Global Capacity Building in Nutrition Science: Training Future Practitioners, Empowering Future Leaders

Journal Articles

Glenn Denning

Denning G, Kabambe P, Sanchez P, et al. Input subsidies to improve smallholder maize productivity in Malawi: toward an african green revolution. PLoS Biol. 2009 Jan 27;7(1):e23.

Sachs J, Remans R, Smukler S, et al. Monitoring the world's agriculture. Nature 2010 Jul 29;466(7306):558-60.

Sachs JD, Remans R, Smukler SM, et al. Effective monitoring of agriculture: a response. J. Environ. Monit. 2012 Mar;14(3):738-42.

Robert Karp

Karp RJ. A teacher's guide to pediatric nutrition. Academic Pediatric Association. 2007.

Pamela Koch

Koch PA. Feeding our kids the right food and inspiring them to eat it. Center for Ecoliteracy.

Calabrese Barton A, Koch P, Contento I, et al. From global sustainability to inclusive education: understanding urban children's ideas about the food system. Int. J. Sci. Educ. 2005;27:1163-1186.

Contento IR, Koch PA, Lee H, et al. Enhancing personal agency and competence in eating and moving: Formative evaluation of a middle school curriculum—Choice, Control, and Change. J. Nutr. Educ. Behav. 2007 Sept-Oct;39 (5 Suppl):S179-S186.

Eto K, Koch P, Contento IR. Variables of the Theory of Planned Behavior are associated with family meal frequency among adolescents. J. Nutr. Educ. Behav. 2011 Nov-Dec;43(6):525-30.

Christina Stark

Stark C, Graham-Kiefer M, Devine C, et al. Online course increases nutrition professionals' knowledge, skills, and self-efficacy in using an ecological approach to prevent childhood obesity. J. Nutr. Educ. Behav. 2011;43:316-322.

Emorn Wasantwisut

Wasantwisut E, Chittchang U, Sinawat S. Moving a health system from a medical towards a dietary approach in Thailand. Food and Nutrition Bulletin. The United Nations University. 2000;2(2):157-60.

Wasantwisut E, Neufeld L. Use of nutritional biomarkers in program evaluation in the context of developing countries. J. Nutr. 2012 Jan; 142(1):186S-190S.

Debra Wolgemuth

Deckelbaum RJ, Ntambi JM, Wolgemuth DJ. Basic science research and education: A priority for training and capacity building in developing countries. Infect Dis. Clin. N. Am. 2011;25(3):669-676.

Derek Yach

Yach D. The private sector and food security. 2011 Global food policy report. International Food Policy Research Institute; 2012:76-77.

Yach D. Nutritional change is not a simple answer to non-communicable diseases. BMJ 2011;343:d5097.

Additional Resources

Crisp BR, Swerissen H, Duckett SJ. Four approaches to capacity building in health: consequences for measurement and accountability. Health Promot. Int. Jul 2012; 27(2):99-107.

de Graaf M. Catching fish or liberating man: Social development in Zimbabwe. J. Soc. Dev. Afr. 1986;1:7-26.

Sajiwandani J. Capacity building in the new South Africa: Contribution of nursing research. Nurs. Stand. 1998; 12 (40): 34-37.

Sponsors

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On June 1, 2012, the Sackler Institute for Nutrition Science and the New York Academy of Sciences presented a conference titled Global Capacity Building in Nutrition Science: Training Future Practitioners, Empowering Future Leaders. At this innovative two-day conference uniting private industry and public organizations from fields as diverse as education and corporate business, participants and speakers came together to discuss some of the most pressing issues in capacity building in nutrition science. The conference had a decidedly multisectoral and international focus, mixing updates from academia from as far afield as Thailand with on-the-ground perspectives from an energetic local New York City non-profit organization. Major topics included: educating and training future leaders and researchers; addressing the knowledge gap between developed and developing countries; changing infrastructure to better support the nutrition science community; preparing future leaders to address malnutrition; creating targeted and sustainable policies and interventions; and fostering cross-disciplinary and multisectoral cooperation.

Capacity building aims to "[increase] the self-sustaining ability of people to recognize, analyze, and solve their problems by more effectively controlling and using their own and external resources" (deGraff, 1986). Building capacity, in essence, involves developing local human and structural resources—community participants, staff, organizations, and infrastructure—to carry out programmatic changes (in this context, nutritional and health interventions) in an independent, self-sustained manner over the long term. A seminal paper on capacity building by Crisp, Swerissen, and Duckett postulates four main approaches to capacity building: "(i) a top-down organizational approach which might begin with changing agency policies or practices; (ii) a bottom-up organizational approach, [which involves] provision of skills to staff; (iii) a partnerships approach which involves strengthening the relationships between organizations; and (iv) a community organizing approach in which individual community members are drawn into forming new organizations or joining existing ones" (2000). Interestingly, the discussion of capacity building at this conference covered all of these approaches; for instance, Emorn Wasantwisut and Debra Wolgemuth presented on institutional and infrastructural change, while Robert Karp and Christina Stark discussed personal capacity building and professional development. Derek Yach and Gayle Binney presented on private-public partnerships and delineated how to facilitate knowledge transfers between industry and the public sector. Pamela Koch discussed community organization and community capacity building through targeted interventions. Hunter Reed delved into community empowerment and provided strategies for educating diverse stakeholders.

Although the perspectives shared ranged from the global to the local, one common theme united the presentations: the need for a holistic and sustained approach to capacity building that focuses on nutrition education. Capacity building and professional development must go beyond individual-level modifications to effect broad environmental and ecological changes. Leadership training and organizational capacity must be scaled up in a sustainable manner, in spite of funding inadequacies and the nutrition field's limited visibility. Moreover—because nutrition is so inextricably linked to public health, education, agriculture, economics, and trade—a multisectoral approach to solving nutrition problems is critical. It is important, however, that partnerships do not overshadow or crowd out the importance of nutrition itself. Public–private cooperation at all levels, from the field to the highest echelons of government and industry, is clearly essential to ensure that pressing issues in nutrition science are addressed effectively.

Speakers:
Emorn Wasantwisut, Mahidol University
Debra Wolgemuth, Columbia University Medical Center

Highlights

• Nutrition science research should adhere to international standards of academic inquiry and should be responsive to national and regional needs.
• Leadership in nutrition should be promoted and should focus on team building and on enabling foreign-trained experts to become leaders in their home countries.
• Partnerships should be created to promote interventions that utilize consortium-based models to combine the strengths of participating organizations.
• Nutrition science graduate training in African countries should address the double burdens of malnutrition and over-nutrition.

Building up nutrition science leadership and research in Asia

Emorn Wasantwisut, a Senior Advisor at the Institute of Nutrition at Mahidol University, drew on her experiences serving on numerous expert advisory groups for organizations like the World Health Organization to present the history of nutrition science education programs and highlight some of the problems encountered by these programs in the past. For example, the United Nations University's Food and Nutrition Programme, inaugurated in 1976, was intended to support fellowships and institutions that would produce high quality researchers and trainers, but, despite being perceived to be of the highest caliber, UNU research often fell short of international standards. Wasantwisut used this example to demonstrate that research should adhere to the highest standards of academic inquiry and be responsive to national and regional needs.

Similar lessons may be garnered by studying other nutrition initiatives. The World Health Organization South-East Asia Nutrition Research-cum-Action Network and the United Nations Standing Committee on Nutrition, Asian Capacity Building Initiative: Capacity Strengthening In Nutrition-Asia (CASNA) both suffered from a host of stumbling blocks which seriously limited their efficacy and longevity: extremely limited funding; high turnover of participant nations; de-stabilizing leadership changes; and a lack of communication between training institutions and participant nations. The CASNA project, which aimed to bring leaders, researchers, and technical experts together, found that it is important to nurture leadership and to focus on team building, and demonstrated that technical experts working alone find it difficult to implement policies in the field. Many fellowships, such as the Ellison Medical Foundation Fellowship, aim to address this need for macro-level changes by funding institutions rather than individuals. Participating institutions must demonstrate a track record of excellence and present a plan for improving nutrition science training. This type of institution-focused funding, with a mandatory stipulation of post-fellowship service in a developing nation, helps to encourage individuals to return home, and to ensure that knowledge and skills acquired at first-class universities are transferred back to developing countries.

Capacity building can be developed through different models: a top-down model, as practiced in China where the government handpicks and trains top scientists, or a collaborative model, as practiced in Singapore where world leaders in science and research are invited to collaborate with local scientists. A primary constraint in developing nations is a lack of resources: money is often diverted to research focused on high-profile health pandemics like HIV/AIDS, while less visible issues like malnutrition receive far less attention. Continuity is very important; ad hoc chaotic policy changes—often tied to leadership change—should be avoided because shifting foci and funding within an organization can divert critical resources from nutrition training and research to other issues.

Wasantwisut emphasized the need to reassess nutrition training amid rapid global changes. Undernutrition and overnutrition are both complex challenges that will only be solved with multi-pronged approaches. Undernutrition and stunting are often intra-country issues in developing nations that can be addressed by local, provincial, or national governments; over-nutrition and obesity are underpinned by global lifestyle and behavior changes and by emulation of Western diets (increased consumption of meat and obesogenic foods), and should be addressed through a concerted inter-government effort. In developing nations especially, a considerable knowledge gap often exists between foreign-trained scientists and incumbents in local institutions, yet the former are often restricted by institutional inertia and hierarchy based on tenure; these experts must be given the opportunity to grow and to assume true positions of leadership.

Building capacity through infrastructural change in African higher education

Debra Wolgemuth, Associate Director for Research at the Institute of Human Nutrition (IHN) at Columbia University Medical Center, presented results from nutrition development programs in East Africa—The Consortium for Advanced Research Training in Africa (CARTA) and The African Economic Research Consortium (AERC), formed in 1995 and 1998, respectively. These programs aim to re-structure and develop local educational institutions, creating internationally-competitive doctoral programs and strengthening laboratory and technical skills at the doctoral level. Spanning 35 African countries, CARTA and AERC have the capacity to foster inter-country cooperation and to facilitate knowledge and resource transfers.

The Institute of Human Nutrition (IHN) is undertaking a similar project to advance nutrition science and education in Africa, building upon the collaborative model instituted by CARTA and AERC to identify and combine the strengths of different organizations. The Institute's interdisciplinary structure combining research and clinical programs, coupled with its cornerstone initiatives—research, service/policy, and education—are key principles guiding the development of its PhD-level training program.

PhD programs in Africa are in short supply. Although African universities have been key intellectual hubs in the past, the combined effects of huge undergraduate enrollment, a paucity of PhD holders, over-reliance on PhD by thesis rather than by laboratory research, and extremely limited resources, have led to the near collapse of African tertiary education structures and contributed to a severe lack of well-trained, internationally competitive PhD holders engaged in quality research at international standards. This problem is exacerbated by an ongoing "brain-drain," as foreign-trained African academics seldom return to their home country as faculty, researchers, or leaders.

Presenting solutions to nutrition science challenges in Africa. (Image courtesy of Debra J. Wolgemuth)

There is an urgent need to focus on graduate training in African countries to address the double burdens of undernutrition and overnutrition—particularly because obesity is rising in sub-Saharan Africa—but no single university or country has sufficient capacity to develop or sustain graduate training programs. According to Wolgemuth, two key steps would enable educational reform: first, stem the flow of talent from developing to developed nations by stipulating a compulsory service period in the home country upon completion of a sponsored fellowship; second, remedy the lack of adequate laboratories and research facilities so that world-class scientists returning home can utilize their training and jump-start research. Lab equipment donated from the European Union and the United States are readily available in many facilities, but are under utilized because of a dearth of technically trained staff and research-minded investigators; this all-too-common scenario must be remedied.

Like Wasantwisut, Wolgemuth underscored the idea that improvements in individual training should be combined with infrastructural, institutional, and systemic changes that will allow universities to buildup faculty in situ and ensure that the capacity building process is sustainable. She also touched upon the need to engage local government to promote policy changes in education and nutrition science practice.

Speakers:
Robert Karp, SUNY-Downstate Medical Center
Christina Stark, Cornell NutritionWorks

Highlights

• Nutrition education should be given a more prominent place in curricula and should be expanded to include experiential learning that focuses on case-based practice.
• Online learning platforms are ideal tools for connecting the global nutrition science community and addressing the needs of community-based practitioners.
• An ecological approach to nutrition and public health should be implemented to account for multiple determinants of behavior.

Preparing practitioners and changing nutrition science curricula

This session featured presentations by Robert Karp, from SUNY-Downstate Medical Center, and Christina Stark, from Cornell NutritionWorks at the Division of Nutritional Sciences at Cornell University, who moved away from macro-level capacity building through organizational change to focus on individual-level capacity building through education and professional development.

Karp gave a humorous yet frank presentation of how inadequately represented nutrition education is in medical school curricula: only 40 of 106 medical schools surveyed currently require the minimum 25 hours of nutrition instruction recommended by the National Academy of Sciences, while 88% of instructors at these schools think that more extensive nutrition education is greatly needed. Karp advocates focusing on experiential learning and evaluation to address some of the gaps in nutrition instruction. To achieve this, Karp has produced A Teacher's Guide to Pediatric Nutrition, which utilizes case-based modules to promote active learning based on clinical practice and encourages students to understand nutrition experientially. Karp aims to outline essential vocabulary and to teach students how to assess diet and nutrition status so that they are better equipped to provide nutrition guidance.

Professional development successes in online learning and the ecological approach

Comparison between traditional and ecological approaches to nutrition interventions. (Image courtesy of Christina Stark)

Christina Stark explained Cornell's online learning platform, Cornell NutritionWorks (CNW), which allows 9500 nutrition science practitioners from diverse backgrounds—public health, medicine, education, food service, and business—to continue to improve their professional skills while on the job. There is strong international representation in membership and in the content of online courses taught. NutritionWorks is a truly global platform, connecting practitioners worldwide to training courses that are often tailored for developing countries.

A highlight of Stark's presentation was her emphasis on taking an ecological approach to nutrition and public health; she believes this is a powerful tool for addressing problems like childhood obesity and should be a focus of nutrition science education. The traditional approach focuses on effecting behavioral changes in diet and lifestyle at the individual level, but has had limited success because it only targets people who want to change; an ecological approach still involves individual modifiers, but shifts the focus to community-level changes in policy, structure, and environment. Cornell NutritionWorks uses a socio-ecological intervention model to educate practitioners to recognize both internal determinants of behavior (knowledge, attitudes, beliefs, and skills) and external determinants of behavior (interpersonal, organizational, community, and society), thus strengthening their ability to address nutrition, diet, and lifestyle changes in the local community.

The Socio-Ecological Model (SEM) encompasses multiple strata of determinants, ranging from those at the individual level to external drivers that influence and shape behavior. (Image courtesy of Christina Stark and the Centers for Disease Control and Prevention)

Online platforms like CNW have major advantages as tools for education and capacity building, providing easy and convenient access to all participants; quality courses and educational resources; and relatively inexpensive education. These platforms are ideal for addressing the needs of community-based practitioners, helping those who are unable to attend traditionally-structured courses to avoid isolation from professional peers. Stark echoed concerns about funding: developing fellowships, strengthening institutions, and building education and online training platforms all require ongoing support and maintenance to succeed.

Speakers:
Derek Yach, PepsiCo
Gayle Binney, The Dannon Company, Inc.

Highlights

• A multi-pronged approach to nutrition is needed to change perceptions among consumers and leaders: industry can promote change.
• Nutrition should not be evaluated in a vacuum, but instead, should be analyzed in the context of national and food security.
• Nutrition practitioners and specialists should be trained to become leaders in their own organizations.
• Tailored international training programs should build networks of nutrition science leaders.

Creating leaders and changing mindsets through private-public partnerships

Kicking off the next session—capacity building across sectors—Derek Yach, Senior Vice President of Global Health and Agriculture Policy at PepsiCo and an advisory board member on several global agricultural and nutritional health initiatives, presented on the importance of ensuring that the world agricultural system is prepared for 21st century challenges. Yach acknowledged a growing global nutrition crisis, with rising health and economic costs associated with obesity in parallel to widespread food insecurity; obese and food insecure populations both number about one billion people each worldwide. Yach highlighted a large body of evidence that pinpoints nutrition as essential for growth and development, in terms of both individual achievement and health, and of the economic success of a generation. The growing global population—which is estimated to reach nine billion by mid-century—combined with climate change, water scarcity, slowing improvements in crop yields, and competition for scarce agricultural land, make finding novel solutions to meet our nutritional needs increasingly important. The world’s agricultural system is limited by its focus on profit—to the exclusion of health and environmental considerations—and by the fact that land is increasingly diverted away from nutritious food staples to other products. The key question to address is whether our current agricultural system can deliver optimal nutritional, including a diverse set of nutritious foods like fruits, pulses, and leafy greens, for all?

Yach proposed that a multi-pronged approach will be necessary. He argued that our current agricultural system has made dramatic improvements in health and development possible, but has “overshot the mark” by producing too many cheap calories and under-emphasizing food quality. It is essential, going forward, that agriculture be set up to meet nutritional needs. To achieve this, Yach proposes that it will be necessary to make fundamental changes to our ideas about what agriculture encompasses and how our nutritional needs can be met: “Could we get to a future where much of the food, or at least the nutrients, are not grown in fields, seas, and rivers, but in laboratories or warehouses?” Small changes towards this shift are already occurring; for instance, the Brooklyn-based group Gotham Greens is developing innovative production methods—such as using hydroponics to cut out soil use—to grow food in rooftop greenhouses. In a starker shift away from traditional agriculture, biotechnology methods are being applied by pharmaceutical companies like AcSentient, Inc. to grow nutrition products in cell lines. Although processed healthy food may sound like an oxymoron, Yach emphasized that it can actually preserve nutrient quality, and could play a very important role in reducing food waste, which estimates put at 220 million metric tons each year. Yach argued that we should be open to these new technologies, which could potentially reduce hunger and enhance human health.

Yach discussed the need to shift the focus of nutrition science away from individual nutrition advice to effecting changes in the world agriculture system as a whole. He proposes key skills nutrition scientists will need to have in order to be able to effect the kind of broad-based changes that he believes will be necessary: a solid grounding in science, with a focus on the interplay between nutrition and the environment; a knowledge of cutting-edge production methods, with a focus on how to maintain and increase nutrient quality; an ability to advocate effectively for policies that will increase the availability of nutritious food; an insight into what motivates farmers, companies, and consumption habits; and an ability to build incentive systems and complex partnerships between disciplines and institutions. The perceptions of world leaders will need to change: nutrition should not be evaluated in a vacuum, but instead be analyzed in the context of national and food security; just as undernourishment was seen as a threat to national defense in the 1940s, so should over-nutrition and obesity be regarded as a threat to our success today.

In closing, Yach touched upon PepsiCo’s role in improving human and agricultural capacity, with initiatives like a program to help Ethiopian farmers with crop bio-fortification and irrigation and educational programs to teach techniques for producing nutrient-dense foods such as oilseeds, pulses, and chick peas. Yach stressed the need for a multi-sectorial approach: nutrition science practitioners should work together with trade leaders and public health leaders to effect policy changes.

Developing leadership and increasing personal capacity through tailored training initiatives

Gayle Binney, from the Dannon Institute, presented on international capacity building and education initiatives supported by The Dannon Company, Inc. (Danone), which are focused on developing future leaders in nutrition. Danone, a multinational food and beverage giant, revamped its corporate portfolio several years ago with the goal of investing only in food brands that are healthy and nutritious. The company achieves its mission—"health through foods to as many people as possible"—by focusing on fresh dairy, bottled water, medical nutrition, and child nutrition. Danone emphasizes affordable nutrition and sustainable production methods; for instance, it has committed to making yogurt products affordable in developing countries and to developing specific nutrient content so that twice weekly consumption of these, aptly named Shakti Doi ("energy" in Bengali), meets a child's minimum nutrient requirement for at least four vitamins and minerals including vitamin A, iron, zinc, and iodine.

The Dannon Institute closely reflects Danone's mission and aims to understand the links between nutrition, diet, and health; to share this knowledge with the public; and to promote education and leadership training. The Nutrition Leadership Institute utilizes the expertise of nationally recognized nutrition specialists to impart capacity building and leadership skills to select group of PhD holders and physicians; the training incorporates self-assessment, effective leadership, professional network building, communication, and team building.

The goals of the Dannon Institute's Nutrition Leadership Institute training program. (Image courtesy of Gayle Binney)

Alumni responses demonstrate the success of these programs, with 98% of participants remaining connected through an alumni network and some working together on RO1 funded projects. According to Binney, this program in North American has been so successful in cultivating and training nutrition science leaders that the Dannon Institute in the U.S. developed and offered Academic Mid-Career Nutrition Leadership Institute training programs in 2010 and 2012. As part of its long-term capacity building and professional development initiative, Danone is considering global support for advanced nutrition science and leadership courses for mid-career professionals and international courses to address sustainability and multicultural challenges. Danone also supports early-career programs in the European Union and Africa, which have similar foci to their North American counterpart, aiming to create a network of future nutrition science leaders. The European Nutrition Leadership Program (ENLP) was the first of its kind; Dannon shares funding responsibility for this program, which inspired many others around the world, including the North American program and similar leadership programs in Africa. These African nutrition leadership programs focus on capacity building to address Africa's unique set of nutritional challenges—food insecurity, malnutrition, and disease—and are good examples of how nutrition science education can be tailored to meet the needs of different geographic regions.

Speakers:
Pamela Koch, Teachers College Columbia University
Hunter Reed, F.A.S.T. NYC

Panel Moderator:
Mandana Arabi, The Sackler Institute for Nutrition Science

Panelists:
Nabeeha Kazi, Humanitas Global Development
Pamela Koch, Teachers College Columbia University
Glenn Denning, Columbia University
Liesel Pritzker Simmons, IDP Foundation

Highlights

• The DESIGN Model for Planning Theory-based Nutrition Education provides a step-by-step guide to changing eating behaviors for curriculum developers in nutrition science and education.
• Dietary choice is influenced by multiple determinants that must all be addressed to effect change.
• Nutrition education in schools should focus on educating the school community and on targeted professional development.
• Informed advocacy should be at the forefront of nutrition interventions and should empower target audiences to effect change themselves.
• A multidisciplinary and multifocal approach to addressing nutrition issues is critical to effect broad-based policy changes.

Theory-based and research-based strategies for designing interventions in nutrition science

The third session focused heavily on theory-based tools and on the actual experiences of practitioners in the field. Pamela Koch, Executive Director at the Center for Food & Environment at Teachers College Columbia University, spoke about drawing on psychosocial theories to motivate, teach, and change behavior in target communities. Koch explained a key theoretical model—the DESIGN Model for Planning Theory-based Nutrition Education developed by her colleague Isobel Contento, Mary Swartz Rose Professor in Nutrition and Education at Teachers College—which provides a step-by-step guide to changing eating behaviors for curriculum developers in nutrition science and education.

Influencers of Food Choices and Diet-Related Behavior: To effectively change nutrition patterns we must identify and address the determinants and mediators of change. (Image courtesy of Pamela A. Koch and Isobel Contento)

Any program aiming to influence dietary choice and behavior must take into account the different factors that influence our diet patterns. Koch explained that these factors are multi-layered and include biologically determined behavioral predispositions, prior experience with food, and individual and environmental determinants. To be effective, nutrition education must target all levels of influence and must focus on not only specific behaviors, actions, and practices, but also on identifying and addressing the determinants, or mediators, of change.

Koch explained the DESIGN model's components and how to translate theory into practice, elaborating on each step by introducing examples from the nutrition education programs she oversees. The first component involves deciding which issue to focus on, identifying an intended audience, and targeting specific behaviors. The second component involves exploring determinants, or mediators, that could motivate, facilitate, and support positive change. Successful strategies for changing behavior increase awareness and motivation (focusing on why people take action), facilitate action taking (focusing on how to take action), or provide environmental or policy-based support for action (focusing on where and when to take action). The third component involves drawing on existing theories in social medical science—like Social Cognitive Theory, Stages of Change, and Theory of Self-Determination—to select appropriate theoretical models that will help curriculum planners to develop a philosophy and to create action-based outcomes; a philosophy might state that shopping at farmers markets improves health, while an outcome might be developing a marketing campaign to increase the visibility of these markets. The final components of the model involve outlining objectives and creating specific activities and lesson plans.

Koch stressed that it is essential to evaluate program outcomes to assess whether behavioral and environmental changes have occurred. This can be done by monitoring indicators of achievement; for instance, measuring Body Mass Indexes to evaluate obesity interventions, or surveying food sold in schools to evaluate environmental interventions. Koch concluded her presentation by giving examples of theory-based capacity building in nutrition education programs she oversees; for example, the Linking Food & the Environment Curriculum (LiFE) Series draws on the DESIGN model to establish its overarching goal—reducing childhood obesity through behavioral change—and to identify mediators of change. The model helped shape a philosophy self-agency within the program, which focuses on giving students tools to monitor and control their intake of sugary and obesogenic foods.

Empowering community stakeholders through nutrition education and training

Local outreach programs promoting nutrition education can build capacity from the ground up. Hunter Reed, President of F.A.S.T. NYC—a local non-profit that partners with New York City schools to implement nutrition and physical activity programs—painted a dismal picture of nutrition and physical education programs in NYC elementary schools, where nearly 50% of students are overweight or obese. He emphasized that nearly all NYC schools currently fail to meet the minimum number of weekly physical education hours mandated by New York State.

Describing the barriers to providing healthy nutrition and adequate physical exercise in schools, Reed stressed the need to change students' behavior and to modify prevalent attitudes among parents, school cafeteria staff, teachers, principals, and policymakers. Reed demonstrated how targeted professional development, combined with educating the school community, can promote significant improvements in nutrition and physical education. For instance, many schools now working with F.A.S.T NYC had previously been unaware of the poor nutrition choices and large quantity of processed foods on school menus, but—with support from F.A.S.T. NYC to develop empowered Parent Associations with basic nutrition education—schools have subsequently succeeded in reducing unhealthy food options. Statistics showing correlations between nutrition, exercise, and test outcomes, among other targeted interventions, are demonstrably successful in appealing to school principals and similar stakeholders. Reed strongly supports empowering teachers and school staff by using professional development interventions like teaching cafeteria staff how to calculate calories and how to plan healthy food choices; and giving teachers opportunities to obtain coaching certifications and to lead after-school programs in arts, dance and sports.

Perspectives on overcoming challenges in capacity building

The conference concluded with a panel discussion moderated by Mandana Arabi, from the Sackler Institute of Nutrition Science, and featuring Nabeeha Kazi, from Humanitas Global Development, Glenn Denning, from Columbia University, Liesel Pritzker Simmons, from the IDP Foundation, and Pamela Koch, from the Center for Food & Environment at Teachers College Columbia University. The discussion drew upon major themes raised at the conference and focused on current gaps in capacity building initiatives in the U.S. and globally.

Kazi shared her perspective on the challenges involved in capacity building and in scaling-up nutrition interventions. She thinks that transforming nutrition interventions from local-based programs into a broader movement requires a people-centered approach. In designing and implementing these programs, nutrition practitioners and leaders must understand basic consumer behavior and be able to cultivate understanding, acceptance, and a desire to change. It is essential to speak to the target audience at a level they can understand and to eliminate unnecessary jargon that would obfuscate the message; furthermore, outreach should not take the form of a didactic translation of knowledge from practitioners to laypeople, but instead, should rally and empower the population to demand appropriate nutrition choices for themselves. Koch underscored the need to encourage change on participants' terms, giving examples of how students in her program have altered their food choices based on education and peer influence.

In her discussion of advocacy, Kazi stressed that informed advocacy—not ivory-tower policy making—should be at the forefront of nutrition interventions. Nutrition science practitioners should be able to recognize, understand, and adapt to target audiences. Simmons illustrated this point clearly with an example from IDP's partnership with microfinance institutions in Ghana, which aims to raise funds for nutritious private school lunches. Although nutrition practitioners were able to successfully promote a transition to a healthier diet among staff and students, their effort did not bear fruit initially because it failed to target the right constituency—in this case, the students' parents—who ultimately managed the types of food their children could consume. Kazi highlighted the utility of mapping out intervention strategies with a model that analyzes associated strengths, weaknesses, opportunities, and threats (SWOT): one should address both allies and detractors, garnering support from the former and taking corrective action to resolve misunderstandings with the latter. Kazi reiterated the importance of taking a multi-sectorial approach to nutrition issues: although competition for visibility and resources between nutrition and other sectors (such as agriculture) can be intense, nutrition practitioners should be open to cooperative partnerships and dialogue. Denning also broached this point, arguing that a singular approach to capacity building in nutrition is deficient; rather, a multidisciplinary and multifocal approach is needed. Columbia University's program, where development practice is taught concurrently with nutrition, human ecology, food security, and economics, is a good example. At the national level, a multifocal approach is equally crucial, and various ministries, including trade, finance, health and education, will need to work together to address the wide-ranging impacts of nutrition on health and economic productivity.

What do we see happening in the near future for partnerships and programs in nutrition?

Agriculture and nutrition seem to be disengaged from each other and the latter is often not at the top of the national agenda. What can we do about this?

To incorporate links and partnerships between agriculture and nutrition, who do we have to convince?

Can the new generation of international nutrition science professionals really help Africa? How can science, technology, and development practice help make a difference in Africa?

What does scaling-up actually mean?

How do we create an argument for nutrition to become a priority vis-à-vis other sectors? Can we create an economic argument to put nutrition at the forefront?