When Tina Moffat returned to Nepal in 2019 after two decades, she was shocked.
It was not the sight of gleaming shopping malls towering above roads widened to the size of boulevards, where thousands of new vehicles jockeyed for space. It was the sheer number of overweight and obese Nepali children she noticed.
‘This was not something I ever saw in Kathmandu in the 1990s,’ writes Moffat, associate professor of anthropology at McMaster University in Hamilton, Canada. Her research at the end of the 20thcentury focused on children in the families of carpet weavers living on the outskirts of the capital. Since then her academic interest has broadened to include how children worldwide are fed, which is reflected in her new book, Small bites: Biocultural dimensions of children’s food and nutrition.
In the first two decades of the 2000s Nepal has made some remarkable advances including a leap forward in nutrition. The country saw the world’s fastest decline in the rate of child stunting (low height for age) from 2001 to 2011 — from 56.6% to 40.6%.
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Yet as Moffat saw, less than 10 years later Nepal was facing what is called the ‘double burden of malnutrition’: both undernutrition — stunting and wasting (low weight for age) which remains a serious issue — and overnutrition, or overweight and obesity.
Small Bites is an attempt to explain how in the third decade of the 21stcentury, when having enough food is generally no longer a widespread concern, but it is food quality and the system that delivers food to children are themselves sources of health risks. The book was written before Russia’s invasion of Ukraine and the resulting food shortages.
Moffat lays out her approach clearly at the start: ‘…children’s food and nutrition cannot be understood in isolation from larger understandings of food, environmental, social, cultural, political and economic systems. Contemporary nutrition problems such as child obesity and undernutrition must be addressed as societal issues that are linked to current problems with the industrial food system as well as social inequities that are embedded in the global capitalist food system.’
In the course of the short volume (181 pages plus notes) she explores issues including breastfeeding, the cliché of the ‘picky eater’, the food industry’s creation of ‘children’s foods’, child obesity and the role of school meals. Based in Canada, many of Moffat’s reference points are understandably in that country, and in the neighbouring US, but she broadens her scope in discussing topics including malnutrition.
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Having recently spent a couple of months looking into Nepal’s school meal program I was especially interested in her description of such initiatives in France and Japan. Although different in delivery (in Japan meals are compulsory for students and teachers for example, while in France about two-thirds of students have at least one lunch per week at school) both are ‘excellent models’ for other countries to follow because they go beyond simply feeding children to exposing them to their food cultures: not only what foods to eat but how to eat them and why they are eaten a certain way.
Moffat describes being served a typical school lunch in Japan: ‘I picked up a tray, and then a student served pan-fried mackerel on one side of the plate and mixed steamed vegetables with ham on the other before placing it on my tray. Next a bowl of rice was placed on the bottom left of my tray, followed by a bowl of miso soup on the bottom right. Finally, the teacher directed that I place chopsticks on my tray between the rice and the miso, and milk at the top right.’
The food looked better than it tasted, reports Moffat, but the bigger point is that ‘food is very dear to the national culture and heritage’ of both Japan and France. Both countries feel threatened by the global spread of American fast food, and have passed laws to strengthen school feeding.
Nepal has invested heavily in its diya khaja program in recent years and by 2024 is planning to take full control of school feeding in all 77 districts from the World Food Programme (WFP). This includes developing a variety of nutritional menus that reflect regional tastes. But the program lacks guidelines to show the way for the thousands of local officials who have direct responsibility for feeding students.
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If child obesity is often seen to symbolise all that is broken with our food systems, Moffat cautions about labelling it an epidemic. One risk is that by focusing on individuals we overlook structural issues.
‘For example, the industrial food system prioritizes cheap, fast and processed food, leaving a significant proportion of the world’s population to live with food insecurity and/or time constraints that necessitate the consumption of nutrient-poor and energy-dense food,’ she writes.
Another reason to avoid alarmist approaches is that the fear of being obese can trigger mental illness in children. I was surprised to learn that anorexia nervosa, known as a Western illness but increasing in Asia, is ‘the mental illness with the highest incidence of mortality, and survivors may experience long-term health issues such as heart disease and osteoporosis’.
Given the breadth of the issues Moffat tackles in Small Bites, it is not surprising that she does not propose a single remedy to improve children’s feeding and nutrition. Her suggestions are broad-based, from governments taxing junk foods and ensuring people have enough income to eat healthy, to communities growing and eating their foods together.
On the menu for those local meals, says Moffat, should be discussions of how to reform the systems that too often neglect children’s health.