Views & Reviews From the Frontline

Bad medicine: medical nutrition

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e451 (Published 18 January 2012) Cite this as: BMJ 2012;344:e451

Re: Bad medicine: medical nutrition

Dr Spence has raised an important concern faced by the nutrition community. I agree with him that local foods that meet the daily dietary requirements are the best to choose among a growing number of options.

Developing countries like Nepal, suffer the double burden of malnutrition. The proportion of children and women victimised by protein-energy mlanutrition and micronutritient deficiencies that emanate from inequitable social and economic systems thus translating to unequal access to food, health, education, and other social services, continue to be unacceptably high. Occurrence of obesity and related chronic conditions is increasing, attributable to the growing epidemic of "junk" foods aggressively marketed by corporate interests, often with questionable claims about their nutrient content.

Programmatic responses by governments and their donors are mostly focused on bringing down prevalence statistics through targeted interventions that fix the symptoms of undernutrition while their social determinants go unabated, unaddressed. Nepal's Ministry of Health has been supplementing Vitamin-A, Iodine, Iron and folic acid, and micronutrient blended food ration, for more than a decade in confirmity with recommendations made by international organisations which fund such activities. In the recent years, children with "wasting" receive ready-to-use-therapeutic food (RUTF). Similarly, multiple micronutrient powders (MNP) are distributed to children in a bid to control anaemia. Organisations that provide money to run these interventions fund studies that report reduction in the proportion of "wasting" and anaemia.

The use of locally produced foods which have been documented to be rich on nutrients[1] is not being actively promoted. Consequently, the victims of malnutrition are exposed to relying on externally aided supplies of ready-made solutions. Without conscientious effort to prevent and manage malnutrition through optimal use of nutritious local foods, internationally propelled interventions may, unintended, produce sustainable dependence.

1. Department of Food technology and Quality Control. Food composition table for Nepal. Kathmandu: Ministry of Agriculture Development, 2012

Competing interests: No competing interests

08 November 2012
Ashok Bhurtyal
Public health professional
People's Health Initiative
Sandol, ward no 9, Gokarneshwar, Kathmandu, Nepal
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