Since the early 1960s, fast-food giants such as McDonalds, Kentucky Fried Chicken (KFC) and Pizza Hut entered Southeast Asian markets and competed with local hawker food stalls and restaurants. This inspired the creation of Jollibee and in 1975, the first two Jollibee stores were opened in Metro Manila, and its hamburger store was opened 3 years later. Fast forward to present day and Jollibee is Asia’s biggest home grown fast-food chain. With over 1,300 Jollibee stores worldwide, with around half located in the Philippines alone, Jollibee serves as a prime example of the nutrition transition in the Philippines. The nutrition transition is important as it poses a public health threat in a country that has both undernourished and increasingly overweight populations, and it is argued that more needs to be done to tackle the serious dietary issue.
What is the nutrition transition?
Countries across the world have been shifting from traditional diets high in fibre and micronutrients to a “Western” diet, and therefore the nutrition transition is a change in nutrient intake that accompanies this shift. Popkin, a prominent researcher on this topic, noted that a Western diet is one that is high in saturated fat, sugar, and refined foods and is low in fibre.
In the last 30-40 years, the Philippines has experienced rapid development, modernisation and social change, which has produced a nutritional transition in the country. Jollibee, a case of the nutrition transition, is famous for its ‘Yumburger’ (hamburger), ‘Chickenjoy’ (fried chicken), and signature sweet ‘Jolly Spaghetti’ among other items such as ‘Jolly Dogs’ (hotdogs) and ‘Lumpiang Shanghai’ (spring rolls), served with a choice of fries or rice, which is a staple food in Asia. Therefore, it has proven to be a highly successful adaptation of Western food to the local Filipino setting, which instils Filipino “Pride”.
A number of factors have led to a shift to high fat and high sugar diets, from shifting consumption patterns to the ways in which work and leisure time is spent.
What factors are driving the nutrition transition in the Philippines?
In Southeast Asia, Manderson and Naemiratch propose that one of the region’s reasons for the shift to eating processed and precooked foods on a regular basis is the lack of affordable housing near workplaces in urbanised areas. As people have to travel far to get home, often in undesirable traffic conditions, people want a relatively cheap and convenient meal and therefore tend to buy their food from a local food stall or restaurant to take home.
Alongside these dietary shifts, changes in eating behaviours have also occurred, whereby more and more people are choosing to eat out. Not only is there no need to cook rice and there is no mess to clean up after, but the choice available at food stalls, fast-food stores and restaurants are bountiful and can cater to every taste palette.
In addition to fast-food chains like Jollibee, another driving factor behind the processed food nutrition in Asia is the supermarketization of the region. In the Philippines, 50-60% of food retail sales were undertaken at supermarkets by the mid-2000s. Baker and Friel also noted that widespread food advertisements targeted at children in the mass media is also a driving force of the aforementioned dietary changes in the Philippines.
Why is the nutrition transition important in the context of food security?
In 1996, the World Food Summit defined food security as a situation when “all people, at all times, have physical, social and economic access to sufficient, safe and nutritious food to meet dietary needs for a productive and healthy life.”
As a result of the dietary changes described above as part of the nutrition transition, the foods that have become commonplace are ‘ultra-processed’, which Monteiro and colleagues has defined as “not entirely or mostly made from foods, but from industrial ingredients and additives, and are highly profitable”. Examples of such food products include, but are not limited to, burgers, sugary drinks and pizza and pasta dishes, which are particularly unhealthy, as opposed to processed foods which are not as highly processed.
Ultra-processed foods such as fast-food, carbonated soft drinks and long-lasting commercial snacks have all become increasingly commonplace in the urban areas of nutrition transitioning countries. For example, Philippines, in 2012, had the third highest carbonated soft drinks consumption volume in Asia at 31.5 litres per capita. Figure 1 below, taken from Baker and Friel’s study in Asia, shows the high level of consumption of processed food, with the large majority classified as ultra-processed in the case of the Philippines.
Jollibee’s advertising in particular is problematic in my view as it is centred on the family unit being altogether and feeling tremendous joy once they have consumed the “jolly” foods that have been served; therefore, promoting unhealthy, ultra-processed foods.
What are the health implications?
The nutrition transition has, combined with a reduction in physical activity and an increase in sedentary behaviour, resulted in a rising incidence of overweight and obesity, and related chronic or noncommunicable diseases (NCDs). NCDs are, as defined by the World Health Organisation (WHO), “of long duration and generally slow progression”. Diet-related NCDs are the leading cause of death in Asia and in the world today, with the majority (some 80%) of all NCD related deaths occurring in low- and middle-income countries, like the Philippines.
In 2010, two out of the four main types of NCDs featured in the top causes of mortality in the Philippines, and they are cardiovascular diseases (such as heart attacks and stroke) and diabetes. Figure 2, taken from WHO figures in 2016, highlights that 35% of deaths were caused by cardiovascular diseases and 5% was caused by diabetes. Such diseases are linked to diet and therefore the nutrition transition has played a role in the large number of deaths in the Philippines.
Manderson and Naemiratch use the example of Southeast Asia, whereby severe morbidity and death rates from NCDs and chronic illnesses, including cardiovascular diseases, diabetes and cancers, have risen 4 to 5 times over a 20-year period, which is in tandem with a substantial increase in the number of overweight and obese people across all age groups. The pandemic of obesity in developing countries has been widely documented. In the context of the Philippines, according to the WHO in Figure 3, obesity has been steadily increasing, with 6% of adults aged 18+ defined as obese.
However, Walls and colleagues argue for the nutrition transition to be measured more robustly rather than using proxy measures such as changes in overweight and obesity as described above, as well as changes in food environments. For example, Baker and Friel‘s use of consumption levels in their study is based on market sales as opposed to food that is actually consumed. Walls and colleagues argue that relatively little is known about actual food consumption in many settings and the factors driving this behaviour. Therefore, they argue that a standardised food questionnaire is needed to study changing dietary patterns and to ensure that data is captured on foods eaten both at home and outside the home as it is a significant aspect to measure.
What can be done?
Manderson and Naemiratch argue that a “whole-of-government” approach is needed to effectively tackle the factors which limit people’s choice to select better food and nutrition options, and therefore deal with the challenges from the source as opposed to treating those already diagnosed with an NCD. Interventions they suggest to support healthy lifestyles include improved public transport links, improving the quality of public housing and food markets in order to get better access to affordable fresh food as well as improve activity levels. I wholeheartedly agree with these suggested reforms and I also propose my own ideas based on my own experience below, as a Filipino.
As discussed earlier, Jollibee is seen as a source of pride for Filipinos. As it is such a large part of popular local culture in the Philippines, Jollibee is here to stay, so pressure needs to be put on the company and others like it to not only provide, but also advertise healthier options. The government also needs to invest in educating the population, teaching them that fresh fruit as a snack is better than popular sugary, processed alternatives such as dried mango. In my view, a re-configuration of taste palettes is needed in the Philippines, from a processed food, sugar-dependent society to a healthier one centred on fresh produce. These are some of the ways in which Filipinos can limit the negative effects of the nutrition transition and instead move towards a healthier, more informed society.