In the last several decades obesity rates have risen significantly. In 2014, 10.8% and 14.9% of the world’s men and women, respectively, were obese as compared with 3.2% and 6.4% in 1975. The obesity “epidemic” has spread from high-income countries to emerging and developing ones in every region of the world. The rising obesity rates are essentially explained by a rise in total calorie intake associated with long-term global changes in the food supply. Food has become more abundant, available, and cheaper, but food affluence is associated with profound changes in the nutritional quality of supply. While calories have become richer in fats, sugar, and sodium, they are now lower in fiber. The nutrition transition from starvation to abundance and high-fat/sugar/salt food is thus accompanied by an epidemiological transition from infectious diseases and premature death to chronic diseases and longer lives. Food-related chronic diseases have important economic consequences in terms of human capital and medical care costs borne by public and private insurances and health systems. Technological innovations, trade globalization, and retailing expansion are associated with these substantial changes in the quantity and quality of food supply and diet in developed as well as in emerging and rapidly growing economies. Food variety has significantly increased due to innovations in the food production process. Raw food is broken down to obtain elementary substances that are subsequently assembled for producing final food products. This new approach, as well as improvements in cold chain and packaging, has contributed to a globalization of food chains and spurred an increase of trade in food products, which, jointly with foreign direct investments, alters the domestic food supply. Finally, technological advancements have also favored the emergence of large supermarkets and retailers, which have transformed the industrial organization of consumer markets. How do these developments affect population diets and diet-related diseases? Identifying the contribution of supply factors to long-term changes in diet and obesity is important because it can help to design innovative, effective, and evidence-based policies, such as regulations on trade, retailing, and quality or incentives for product reformulation. Yet this requires a correct evaluation of the importance and causal effects of supply-side factors on the obesity pandemic. Among others, the economic literature analyzes the effect of changes in food prices, food availability, trade, and marketing on the nutrition and epidemiological transitions. There is a lack of causal robust evidence on their long-term effects. The empirical identification of causal effects is de facto challenging because the dynamics of food supply is partly driven by demand-side factors and dynamics, like a growing female labor force, habit formation, and the social dynamics of preferences. There are several important limitations to the literature from the early 21st century. Existing studies cover mostly well-developed countries, use static economic and econometric specifications, and employ data that cover short periods of time unmarked by profound shifts in food supply. In contrast, empirical research on the long-term dynamics of consumer behavior is much more limited, and comparative studies across diverse cultural and institutional backgrounds are almost nonexistent. Studies on consumers in emerging countries could exploit the rapid time changes and large spatial heterogeneity, both to identify the causal impacts of shocks on supply factors and to document how local culture and institutions shape diet and nutritional outcomes.
Fabrice Etilé and Lisa Oberlander
The rise in obesity and other food-related chronic diseases has prompted public-health officials of local communities, national governments, and international institutions to pay attention to the regulation of food supply and consumer behavior. A wide range of policy interventions has been proposed and tested since the early 21st century in various countries. The most prominent are food taxation, health education, nutritional labeling, behavioral interventions at point-of-decision, advertising, and regulations of food quality and trade. While the standard neoclassical approach to consumer rationality provides limited arguments in favor of public regulations, the recent development of behavioral economics research extends the scope of regulation to many marketing practices of the food industry. In addition, behavioral economics provides arguments in favor of taxation, easy-to-use front-of-pack labels, and the use of nudges for altering consumer choices. A selective but careful review of the empirical literature on taxation, labeling, and nudges suggests that a policy mixing these tools may produce some health benefits. More specifically, soft-drink taxation, front-of-pack labeling policies, regulations of marketing practices, and eating nudges based on affect or behavior manipulations are often effective methods for reducing unhealthy eating. The economic research faces important challenges. First, the lack of a proper control group and exogenous sources of variations in policy variables make evaluation very difficult. Identification is challenging as well, with data covering short time periods over which markets are observed around slowly moving equilibria. In addition, truly exogenous supply or demand shocks are rare events. Second, structural models of consumer choices cannot provide accurate assessment of the welfare benefits of public policies because they consider perfectly rational agents and often ignore the dynamic aspects of food decisions, especially consumer concerns over health. Being able to obtain better welfare evaluation of policies is a priority. Third, there is a lack of research on the food industry response to public policies. Some studies implement empirical industrial organization models to infer the industry strategic reactions from market data. A fruitful avenue is to extend this approach to analyze other key dimensions of industrial strategies, especially decisions regarding the nutritional quality of food. Finally, the implementation of nutritional policies yields systemic consequences that may be underestimated. They give rise to conflicts between public health and trade objectives and alter the business models of the food sector. This may greatly limit the external validity of ex-ante empirical approaches. Future works may benefit from household-, firm-, and product-level data collected in rapidly developing economies where food markets are characterized by rapid transitions, the supply is often more volatile, and exogenous shocks occur more frequently.
Michael D. Kurtz, Karen Smith Conway, and Robert D. Mohr
The primary goals of food assistance programs are to alleviate child hunger and reduce food insecurity; if successful, such programs may have the added benefit of improving child academic outcomes (e.g., test scores, attendance, behavioral outcomes). Some U.S. government programs serve children in the home, such as the Supplemental Nutritional Assistance Program (SNAP), others serve them at school, such as the National School Lunch Program (NSLP) and School Breakfast Program (SBP), and still others fall in-between, such as the Summer Food Service Program (SFSP) and the Child and Adult Care Food Program (CACFP). Most empirical research seeking to identify the causal effect of such programs on child academic outcomes addresses the endogeneity of program participation with a reduced form, intent-to-treat approach. Specifically, such studies estimate the effect of a program’s availability, timing, or other specific feature on the academic outcomes of all potentially affected children. While findings of individual studies and interventions are mixed, some general conclusions emerge. First, increasing the availability of these programs typically has beneficial effects on relatively contemporaneous academic and behavioral outcomes. The magnitudes are modest but still likely pass cost-benefit criteria, even ignoring the fact that the primary objective of such programs is alleviating hunger, not improving academic outcomes. Less is known about the dynamics of the effects, for example, whether such effects are temporary boosts that dissipate or instead accumulate and grow over time. Likewise, the effects of recent innovations to these programs, such as breakfast in the classroom or increases in SNAP benefits to compensate for reduced time in school during the pandemic, yield less clear conclusions (the former) and/or have not been studied (the latter). Finally, many smaller programs that likely target the neediest children remain under- or un-examined. Unstudied government-provided programs include SFSP and CACFP. There are also a growing number of understudied programs provided primarily by charitable organizations. Emerging evidence suggests that one such program, Weekend Feeding or “Backpack” programs, confers substantial benefits. There, too, more work needs to be done, both to confirm these early findings and to explore recent innovations such as providing food pantries or “Kids’ Cafés” on school grounds. Especially in light of the uncertain fate of many pandemic-related program expansions and innovations, current empirical evidence establishes that the additional, beneficial spillover effects to academic outcomes—beyond the primary objective of alleviating food insecurity—deserve to be considered as well.