream in the form of a large milkshake, the serving size may yield as much as 1,000 calories. Yet because it’s only a drink, you might have a burger and fries alongside.

It doesn’t make sense to talk about changes to eating habits without bringing in the revolution in what we drink. Perhaps no single change to our diet has contributed more to unthinking excess energy intake than liquids, both soft and alcoholic. We have reached a state where many people, adults and children, can no longer recognise a simple thirst for water, because they have become so accustomed to liquids tasting of something else.

By 2010, the average American consumed 450 calories a day from drinks, which was more than twice as many as in 1965: the equivalent of a whole meal in fluid form. Whether it’s a morning cappuccino or an evening craft beer, a green juice after a workout or an anytime bottle of Coke, the choice of calorific beverages available to us has become immense and varied. Around the world, there are bubble teas and agua frescas; cordials and energy drinks; and then there are all the new-fangled ‘craft sodas’ infused with green tea or hibiscus that pretend to be healthy, even though they probably contain nearly as much sugar as a Sprite. Many modern beverages are better thought of as food than drinks, judging by the number of calories they contain. Yet for reasons both cultural and biological, we don’t categorise most liquids as food. To our bodies, this endless stream of drinks registers as little more satisfying than water.




Picture a typical day for an average Westerner, and start counting the drinks. It’s a lot. It surprised me to learn that more than 5 per cent of Americans now start the day with a sweetened fizzy drink, but then again, cola for breakfast is a logical enough choice if you work early shifts and don’t have access to a kitchen. A more universal morning drink is coffee, which is often more milk than coffee. Maybe there’s an orange juice on the side. (After decades of growth, however, our appetite for orange juice is finally waning, hit by growing consumer awareness that it is little more than sugar. From 2010 to 2015, the amount of Tropicana fruit juices consumed in the US dropped 12 per cent.) By mid-morning, survey data suggests that 10 per cent of Americans are ready for another coffee or soda. Personally, I am in awe of anyone who waits that long. I am so addicted to coffee, particularly when working, that I am often thinking about my second cup before I have finished the first (which is one of the reasons why I try to take my coffee black as the default. Try).




And so our days continue, punctuated by sips of sugar-water and caffeine of one kind and another, with or without the addition of milk and various syrups, until the cocktail hour arrives, time for more soft drinks or alcohol. We sometimes imagine that the Mad Men generation of the 1950s were much bigger drinkers than the average person today. But except for a small affluent minority, Americans consumed vastly less alcohol in the 1950s than today – total alcohol intake increased fourfold from 1965 to 2002 in the US.




This is a global story. A rise in beverage consumption is one of the key elements in the nutrition transition, wherever it has happened. In 2014, a market report on soft drinks wrote of Latin America as ‘the global bright spot for soft drinks brand owners and bottlers’.


Young people in the emerging economies of Mexico and Argentina drink more of these drinks every year, as incomes increase. In China, people who lived their whole lives drinking nothing but unsweetened tea and water now have access to beer and fizzy drinks and a whole smorgasbord of Starbucks flavoured coffees.

It’s a sign that times are good when you can afford to quench your thirst with liquids other than water. The drinks industry – both soft and alcoholic – has conditioned us to believe that whatever the occasion, it will be improved with a drink in our hand. Studying? An energy drink will help you concentrate. Out with friends? You need a beverage to help you relax. By 2004 the average American was consuming 135 gallons of beverages a year other than water – around one and a half litres a day.









Wine glasses in England from 1700 to 2017: a sevenfold increase in size (based on an article by Theresa Marteau and colleagues in the British Medical Journal 2017).

It would be easy to paint all this modern beverage consumption as a novel kind of gluttony which those wise great-grandmothers of ours would never have indulged in. But in middle-income countries such as Mexico where much of the water supply is unsafe, buying soft drinks can be a move of self-preservation. Bottled drinks do not contain the bacteria of unclean water and are less likely to make you and your children sick. What’s more, a fizzy drink can look like the frugal choice. Given the option between paying a similar amount for a bottle of water or a bottle of cola, the cola can appear to be better value, because it offers flavouring and energy along with the liquid.

But our biology is not well adapted for this switch to high-calorie beverages. When we talk about what’s wrong with modern drinks, we discuss the problems with sugar, but we don’t talk so much about our own hunger and fullness. It seems that our genes have not evolved to be satisfied by drinking clear liquids, even when those liquids contain as much energy as a three-course lunch. This is the liquid conundrum. A person might easily drink two large glasses of Chardonnay before dinner, and then go ahead and eat a substantial meal as if nothing had happened (or maybe this is just me). Another person might have half a litre of Mountain Dew and feel no less hungry for a foot-long sandwich. With certain exceptions, our bodies simply do not register the calories from liquids in the same way that we do with solid food. This is one of the starkest mismatches between human biology and our current patterns of consumption.

Before the first experiments with honey-wines around 11,000 years ago, the only drinks available to humans were water and breast milk. For most of our evolution as a species, drinks and food were thus two entirely separate things, except for babies. There were survival benefits to keeping the mechanism of thirst separate from the mechanism of hunger. If hunter-gatherers had become full from drinking water, they wouldn’t have felt the need or desire to go out and search for food, and they would have died.




Numerous studies have shown that most people do not compensate for the energy they drink by eating less. When you drink water, it rapidly enters your intestine, quenching your thirst but doing little to dent your hunger. The same is true even when the water is laced with sugar. It’s as if our bodies simply don’t register the calories in the same way when they arrive from a glass, a cup or a can. Clear fluids such as sports drinks, fruit juices, cola and sweetened iced teas seem to be particularly bad at killing hunger, but milk-based drinks such as lattes and chocolate milk are also surprisingly unfilling for most people, despite the nutrients they contain. Scientific studies show that people have a weak satiety response to clear drinks regardless of how many calories they are laden with – meaning that they don’t fill us up as much as the equivalent calories taken as food. And so we end up consuming a lot more energy from drinks than we intended or even knew.




As of the year 2000, sugary drinks were the single largest source of energy in American diets. Westerners have been drinking sugar-sweetened tea and coffee for a few centuries, but never before have ‘caloric beverages’ taken up so large a proportion of the average diet. In the past, the largest source of energy in human diets would have been a staple food that actually filled a person up, such as bread. It’s a sign of how disconnected we are from our own hungers that we have reached the point when so many people receive most of their energy from something that gives our stomachs so little satisfaction.

The relationship between liquids and hunger is still not fully understood. One biological explanation for our lack of fullness after a drink is that the normal hormones – peptides – that are triggered in our gut when we eat food are not triggered when we drink sugary or alcoholic drinks. The role of these hormones is to signal to our brains that we are full. When we have a large sugary drink, there is faulty communication between our gut and our brain and somehow we don’t get the message that we have just ingested hundreds of calories.

We need a way to think about liquid-fullness as well as food-fullness. I’ve found it helpful to start telling myself that anything other than water is a snack not a drink: to be savoured, not gulped down. A cappuccino can taste amazingly creamy and delicious when you tell yourself it’s food. Whether this kind of mindful drinking would work when you have just ingested three beers and are wondering about a fourth on a Friday night is debatable, however.




There are exceptions to the rule that liquids don’t fill us up. After all, breast milk is both food and drink to a baby. Some liquids – soup being the prime example – are actually even more filling for most people than solid food. The thickness or viscosity of a liquid seems to be important for whether it is filling or not. The more viscous a liquid is, the more it suppresses hunger.


Our beliefs about different liquids may also affect how much satisfaction they bring us. Soup has a long-standing reputation as satisfying – something that nourishes us and feeds us, body and soul. A cold, fizzy drink, by contrast, has no such nourishing connotations.

The rise of highly marketed calorie-filled drinks is a big part of why our energy balance – calories in and calories out – is so out of sync. The average BMI of the US population has been increasing for over 250 years but it only took a sudden sharp turn upwards in the mid to late 1970s. This was the same moment when the daily energy gained from beverages suddenly increased – from 2.8 per cent of all energy to 7 per cent for the average person. Correlation is not causation, but the timing supports an association between rising beverage intake and rising obesity. The correlation between a sudden growth in consumption of caloric drinks and increasing BMI maps onto the whole population, across all ages and ethnic groups.




Mainstream opinion will – charmingly – tell a person that if he or she is fat, the reason must be a lack of willpower. But the example of calorie-laden drinks shows once again that obesity cannot simply be attributed to individual laziness or greed. Around forty years ago, companies began marketing a completely new set of drinks to American and European consumers. Another couple of decades on and these novel liquids were travelling the world and becoming ever larger. In 2015, Starbucks marketed a cinnamon-roll-flavoured frappuccino that contained twenty teaspoons of sugar (102 grams) in a single serving. In some ways, the surprise is not that two-thirds of the population in the UK and US are overweight or obese; but that one-third of the population are not.




Yet we live in a culture that says that despite all this sugar being pumped into our drinks, we are not allowed to be fat. This is one of the cruellest aspects of our current food culture. There is a huge mismatch between the availability of foods and drinks and the way we talk about the people who consume the most everyday and easily available items.




The stigmatised majority


In most countries, the majority of people eating today are overweight or obese. Yet there has been remarkably little discussion of how the overall experience of eating is affected by this change. We wring our hands about the ‘obesity crisis’ but we do not pay much attention to how it feels to eat in the modern world as a person with obesity. Culturally, we have not yet adapted to the new reality and we continue to hold up slim bodies as ‘normal’. This is sad, not least because the psychology of fat shaming is one of the reasons most people with obesity find it so hard to lose weight.

The fact that weight stigma is a problem has been known since the 1960s. A series of studies carried out by sociologists in the early 1960s found that when shown pictures of six children and asked to rank them in order of preference, ten-year-old American girls consistently ranked the girl with obesity as the least preferred, lower in the friendship stakes than a child in a wheelchair, a child with facial disfigurement or a child with an amputated arm.




In 1968, a German-American sociologist called Werner Cahnman published an article titled ‘The Stigma of Obesity’. In it, Cahnman documented the terrible discrimination suffered by young people with obesity in America, based on a series of thirty-one interviews he conducted at an obesity clinic in New York City. They told him stories of rejection and ridicule, of doors slammed and opportunities lost. Rejection of people with obesity ‘is built into our culture’, wrote Cahnman. In 1938, as a young Jewish man, Cahnman had been interred in the Dachau concentration camp. After his escape, he emigrated to the US, where he spent much of his career as a sociologist considering the various forms that social prejudices took. To him, it was clear that being overweight in America was not just seen as ‘detrimental to health’ but as ‘morally reprehensible’.




The worst aspect of weight stigma, Cahnman suggested, was that it created an internalised sense of shame from which the obese ‘cannot free themselves’. In the fifty years since Cahnman’s article was published, much research has been done confirming that weight stigma has damaging effects on the health and wellbeing of the stigmatised.

Yet stigma about being overweight or obese goes almost unchallenged. Negative messaging about fatness is the norm rather than the exception in our culture and has become a global phenomenon. There used to be numerous cultures where non-thin bodies were celebrated, but a study from 2011 found that fat stigma has now spread to Mexico, Paraguay and American Samoa. Meanwhile in Western societies, psychologist A. Janet Tomiyama has found, weight stigma is now ‘more socially acceptable, severe, and in some cases more prevalent than racism, sexism and other forms of bias’.




Clearly, not everyone who is overweight or obese is equally sensitised to negative stereotypes about weight. Some are cheerfully unfussed by such questions as body mass index, while others find solace and pride in the ‘body acceptance’ movement that celebrates human bodies in all their diversity. Nevertheless, the indications are that millions of people worldwide are negatively affected – both psychologically and physically – by obesity stigma.

The history of public health is littered with examples of health-related stigma, and it never ends well for those affected. Cholera, syphilis and tuberculosis were all impossible to bring under control when the sufferers were seen as morally to blame. In 2017, an editorial in the British medical journal The Lancet argued that health systems will never effectively prevent childhood obesity until it stops being treated as a personal moral failing caused by faulty willpower. Until there is collective recognition that obesity is ‘not a lifestyle choice’, argues The Lancet, the prevalence of obesity is unlikely to be reduced.




In the absence of collective action, the main way anyone can shield themselves against an obesogenic world is through embarking on an individual programme of diet and exercise. Yet here, again, the stigma of weight serves to thwart us. There is now a gathering body of evidence that obesity stigma negatively affects a person’s efforts to lose weight. This will come as no surprise to anyone who has ever tried to force themselves on a diet, only to fall rapidly off the wagon, thwarted by a debilitating sense of shame.

When I was an overweight teenager, the whole experience of eating was quite different to how it feels to me now, as a so-called ‘normal weight’ middle-aged woman. It was the difference between eating in an atmosphere of freedom – as I am lucky enough to do now – and eating in a cloud of judgement. I remember feeling that I did not really have permission to eat most of the foods that I wanted to eat, especially in public. Because of my age (I was born in 1974), I feared fat more than carbohydrates. This translated into years of pointlessly and joylessly denying myself butter, because you were not allowed to eat butter – or so I believed – if you were bigger than a size 10 (a US size 6).

During my overweight years, I had two completely different ways of eating, one for public and one for private. In public – most of the time, anyway – I ate what I believed to be socially acceptable. When I was at university, my best friend was anorexic and I felt that if I followed her lead, I must be above reproach. I ate dreary salads made from shredded iceberg lettuce and dried-up chicken breast with no dressing. I ate tiny portions of unseasoned poached salmon and cottage cheese. I drank gallons of Diet Coke. All of these items had an unpleasant overtone of duty.




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