Thailand's food system in transition : implications for nutrition and population health

The world food system has profoundly transformed and globalised in recent decades with transnational food companies expanding control of food production, distribution, and retailing. As well a nutrition transition has been observed worldwide as diets become higher in fats, sugars, salts and highly processed foods. This nutrition transition is connected with a global increase in obesity and diet-related disease with 2 billion people worldwide now overweight or obese. There is a pressing need to understand how this increasingly complex global food system operates to affect nutrition and to identify optimal points for interventions to promote better health outcomes. This study addresses these problems in Thailand, which has experienced rapid economic growth, globalisation and lifestyle change in recent decades. A comprehensive literature review of Thai food system transitions found Thailand has emerged as a major food exporter with an increasingly important agri-business and food processing sector. However the country's numerous small-holder farmers are not enjoying the benefits, experiencing relative poverty and food insecurity. Modern food retail (ie hypermarkets, supermarkets and convenience stores) has also expanded rapidly since the late 1990s capturing nearly half of food sales, but only around 10-20% of fresh food sales. Thailand has been one of the most successful developing countries in rapidly reducing malnutrition through comprehensive Primary Health Care and nutrition programs at the village level. Now obesity affects more than 30% of Thai adults and nutrition policies are struggling with this new challenge which is unfamiliar, and nutritionally opposite to what went before. To understand how changes in food retailing and local food environments interact with diet and nutrition, in 2012 a questionnaire based study was carried out utilising a 4-region sub-sample (n=1516) drawn from a large Thai Cohort Study underway since 2005. Analysis revealed almost all participants had access to a range of food retail formats. Logistic regression models taking into account potential confounding factors found those who shopped regularly at supermarkets and convenience stores were more likely to be regular consumers of a range of "problem foods" known to be associated with the nutrition transition: soft drinks, instant foods, snack foods, processed meats, and western bakery items. Qualitative interviews with questionnaire respondents investigated motivations in food retail choices. Most respondents were satisfied with shopping at a range of formats but had strong preferences for fresh markets as a source of fresher, cheaper, higher quality and culturally important foods. The results of this study indicate modern food retail formats are associated with negative aspects of the nutrition transition in Thailand. Expansion of supermarkets into the fresh food sector may face cultural and economic limits, at least in the short to middle term. This has positive implications with Thai consumers retaining access to affordable, fresh, health protective foods. The Thai government should consider more actively protecting and assisting fresh markets promoting them as healthy food sources and as repositories of Thai food culture with social, economic and health benefits for future Thais