While food insecurity is a well-known cause of under-nutrition and stunting, in recent decades it has also been linked with obesity. Understanding and thus minimising the risk factors for obesity in low- and middle-income country contexts, which often lack the health system capacity to treat the consequent obesity-related illnesses, is crucial. This study adopted realist review methodology because it enabled us to analyse and organise the evidence from low- and middle-income countries into a coherent scheme. By comparing this evidence to existing theory on food security and nutrition, we aimed to provide a richer understanding of the nuances and the socio-demographic nature of the food insecurity–obesity relationship. The review generated 13 peer-reviewed articles which studied the relationship between food insecurity and overweight/obesity in low- and middle-income countries. Affordability of high-energy, processed foods was identified as a main mechanism, which determined whether or not food insecurity leads to obesity in low- and middle-income countries. Other mechanisms identified were: quantity and diversity of food consumed; spatial-temporal access to nutritious food; inter-personal food choice and distribution; and non-dietary behaviours. Despite the limited empirical evidence available, our review presents meaningful and policy-relevant insights into the food insecurity–obesity relationship in from low- and middle-income countries. Interventions to address the food insecurity–obesity link need to address diet quality, and demand a broad understanding across a variety of experiences.

Extensive literature describes the importance of food environments (FEs) as a driver of food choices and nutrition outcomes; yet existing FE frameworks do not adequately capture the diversity of FEs relevant to the Pacific Region. This limits identification of opportunities in food systems to reduce the multiple burden of malnutrition. We present a conceptual typology of FEs including six primary FEs relevant in the Pacific; wild; cultivated; kin and community; informal retail; formal retail; and food aid and services. We then apply this typology to food acquisition data from Solomon Islands 2012/13 Household Income and Expenditure Survey and analyse the relationship between FEs and diet quality. The cultivated FE accounts for 60% of the quantity of food acquired nationally, followed by wild (15%), kin and community (9%), and formal and informal retail FEs (8% each), with wide variation between urban and rural households, provinces and wealth groups. Reliance on different FEs is a significant predictor of diet quality and affirms the importance of subsistence fisheries and agriculture, and community and kinship networks. Integration of a FE typology such as the one presented here in commonly conducted household expenditure surveys offers significant opportunity to advance our understanding of food system leverage points to improve nutrition and health.

The unsustainability of food systems is a global policy challenge. There is an urgent need for the improved coordination and integration of policies across sectors to improve food system outcomes. The aim of this study was to examine the role and opportunities for regional governance in strengthening policy for food system transformations, using the Pacific Island region as a case study. We conducted a qualitative policy analysis, drawing on data from 21 interviews with experts and participants in Pacific Island regional food system governance, and the analysis of 17 key regional commitments (policy documents) relating to food systems. The findings indicate that the Pacific Island region has made significant progress towards improved regional food systems governance. Regional governance has been used to address multiple shared and inter-related challenges associated with food systems, improve coordination across silos, and facilitate constructive engagement on policy issues between international, regional, and national actors. However, food systems outcomes related to the economy, nutrition, and environment continue to be mixed, and there are challenges to policy coordination and effectiveness at the regional level. Interviewees envisaged a regional approach characterized by being rooted in regional values, meeting multiple objectives, balancing tensions, and providing meaningful support and resources for countries. Following food systems disruptions associated with the COVID-19 pandemic, this study suggests that there is an opportunity to strengthen regional food system governance through paradigm change, the development of new modes of coordination, and increasing the dynamic interactions between regional institutions, countries, and communities.

The adult obesity prevalence in Samoa is the third highest globally, and diet is a significant contributor. Our study aimed to explore the behavioral and demographic factors which influence diets in Samoa. The most important findings for strategic policy design were: i) cost was the most important reason for food choice, ii) participants reported high rates of consumption of sugary and fatty energy foods – along with high rates of food insecurity, and iii) the food frequency questionnaire findings from our small sample are in line with the existing evidence that the nutrition transition is underway in Samoa.