Dramatically expanding waistlines, rocketing levels of type-2 diabetes and soaring blood pressures – chronic diseases caused by unhealthy eating – present one of the biggest challenges for China’s healthcare system. A long-time advocate for dietary reform across the Asia region, healthcare foodservice specialist and consultant Clara Ming Pi FFCSI has been following the change in China’s eating habits for the better part of her 40-year career.
Speaking from her office in Hong Kong, where she’s also an adjunct associate professor at the HKU School of Professional & Continuing Education, Pi explains that a lot of the country’s dietary issues today can be traced back to major economic reforms introduced in the 1980s and the rampant development that followed. The influx of Western fast food imports – high in fat, sugar and salt – have gradually usurped China’s healthy staples, particularly in the growing number of urbanised areas where chains such as KFC and McDonald’s have boomed.
At the same time, a sudden shift in economic status and busier lifestyles mean the time-pressed population is seeking more convenient processed foods. A recent report found that Chinese packaged foods contain the most “harmful” levels of saturated fat and sugar globally.
Healthy China 2030
As officials increasingly devote resources to tackling chronic diseases, Pi has noticed a gradual shift in mindset. Progress can be seen in the form of government-implemented long-term goals such as “Healthy China 2030”, that – among other factors including more exercise and health literacy – calls for a stark reduction in oil, sugar and salt to tackle the onslaught of chronic diseases.
A heightened understanding of the impact of dietary choices on health is also evident in consumer demands. “People want less junk food and instead are opting for healthy and green options,” Pi notes. More recently, she believes the impact of Covid-19 is resulting in an “increased awareness of improving health and immunity status by eating proper food.” Early studies have shown that the virus tearing across the globe is more fatal in patients with chronic health conditions such as obesity and diabetes.
But how is the drive for reform affecting foodservice and what more needs to happen to enable China to reach its goals for a healthy population by 2030?
Taking school lunch programmes as an example, Pi explains: “Kids are one of the most high-risk groups in society. There has been a drastic climb in obesity and diabetes rates, especially among young children, but in teens too.” Today, one in five children in China is obese up from one in 20 in 1995, while deficiencies in macronutrients and dietary fibre hamper healthy development.
Often outsourced to private contractors and shaken by food safety scares and a lack of regulation, in order to promote healthy growth there’s widening scrutiny over what children are fed at school. Issues occur where school meals aren’t monitored, “resulting in problems related to safety and many school kids receiving next to nothing in terms of nutritional value,” Pi explains. “In the past, it was often a case of dishing out whatever was available without much focus on nutrition.”
Addressing this in rural areas, where the Ministry of Education launched a series of free school lunch pilot programmes a decade ago to improve child nutrition, she finds supervision is key. “The government is investing a lot of money to build canteens or kitchens in schools in rural areas and to have somebody supervising what kind of food should be served.” In urban areas, too, “officials also are in the process of coming up with standards and menu guidelines for what schools need to provide for kids to make sure meals are nutritious.”
Such steps are undoubtedly a move in the right direction, but not a whole solution. In order to effect long-lasting change, Pi believes dietitians must be on the ground to implement standard operating procedures that suit local needs. “I’ve spoken to people behind some of the programmes in rural areas and asked who gives the meal recommendations. They said they were working with university professors,” she explains.
“But my concern is how do [the professors] know what’s available in particular areas? Dietitians need to visit specific regions and look at the food that’s available to determine how local produce can be used to come up with combinations for nutritious, sustainable meals. That’s what’s missing right now.”
Importantly, it can’t be a one size fits all solution. “At the moment, there are broad high-level guidelines that advise how many servings of this and how many servings of that, but what about portioning meals for different age groups who have different caloric requirements? It’s so important to ensure that menus are created with these factors in mind.”
Responsible for designing Asia’s first computerised foodservice management systems, including the first in China, Pi believes IT needs to be part of the solution to increase standardised production. “This way you can see the recommended intake and the exact analysis based on the meal being served and whether it matches requirements.” Additionally, she continues, “If dietitians cannot be at every production kitchen, they need to introduce simple and practical standardised guidelines so operators can follow them.”
With this in mind, Pi is pushing for a more fundamental shift to help China meet its 2030 targets: the training of more administrative or foodservice dietitians. “As the government promotes the importance of nutrition and its need for more dietitians, it’s become a hot profession, and positive changes are happening,” she explains. “Fortunately, the old public nutritionist courses that only required [limited] hours of training to become qualified have gone by the wayside, and dietitians are beginning to make their own accredited programmes.”
Still, there’s a gap she wants to address. “A lot of local programmes focus mostly on the clinical side, so graduates are very good at calculating nutrients, but less practised at translating that into real, tasty food people want to eat. Dietitians need to be trained in foodservice and food production so they can communicate and collaborate with operators effectively on everything from menu planning to standardised ways of production.”
This holistic approach to the study of nutrition reflects Pi’s views generally. For long-term health and development, she explains we must further expand the definition of what constitutes a healthy nation. Looking beyond the myopic view of salt, sugar and oil reduction that a number of foodservice operators limit themselves to, Pi emphasises the need for more sustainably sourced vegetables and whole grains and less animal protein. “It’s a challenge faced by nutritionists and dietitians all over the world right now,” she says.
“Issues such as climate change and food sustainability need to be taken into consideration when working on programmes and menus.”
While there’s a lot of work to be done, Pi remains hopeful that change is on the horizon. “The government understands that for the prosperity of a nation, your people have to be healthy. It understands the issues it faces and is working on addressing them.” However, in a country as vast and diverse as China, change takes time to trickle down through society. It’s a pivotal moment, she concludes: “The correct direction has been set, now it’s a matter of getting there.”