Eat a balanced diet!

Growing up, and indeed, well into adolescence and adulthood, this has been a message I’ve heard from a number of angles (my mother, cartoon characters, and official guidelines, to name but a few). While great advice, theoretically, it can be hard, practically, to know exactly what this means. Even harder still is sorting through media interpretations of nutrition research, which can more often serve to confuse and disorient than to provide relevant information for everyday living.

The importance of a balanced diet, however, cannot be overstated. Simply put, balance means building meals and snacks on a daily basis that (1) provide energy (macronutrients: proteins, fats, carbohydrates) and (2) are rich in nutrients that enable essential chemical processes to take place in the body (micronutrients: vitamins and minerals). Together, these macro- and micronutrients, along with water, are the foundation for proper growth and development of the body and the brain, a process that begins at conception.

In my early days as a food policy and nutrition graduate student, I distinctly remember when we began studying Scaling Up Nutrition (SUN) and focused on Malawi (my current home), which signed on in 2011 as an early adopter of the movement. In doing so, Malawi indicated political commitment and demonstrated a fundamental understanding that continued development for the country, broadly speaking, would have to be preceded, or at least accompanied by, the improved nutritional status of its people.

Much like the disconnect between the theoretical soundness of our mothers urging us toward a balanced meal and the daunting task of figuring out what to put on the table for dinner tonight, grappling with the hows of improving the nutritional status of an entire nation is not a course with a well-marked path. According to the 2010 Demographic and Health Survey (DHS), generally conducted every five years, the rate of nutritional stunting, also known as chronic malnutrition, for Malawian children under the age of five was approximately 47% – nearly half of the entire nation’s children. This rate is almost twice the global average and eight percentage points higher than the Eastern and Southern African average. The highest rate of stunting in the world is 59%, in Afghanistan (UNICEF, State of the World’s Children 2014), where the challenges surrounding how and what to feed one’s family have been inextricably woven within the complex backdrop of ongoing civil, political, and military insecurity.

Nutritional stunting, to which its name hints, means that adequate growth has not occurred and height-for-age is low. Beyond two years of age, it is an irreversible condition that results from chronically insufficient consumption or absorption (often due to complications related to illness) of both macro- and micronutrients. One of the main problems with stunting is that it is not very easy to detect without regular growth monitoring and recordkeeping. While talk of malnutrition often calls to mind heartbreaking images of famine – children with distended bellies, stick-thin limbs, and vacant expressions in their eyes – stunting does not look like this. It does not look like much of anything, really, especially if short stature due to nutritional stunting is the norm in a family, community, or village. There are no alarm bells; no immediate or obvious threats to life.

Life is about much more than surviving, however, and this is where the dangers posed by stunting become pronounced. Stunting refers not only to physical growth, but to cognitive development as well. Stunted children have lower school performance than their non-stunted counterparts, with fewer job prospects and lower economic productivity (not just for themselves, but for their nations as well) into adolescence and adulthood. The overall impact on health is lower immune function and higher susceptibility to illness and infection. Women who are stunted do not have space in the womb to allow for adequate growth of a developing fetus – a condition called intrauterine growth restriction (IUGR). Their infants are born smaller, further perpetuating the cycle. Begin to imagine the implications of this for a nation with almost half of its children stunted!

In Malawi, one need only to look at a typical meal to appreciate that dietary diversity is low. Domestic agricultural production is centered on maize, a crop indigenous to Mexico and Central America that was only introduced in Southern Africa during the last century. This affinity is reflected in the staple dish, nsima, a thick maize porridge often eaten with a small amount of stewed greens and either beans or a small amount of meat. It is a common joke that one could eat just about anything, and in copious amounts, but one would not have eaten anything at all unless it was accompanied by nsima.

A 2013 World Food Programme manual titled Sustainable Nutrition: Growing and Eating Best Using Less (Nordin, S.) identified over 550 food species common to Malawi – staple crops, vegetables, fruits, legumes & nuts, animals, and fats. It’s within this array of food sources, specifically the colorful fruits and vegetables, as well as in meat, eggs, fish, and dairy, where vitamins and minerals essential for growth and development are found. Although the effects of climate change (both droughts and floods), have had an impact on the growing season for maize, all sorts of these nutrient-rich foods can grow in Malawi year-round.

In our role this year as Community Nutrition Support Fellows with the Clinton Development Initiative (CDI), my co-fellow and I are working to mobilize communities around areas vital to good nutrition, such as improved dietary diversity through increased production of nutritious foods, exclusive breastfeeding through 6 months of age followed by appropriate complementary feeding, and food preparation and safety measures involving key water, sanitation, and hygiene practices. For us, one of the most exciting aspects of our work is the opportunity to engage with communities in identifying their priorities and the ways in which we can support them in achieving their goals. One interesting component of this is discovering what communities and households used to grow in the past, which of those crops they continue to grow, and why they stopped growing the others. Equipped with this information, and working together with the communities CDI serves, we can begin to determine how supporting the production and consumption of these indigenous crops can work to ameliorate nutritional deficiencies.

The focus is not on bringing in solutions from outside of Malawi. As we can plainly see, the solutions exist here. The focus must be on honoring the rich variety that Malawi is capable of providing for its children, women, and men, and using that to catalyze long-lasting change from within households, communities, and beyond.

Leave a Reply