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Bad Diets Are Responsible For More Deaths Than Smoking, Global Study Finds

Apr 3, 2019
Originally published on April 5, 2019 10:04 am

About 11 million deaths a year are linked to poor diet around the globe.

What's driving this? As a planet we don't eat enough healthy foods including whole grains, nuts, seeds, fruits and vegetables. At the same time, we consume too many sugary drinks, too much salt and too much processed meat.

As part of a new study published in The Lancet, researchers analyzed the diets of people in 195 countries using survey data, as well as sales data and household expenditure data. Then they estimated the impact of poor diets on the risk of death from diseases including heart disease, certain cancers and diabetes. (They also calculated the number of deaths related to other risk factors, such as smoking and drug use, at the global level.)

"This study shows that poor diet is the leading risk factor for deaths in the majority of the countries of the world," says study author Ashkan Afshin of the Institute for Health Metrics and Evaluation at the University of Washington. Unhealthy diets are "a larger determinant of ill health than either tobacco or high blood pressure," he says.

Which countries do best when it comes to diet? Israel, France, Spain and Japan were among the countries with the lowest rates of diet-related disease. The U.S ranked 43rd, and China ranked 140th. It should be noted that there were data gaps for intake of key foods in some countries, so some estimates could be off.

"Generally, the countries that have a diet close to the Mediterranean diet, which has higher intake of fruits, vegetables, nuts and healthy oils [including olive oil and omega-3 fatty acids from fish] are the countries where we see the lowest number of [diet-related] deaths," Afshin says. And as we've reported, the Mediterranean pattern of eating is linked to a reduced risk of heart attacks and memory decline.

I asked Afshin which ranking surprised him and why. "Mexico is interesting," Afshin told me. The country ranked 57th on the list. On the one hand, people in Mexico consume a lot of whole grain corn tortillas, he says — and whole grains are beneficial. But on the other hand, "Mexico has one of the highest levels of consumption of sugar-sweetened beverages." It's hard to say how the benefits of whole grains may influence the risks of too much sugar, but Afshin says it underscores a problem seen in many countries: The overall pattern of eating could be improved.

Of course, there are obstacles to eating well, including access and affordability. As the Trump administration and U.S. lawmakers debate whether able-bodied people who don't work should be entitled to public food assistance, it's clear that many people around the globe struggle to afford healthy foods.

And at a time when 800 million people around the globe don't get enough to eat, and 1.9 billion people weigh too much, it's important to remember that hunger and obesity are both forms of malnutrition. And the costs are staggering. Consider a recent report from the Center for Strategic and International Studies, which notes: "Worldwide, malnutrition costs $3.5 trillion annually, with overweight- and obesity-related noncommunicable diseases, such as cardiovascular disease and type 2 diabetes, adding $2 trillion."

Globally, these findings may serve as a reminder that when it comes to ending hunger and improving health, people don't just need food. They need nourishment. If you fill up on a diet of packaged snacks made from refined-carbohydrates and sugary sodas, you may get the calories you need, but those calories will put you on a path toward disease.

What would happen if everyone around the globe began to eat a healthy diet, filling three-fourths of their plates with fruits, vegetables and whole grains? We'd run out. Yep, that's right. A recent study published in the journal PLOS One by researchers at the University of Guelph found that there would not be enough fruit and vegetables to go around.

"We simply can't all adopt a healthy diet under the current global agriculture system," says study co-author Evan Fraser, director of the Arrell Food Institute at the University of Guelph. Fraser says we produce too much fat, too much sugar and too many starchy products. So, food companies and farmers play a role, too. "At a global level, we have a mismatch between what we should be eating, and what we're producing," Fraser says.

Perhaps that's why the authors of the new Lancet study say their findings point to the need for coordinated, global efforts. Improving diets won't be easy: A range of initiatives may be needed, including nutrition education and increased access to healthy foods, as well as rethinking agricultural production.

If you like this article, check out our deeper dive: NPR's Life Kit podcast on six food rules to help you eat your way to a healthier life. Follow NPR's Allison Aubrey at @AubreyNPRFood.

Copyright 2019 NPR. To see more, visit https://www.npr.org.


Around the world, poor diets are linked to more deaths than smoking or drug use; that's the conclusion of a study just published in The Lancet medical journal. NPR's Allison Aubrey reports the research finds that 11 million deaths a year are tied to what people eat.

ALLISON AUBREY, BYLINE: Researchers analyzed people's diets in 195 countries around the globe. They used survey data, as well as sales and household expenditure data, to try to capture what people eat. Then they estimated the impact of diets on the risk of death from diseases including heart disease, diet-related cancers and diabetes. Here's study author Ashkan Afshin of the University of Washington.

ASHKAN AFSHIN: This study shows that that unhealthy diet is the leading risk factor for deaths in the majority of the countries of the vote.

AUBREY: It's kind of a stunning thought, given the risks of smoking or drug use, this idea that poor diet may top them all. So big picture - what do people eat, or not eat, that's so bad? For starters, many parts of the globe are awash in salty snacks and treats made of refined carbohydrates, as well as sugary drinks, and the largest number of diet-related deaths are tied to this - too much sodium, too much sugar and not enough whole grains, fruits or vegetables. The countries that do best at fending off diet-related diseases include Japan, Israel, France and Spain. And Afshin says they all have one thing in common - a pattern of eating close to the Mediterranean diet; this includes lots of...

AFSHIN: Fruits, vegetables, nuts and healthy oils.

AUBREY: Including olive oil and omega-3s from fish. At a time when there's debate here in the U.S. about who should qualify for government food assistance, it's worth noting that many people here and around the globe struggle to afford healthy foods. But let's just say, for argument's sake, that tomorrow everyone on the planet began to fill their plates with fruits and vegetables, what would happen? Evan Fraser of the University of Guelph in Canada says, we would run out. He says, globally, we produce too many starchy foods, too much sugar and too much fat - but not enough produce.

EVAN FRASER: At a global level, we have this mismatch between what we should be eating and what we actually are producing.

AUBREY: Which is another big hurdle when it comes to nudging people towards healthier diets. Allison Aubrey, NPR News.