Acting in the Anthropocene: the EAT-Lancet Commission.

2364 www.thelancet.com Vol 387 June 11, 2016 Expanding waistlines are a problem not just for dietitians and population health specialists but, increasingly, for Earth system scientists too. The waistlines belong largely to the growing global middle class. The world is undergoing a dramatic nutrition transition to western diets. Wealth, industrialisation, and rapid urbanisation are driving a surge in resourceintensive meat and dairy products and ultra-processed foods. This dietary shift is the main cause of an exponential rise in obesity and non-communicable diseases (NCDs). Worldwide, in 2014, about 1·9 billion adults were overweight, of whom 600 million were obese. This epidemic is accompanied by another horror: almost 800 million people suff er from hunger and about 2 billion have micronutrient defi ciencies. Overconsumption of unhealthy food occurs at the expense of the resilience of the planet—the atmosphere, oceans, waterways, land, and a rich diversity of life that supports a population of 7·3 billion people. The global food system is one of the most important drivers of detrimental change of the Earth system. An area about the size of South America is used for crops and of Africa for livestock, and food production commandeers up to 25% of net primary productivity on land. Human activity is drawing upon the Earth’s resources to such an extent that some geologists now argue Earth has left the relative climatic stability of the 11 700-year-long Holocene. This stability allowed agriculture, and then civilisation, to fl ourish. The world is slipping rapidly into a less predictable place: the Anthropocene. A recent analysis to identify planetary boundaries protecting this stability shows that four out of nine boundaries have been transgressed. These relate to climate, deforestation, biodiversity loss, and nitrogen and phosphorus use in fertilisers. The global food system is a major emitter of greenhouse gases and the prime driver of the transgression of the other boundaries. This situation should set global alarm bells ringing. With the population set to top 9 billion by 2050, the world must increase food calories by about 70%. But continued food-induced global environmental degradation generates shocks—droughts, fl oods, disease, desertifi cation, biological collapse—potentially closing the door for future food security. A transition from business as usual to sustainable intensifi cation has the potential of feeding the world a healthy diet without undermining the Earth system. Yet, political progress on sustainable intensifi cation has been haphazard and often counterproductive. According to WHO, modifying four risk factors—ie, unhealthy diets, physical inactivity, tobacco use, and excess alcohol consumption—could prevent up to 80% of cardiovascular disease and type 2 diabetes, and at least one-third of all common cancers. NCDs are expected to cost the global economy US$47 trillion over the next two decades, with unhealthy diets leapfrogging smoking as the leading risk factor for disease globally. However, the good news is that new data show that minimally processed diverse diets rich in fruits and legumes, whole grains, nuts, seeds, and tubers with little meat and moderate amounts of sustainably-sourced seafood are benefi cial for health. These diets generally come with a lower environmental footprint than the typical North American diet. However, several tradeoff s exist—for example, many dietary guidelines recom mend regular consumption of fatty fi sh. This is incompatible with the current availability of sustainably sourced fi sh. Or, so-called nose-totail use of the whole carcass, which leads to greater processed meat production with potential adverse health consequences. Acting in the Anthropocene: the EAT–Lancet Commission