When in Rome... spread better health

HU Medical School nutritionist Prof. Elliot Berry spent a year at the UN Food and Agriculture Organization in Italy to help fight world malnutrition.

JANUARY 11, 2015 04:45

PROF. ELLIOT BERRY (photo credit: JUDY SIEGEL-ITZKOVICH) — PROF. ELLIOT BERRY

(photo credit: JUDY SIEGEL-ITZKOVICH)

There aren’t many Israeli professionals working in United Nations agencies abroad – either because their country is not popular among many member countries or because many are reluctant to take time from their careers to work for international causes. But Prof. Elliot Berry, a London-born internal medicine, public health and nutrition specialist, left Jerusalem for a year to serve as a consultant to the UN’s Food and Agricultural Organization (FAO) in Rome, returning just before the Operation Protective Edge campaign in the Gaza Strip. And both he and his UN agency colleagues are glad he did.

A young MD graduate with distinction from the University of Cambridge in the UK, Berry won a Fogarty Research fellowship at New York’s Rockefeller University to work on fat cell metabolism. His principal research interests are the bio-psycho-social problems of weight regulation from obesity to anorexia, and the benefits of the Mediterranean diet. He has published over 230 articles and chapters in books, and is on the editorial board of three journals on clinical nutrition.

He has also been a visiting scientist at the department of brain and cognitive sciences at the Massachusetts Institute of Technology, a distinguished visiting scholar at Christ’s College in Cambridge and a visiting professor at Yale University.

Berry, who spent decades at the Hadassah University Medical Center in Ein Kerem until his retirement in 2013 and continues to teach and do research at the Hebrew University Medical Faculty in Jerusalem, utilized his immense store of knowledge about eating disorders – from anorexia and bulimia to morbid obesity – to work at the FAO on new ways to measure and take action against food insecurity in the Third World.

ALTHOUGH MUCH less known to Israelis than the UN General Assembly and Security Council, UNICEF, UNESCO and various peacekeeping forces in the Middle East, the FAO serves important roles in helping to eliminate hunger, food insecurity and malnutrition; making agriculture, forestry and fisheries more productive and sustainable; reducing rural poverty; studying climate change; and fighting plant and animal pests that ravage crops.

Founded exactly 70 years ago by the UN in Washington, the intergovernmental organization moved to Rome in 1951. FAO’s decentralized network includes five regional offices, 10 sub-regional offices, two multidisciplinary teams, 74 full-fledged country offices (excluding those hosted in regional and sub-regional offices), eight offices with technical officers/FAO representatives and 38 countries covered through multiple accreditation.

In addition, it maintains five liaison offices and four information offices in developed countries. There is no local office of the FAO in Israel, which is famed for its outstanding agricultural and water conservation technology; the nearest representation is in Egypt.

It has nearly 1,800 professional employees and 1,650 support staff (Berry was not included in the figure) – more than half of them based in Rome. Nearly 60 percent are based at the headquarters, while the remainder work in dozens of offices worldwide. During the past 15 years, the proportion of women in the professional staff category has nearly doubled, from 19% percent to 37%. Its main product is updated information, collected, analyzed and disseminated among member states by agronomists, foresters, fisheries and livestock specialists, nutritionists, social scientists, economists, statisticians and other professionals.

Finances come from members assessed “taxes” as well as voluntary contributions, while the annual budget is $2.4 billion. Every two years, the FAO holds an international conference to review global governance policy, approve the budget for the following two years and evaluate work it carried out since the previous meeting. Each member country has one vote. The current director-general, José Graziano da Silva of Brazil, began serving in January 2012 and will complete his term in July.

BERRY, WHO between 2003 and 2006 was dean of the Hebrew University-Hadassah Braun School of Public Health and Community Medicine (where he continues to teach), used a sabbatical from the medical school nutrition department to work in Rome. He has other experience with UN agencies, being involved for years in the World Health Organization’s Collaborating Center for Capacity Building in Public Health at HU, as well as with the World Bank.

“I worked on food security in Israel with various colleagues from Hadassah and elsewhere, so I was very familiar with the subject in developed countries. But I didn’t have as much experience on hunger and malnutrition in the Third World,” he said in a recent interview with The Jerusalem Post in his medical school office. When invited by the FAO to consult for a year at its department of statistics, he jumped at the chance. “The Rome-based organization is the largest in the UN. Israelis don’t appear there very often. In fact, I was the only Israeli there,” he recalled.

Israel, by the way, is listed on FAO charts as being among the 31 developed countries described as having “very high food security.”

This is a bit ironic, as national organizations here have decried the relatively large number of Israelis who cannot take for granted a well-balanced meal tomorrow. But obviously, Israeli are doing better than countries with “very low food security” such as Afghanistan, Angola, Mozambique, Zambia and Zimbabwe.

Variations in nutrition are widespread, even in developed countries.

“The French are pretty good. But the differences between the north and south of the country are huge. The south observes good eating, while the north does not. There are major differences between them in mortality and morbidity [disease rates]. The same is in Israel, with the center of the country eating more nutritiously than the periphery,” Berry pointed out.

“In Rome, we worked in the field of food availability, food accessibility (reaching the market), transport, infrastructure, economic aspects in food distribution and utilization at the individual and household level. If you have enough money even in a very poor country like Sudan you can get good food.”

Working with local and international colleagues, Berry designed a composite Food and Nutritional Security Index (FaNSI), turning data on food availability, access, utilization and (governmental) stability into a single index number from one to five.

“FaNSI makes critical information from which it is built more readily transparent and understandable, rather than hiding it,” his FAO team said. “Furthermore, it may be used at different levels – as a single composite index; at the level of the four dimensions of food security; and more specifically to analyze the individual indicators making up each dimension. The level chosen will depend on the user and the purpose (policy making, tracking progress, advocacy, aid delivery and more).”

Composite indices are recognized as a useful analytical and communications tool, the team wrote in their FAO working paper.

“Most individual indicators capture a specific, often highly technical component of food security. Such specificity and technical detail are important elements of targeted policy interventions, but they are seldom a good basis for communication, raising awareness or sensitizing large segments of a non-expert but informed and involved population.”

Although such statistical work sounds dull, noted Berry, the FaNSI composite index can provide information for targeting practical policy in poor countries and provide the basis for monitoring changes in the distribution and use of food by the people. This is especially important for vulnerable populations that face man-made natural disasters and those with unstable politics, climates and economies.

Berry and his colleagues also designed a new, more relevant “food pyramid.”

“If a child goes to bed hungry, we’ve failed.”

“MY WIFE Hadassah [an artist], and I traveled around Italy during my spare time.” Hadassah learned good Italian during their year there, while Elliot “learned some” but spoke mostly English. As they are a kosher, modern- Orthodox couple, they hardly ate any meat or chicken, “But we really didn’t miss anything. The markets are very colorful and seasonal. There is high unemployment among young people, and many of them still live with their parents because of the economy.

The fertility rate of native Italians has declined to below the replaceable rate.”

“Family life in Italy is very similar to that of the Jews,” he said. After returning to Jerusalem, Berry remains in regular email contact with his former FAO colleagues, including people he met at La Sapienza, the university in Rome.

ASKED ABOUT the Italian diet, which should be like Israel’s because it shares a spot on the Mediterranean Sea, he said that just like his own country, there is both a healthful Mediterranean diet of olive oil, lots of fruits and vegetables, fish and chicken. But many – especially the young – have adopted a junk diet of hamburgers, chips and soft drinks.

Berry was the coauthor of a paper on “Adherence to the Mediterranean Diet: Intervention in Kindergartens” researched by his Ph.D.

student Dr. Ronit Yakobovich. They examined 1,890 children aged four to six years and supervised by 74 kindergarten teachers who were trained to improve their eating habits and knowledge. Within the 1,890 were 842 children and 32 teachers who served as a control group.

The intervention group was taught to drink more water rather than sweetened beverages, eat more healthful snacks and get more physical exercise. They were taught about the food pyramid, made conscious of how much water they drank per day, their consumption of sweets was reduced and they were taught to prefer humus, white cheese and tuna to chocolate spread as a sandwich filling.

“It is possible to change behaviors toward a Mediterranean lifestyle – even in kindergartens,” the researchers concluded.

While Berry deals a lot with obesity, diabetes and eating disorders such as voluntary anorexia among mostly young women and girls due to poor body image and media pressure, in the developing world, malnutrition is the main theme. He recommended in Rome the Mediterranean diet for maintaining good health and a “modified Atkins diet” of more protein and fewer simple carbohydrates for losing weight. But most of all, Berry continues to advocate regular exercise, including just plain walking, above all. He is known for preaching that people of all ages should take “10,000 steps” per day and monitor this activity by wearing a pedometer. “I realize, however, that for most of the population, this is very hard to do.”

The lithe, nimble professor used to leave the Ein Kerem campus in the middle of the day, donning a running outfit and jogging through the neighborhood. But a weak knee made him forgo this, and he now walks instead.

“The family meal at least several evenings a week is very important for improving parent- child relations and teaching habits for good health,” he said. “We’re getting there, to more exercise and more public interest in their health. But you can’t change things all at once. In 1966, I proposed food fortification – adding vitamin D to all milk, iodine to table salt and folic acid to flour – but the Health Ministry still hasn’t done it.”

Public health and nutrition lessons for healthy lifestyles “should begin in kindergarten, but it doesn’t,” he said. “There is plenty to do in the educational system. A well-fed nation is a healthy nation is a productive nation.”