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

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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."

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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.