Poverty, Obesity, and Malnutrition:
An International Perspective Recognizing
SHERRY A. TANUMIHARDJO, PhD; CHERYL ANDERSON, PhD, MPH; MARTHA KAUFER-HORWITZ, DSc; LARS BODE, PhD;
NANCY J. EMENAKER, PhD, RD; ANDREA M. HAQQ, MD; JESSIE A. SATIA, PhD, MPH; HEIDI J. SILVER, PhD, RD;
DIANE D. STADLER, PhD, RD
In the year 2000, multiple global health agencies and
stakeholders convened and established eight tenets that,
if followed, would make our world a vastly better
place. These tenets are called the Millennium Develop-
ment Goals. Most of these goals are either directly or
indirectly related to nutrition. The United Nations has led
an evaluation team to monitor and assess the progress
toward achieving these goals until 2015. We are midway
between when the goals were set and the year 2015. The
first goal is to “eradicate extreme poverty and hunger.” Our
greatest responsibility as nutrition professionals is to
understand the ramifications of poverty, chronic hunger,
and food insecurity. Food insecurity is complex, and the
paradox is that not only can it lead to undernutrition and
recurring hunger, but also to overnutrition, which can
lead to overweight and obesity. It is estimated that by the
year 2015 noncommunicable diseases associated with
overnutrition will surpass undernutrition as the leading
causes of death in low-income communities. Therefore,
we need to take heed of the double burden of malnutrition
caused by poverty, hunger, and food insecurity. Informing
current practitioners, educators, and policymakers and
passing this information on to future generations of nu-
trition students is of paramount importance.
J Am Diet Assoc. 2007;107:1966-1972.
hunger” (1). The United Nations has led the Inter-agency
and Expert Group on Millennium Development Goal In-
dicators to monitor and evaluate progress toward the
Millennium Development Goals until 2015. The first tar-
get point for poverty eradication is to reduce by 50% the
proportion of people whose income is less than $1 per day.
The second target point is to reduce the proportion of
people who experience hunger by 50% (1). Several regions
of the world have made progress toward meeting this goal
(1), but hunger and food insecurity are still prevalent,
and both lead to malnutrition.
Historically, use of the term malnourished or reference
to malnutrition has been associated with a state of un-
dernutrition. Malnutrition is usually associated with pov-
erty and food insecurity, and malnourished is defined as
poorly or wrongly fed and having a poor or inadequate
diet (2). However, a newly appreciated paradox has been
described that links poverty, food insecurity, and malnu-
trition to obesity, or the state of overnutrition. This par-
adoxical condition exists because many of the diets of
people living in poverty have adequate kilocalories to
meet or exceed their energy requirements, but lack the
dietary quality needed to promote optimal health and
prevent chronic disease. As a result, we need to expand
the construct of malnutrition to include two subcatego-
ries, specifically undernutrition and overnutrition, and
recognize that both conditions can emerge from living in
poverty or having an inadequate food supply (Figure 2).
Millions of children and adults face premature death
due to both undernutrition and the chronic diseases as-
he first of the eight Millennium Development Goals
set by the United Nations Millennium Declaration in
2000 (Figure 1) is to “eradicate extreme poverty and
S. A. Tanumihardjo is an associate professor in the
Department of Nutritional Sciences at the University of
Wisconsin-Madison and Extension, Madison. C. Ander-
son is an assistant scientist in the Department of Epi-
demiology at Johns Hopkins Bloomberg School of
Public Health, Baltimore, MD. M. Kaufer-Horwitz is a
certified nutritionist by the Mexican College of Nutrition
(Colegio Mexicano de Nutriólogos) and a researcher at
the Fundación Mexicana para la Salud, Mexico City,
Mexico, and a member of the International Union of Nu-
tritional Sciences (IUNS) Task Force on Nutrition, Diet
and Long-term Health. L. Bode is a staff scientist at
Burnham Institute for Medical Research, La Jolla, CA.
N. J. Emenaker is a program director at the National
Cancer Institute, Bethesda, MD. A. M. Haqq is an assis-
tant professor at Duke University Medical Center,
Durham, NC. J. A. Satia is an assistant professor in the
Departments of Nutrition and Epidemiology at the Uni-
versity of North Carolina at Chapel Hill. H. J. Silver is
a research assistant professor at Vanderbilt University
Medical Center, Nashville, TN. D. D. Stadler is a re-
search assistant professor at Oregon Health & Science
Address correspondence to: Sherry A. Tanumihardjo,
PhD, University of Wisconsin-Madison, 1415 Linden Dr,
Madison, WI 53706. E-mail: firstname.lastname@example.org
Copyright © 2007 by the American Dietetic
Journal of the AMERICAN DIETETIC ASSOCIATION
© 2007 by the American Dietetic Association
sociated with the obesity pandemic or overnutrition (3).
The fourth Millennium Development Goal is to “reduce
child mortality” (1). In 2004, 10.5 million children died
before their fifth birthday and many of these deaths were
from preventable causes (1) that were exacerbated or
caused by undernutrition. Furthermore, it is estimated
that by 2015 noncommunicable diseases partially caused
by overnutrition in both children and adults, such as type
2 diabetes, hypertension, and coronary vascular disease,
will overtake undernutrition as the leading cause of
death in low-income countries (4).
In this essay, we focus on the double burden of malnu-
trition and the need for educators, clinicians, researchers,
and policymakers to address the consequences of under-
nutrition and related disease sequelae as well as the
ramifications of overnutrition and its relationship to
chronic diseases and premature death. To address this
double burden, our challenge is to reach people in need
through delivery of health services and improved nutri-
tion (3). The objectives of this report are twofold: to illus-
trate links between poverty, obesity, malnutrition, hun-
ger, and food insecurity; and to comment on current
research and intervention programs that address these
POVERTY AND OBESITY ARE CONNECTED TO HUNGER AND
Poverty results in food insecurity and often hunger,
which can lead to malnutrition. Furthermore, the ab-
sence of a diversified, nutrient-dense diet can lead to
overnutrition, subsequent obesity, and failure to meet
micronutrient requirements. The US Department of Ag-
riculture (5) and the Food and Agriculture Organization
(6) have specific language and definitions to describe hun-
ger and food insecurity (Figure 3).
Interrelationship of Hunger and Food Insecurity
Hunger is a potential, although not necessary, conse-
quence of food insecurity (5). When hunger is recurrent, it
results in undernutrition. Socially, the term hunger can
describe individuals who occasionally cannot obtain an
adequate quantity or quality of food and nourishment,
and hunger can be present even when no clinical symp-
toms or health problems associated with food deprivation
exist (5,7). Thus, hunger can signify the existence of a
social problem and not necessarily a medical condition.
Individuals living in poverty are likely to be malnour-
ished, fitting the clinical and social definitions of hunger.
Although hunger has been an issue of public interest for
a long time, the concept of household food insecurity as it
relates to hunger has only recently emerged in the United
States (5). In poorer countries and regions of the world,
food insecurity describes the inadequacy of national or
Eradicate extreme poverty and hunger
Achieve universal primary education
Promote gender equality and empower women
Reduce child mortality
Improve maternal health
Combat HIV/AIDSa, malaria, and other diseases
Ensure environmental sustainability
Develop a global partnership for development
Figure 1. Millennium Development Goals set forth by the United
Nations Millennium Declaration in 2000.aHIV/AIDS?human immuno-
deficiency virus/acquired immune deficiency syndrome.
Figure 2. Poverty almost inevitably leads to hunger and food insecu-
rity. This can lead to malnourished individuals, which can result in overt
clinical signs of nutrient deficiency or micronutrient depletion that is not
clinically apparent. Often, food insecurity can lead to overnutrition,
which chronically will result in obesity. The link between obesity and
the degree of micronutrient depletion has not been systematically
Hunger: The uneasy or painful sensation caused by a lack of
food. When used in program evaluations, lack of access to food
must be involuntary.
Hidden hunger: When an individual suffers from subclinical
nutrient deficiencies (eg, iron, folic acid, and vitamin A), but does
not have overt clinical signs of undernutrition.
Food insecurity: When people do not have adequate physical,
social, or economic access to sufficient, safe, and nutritious food
that meets their dietary needs and food preferences for an active
and healthy life.
Food security: Access by all people at all times to enough food
for an active, healthy life, including, at a minimum: (a) the ready
availability of nutritionally adequate and safe foods, and (b) an
assured ability to acquire acceptable foods in socially acceptable
ways (eg, without resorting to emergency food supplies,
scavenging, stealing, or other coping strategies).
Figure 3. Glossary of terms as defined by the US Department of
Agriculture and/or the Food and Agriculture Organization.
November 2007 ● Journal of the AMERICAN DIETETIC ASSOCIATION
regional food supplies over time. The term food insecurity
includes lack of access to food at the household and indi-
vidual levels (8,9). The most severe level of individual
hunger and household food insecurity is when the house-
hold includes hungry children as judged by the parents
(10). If a parent or caregiver reveals that a child in his or
her household is experiencing recurrent hunger, the sit-
uation is dire and social intervention is recommended.
The Problem of Hidden Hunger
Nationally and internationally, hidden hunger is a major
issue (11), and is not necessarily associated with the
world’s poorest people. The most common examples of
hidden hunger in the world are poor iron status among
women (12-14) and vitamin A deficiency in preschool
children. The fifth Millennium Development Goal is to
“improve maternal health,” and targeting the vulnerable
period of the childbearing years is of utmost importance
(1). For example, pregnant women have been targeted to
receive vitamin A, iron, and/or folic acid supplementation
to improve both their nutritional status (12-14) and the
health of their infants (15). Several international agen-
cies are committed to the prevention of blindness caused
by vitamin A deficiency in children (eg, United Nations
Children’s Fund [New York, NY], Helen Keller Interna-
tional [New York, NY], and Sight and Life [Basel, Swit-
zerland]), and many countries have routine supplemen-
tation programs. However, as developing countries move
from a state of undernutrition to overnutrition, current
programs aimed specifically at improving undernutrition
will likely be reevaluated. The direct effects of obesity on
micronutrient requirements, and the accuracy of tradi-
tional measures of micronutrient status remain to be
determined (Figure 2). One cannot assume that over-
weight or obese individuals are micronutrient replete and
that hidden hunger does not coexist. These issues need
further evaluation in well-designed studies with sensitive
measures of micronutrient status.
Assessment of Hunger and Food Insecurity
Although assessing poverty rates in countries is routine,
challenges in assessing hunger and food insecurity still
exist, including establishing a relationship between food
insecurity, health outcomes, and quality of life; and de-
termining the cognitive, emotional, and behavioral
changes that occur under conditions of food insecurity
(10). Methodology to assess food insecurity is evolving,
and standardized tools for global use do not yet exist.
Assessing food insecurity is not simple. It requires that
researchers use valid methodology with ethical designs
(16) and that policy implementation is evidence-based.
Determination of the intimate relationships between food
insecurity and adverse outcomes, including obesity and
its related morbidities, is essential to the implementation
and expansion of policies and programs. Nutritional sta-
tus not only affects health, but also social, emotional, or
psychological well-being, parameters that are much
harder to measure (17).
THE PARADOX OF FOOD INSECURITY AS A CAUSE
The paradox within these intertwined social and eco-
nomic relationships is that poverty causes food insecu-
rity, yet one of the overwhelming outcomes of food inse-
curity is obesity. When food insecurity exists in a
community, sufficient or even excessive energy may be
provided by the limited foods available, but the nutri-
tional quality and diversity of the foods in the diet may
not support a healthy nutritional status due in part to
inadequate micronutrients. The number of US residents
in households experiencing hunger increased from 7.8
million in 1999 to 9.6 million in 2003 (18), an increase of
24%. The least severe level of food insecurity is a house-
hold that runs out of food, is uncertain about the ability to
obtain sufficient food, and begins to compromise the qual-
ity of the family diet (10). Compromising diet quality
often leads to a higher intake of energy from foods that
are higher in fat and carbohydrate, but lower in nutrient-
density. These energy-dense foods are often less expen-
sive than foods of lower energy density or higher nutrient
density, such as fruits, vegetables, and whole-grains
(19,20). Despite the link between poverty, food insecurity,
and malnutrition, it should come as no surprise that
households characterized as food insecure also have the
highest body mass index (BMI; calculated as kg/m2) and
prevalence of obesity (BMI ?30) (10).
This paradox between poverty and obesity occurs
throughout the world. Globally, 28% of the world’s people
lived in extreme poverty in 1990, and by 2002 this per-
centage had decreased to 19% (1). In much of the world,
women are overrepresented among the poor, due mainly
to inequalities in the workforce (1). Nearly half of Jamai-
can households are headed by women, and they experi-
ence more severe poverty than households headed by
men. In a cross-sectional, population-based survey of Ja-
maicans, income was strongly and positively related to
obesity in men, but in women rates of obesity were high
even among the poor (21). This relationship is very sim-
ilar among non-Hispanic black women in the United
Measures to correct poverty among women are impor-
tant because women are often the main providers of
health care and education for their children, and they are
critical to the political and economic success of their com-
munities. In fact, this is realized in the third Millennium
Development Goal, which is to “promote gender equality
and empower women” (1). Household structure is an im-
portant contributing factor to children’s nutritional out-
comes because children in single-parent, low-income fam-
ilies with siblings, and low-income extended families, are
more likely to have low height-for-age (23). Finally, nu-
merous studies find that early prenatal and postnatal
metabolic conditions of mothers (eg, diabetes, obesity,
and undernutrition) can produce metabolic imprinting of
the neuroendocrine pathways involved in energy ho-
meostasis in the developing fetus. Thus, measures to
correct poverty among women are needed to prevent this
vicious cycle of increasing body weight in future genera-
According to the United Nations, sub-Saharan Africa
made little progress and southeast Asia made rapid
progress in improving the proportion of people living in
November 2007 Volume 107 Number 11
extreme poverty from 1990 to 2002 (1). Latin America
made some progress (1), but there remains room for im-
provement. More than 50% (?50 million individuals) of
Mexico’s population is considered poor, with 35% of in-
come concentrated in the upper-income decile, and 1% of
income distributed among the lowest decile. Moderate
poverty decreased from 69.6% in 1996 to 51.7% in 2004;
whereas extreme poverty decreased from 37.1% to 20.3%
during the same period. Although poverty and undernu-
trition are more prevalent in rural areas, overweight and
obesity predominate in urban areas (25,26). Yet, despite
this geographic relationship, familial overnutrition and
undernutrition often coexist, with an estimated 6.1% of
overweight Mexican mothers having a growth-stunted
child younger than 5 years of age (27). Even more ex-
treme is the occurrence of intra-individual overweight or
obesity coincident with stunting. In one study, 5% of
indigenous preschoolers and more than 10% of nonindig-
enous preschoolers were stunted and either overweight or
DETERMINANTS OF OBESITY CONNECTED TO POVERTY
In the Third National Health and Nutrition Examination
Survey, conducted between 1988 and 1994, theoretical
models of relationships were determined between multi-
ple factors and the risk for being overweight (29). Lack of
family resources and food insufficiency were intricately
related (ie, no money results in no food), and both factors
were associated with obesity. Similar to much of the
world, relationships exist between obesity and social (30)
and lifestyle (31) factors in Jamaica; BMI is affected by
income, marital status, sex, vegetable consumption, and
exercise (21-23,30,31). In an in-depth analysis of income,
education, and poverty (19), as income increased and
people became more educated, prevalence of obesity de-
creased. As income increased, calorie needs were met or
exceeded before food security was achieved. Adequate or
excessive calories were available, but not necessarily
from nutritionally dense foods (ie, vegetables and fruits,
whole-grains, low-fat dairy products, and lean meats). An
indirect relationship existed between the energy density
of the food and the cost of the diet so that foods of high
energy density cost less.
Having enough food to eat and sufficient calories to
ward off hunger is an issue in poverty. Globally, as eco-
nomic improvement continues, individuals who were un-
dernourished as children to the point of exhibiting
stunted growth are more susceptible to becoming obese as
adults, in part because they have more money than their
parents and can afford to consume more food and more
calories. A key question in the value system of poverty is
“Did you have enough to eat?” (32). This question does not
equate to: “Were there enough fruits and vegetables on
your plate?” (which are expensive relative to energy den-
sity), but rather to: “Do you want more noodles, rice,
maize or cassava?”, staple foods that are inexpensive and
readily available. Historically, national and international
food programs have focused on providing communities
with staple crops to meet the energy needs of the people
so that they can lead productive lives. Today, this practice
continues despite the health-related consequences of
resulting obesity. Now is the time to reevaluate these
practices and change policies to promote healthful, nutri-
tionally dense eating practices rather than harmful en-
ergy-dense eating practices. Biofortification of staple
crops with ?-carotene, iron, and zinc is an emerging and
sustainable way to improve micronutrient status of pop-
ulations (33), but it still cannot replace the importance of
a diet rich in fruits and vegetables.
Data show that household cost constraints result in a
diet that favors foods high in fat and carbohydrate
(19,34), such as industrialized snacks and sweets. Under
conditions of limited financial resources, a rational indi-
vidual will make food choices to reduce his or her food
budget, while retaining a diet as close as possible to the
typical diet of the community. By introducing a cost-
constraint model and assessing the effect of cost on the
selection of foods, the resultant diet was lower in the
proportion of energy derived from fruits and vegetables,
meat, and dairy products, and higher in the proportion of
energy derived from cereals, sweets, and added fats, a
pattern similar to that observed among low socioeconomic
groups. The diets modeled to be lowest in cost had lower
vitamin C and ?-carotene densities than the average
adult diet (34). All economic factors seem to favor con-
sumption of higher energy intakes and lower micronutri-
ent intakes, characteristics that lead to weight gain and
Demographic factors are related to the incidence of
obesity. The prevalence of adult obesity in the United
States is skewed to non-Hispanic blacks, with the highest
prevalence in women (almost 50% with a BMI ?30 kg/m2)
(22). Not surprisingly, this is in direct correlation with
the demographic distribution of individuals living below
the poverty line (35). African Americans have the highest
prevalence of households living in poverty, followed by
individuals of Hispanic origin. Globally, living in poverty
predicts overweight and obesity more directly than race
PROGRAMS THAT ADDRESS FOOD SECURITY
Around the world, poverty is acknowledged as a major
cause of food insecurity, and efforts to improve access to
food must include poverty eradication (1). According to
the World Health Organization, malnutrition is a medical
and societal disorder with substantial consequences, in-
cluding increased risks for morbidity and mortality (36).
The World Bank Strategic Objectives are centered on the
improvement of Health, Nutrition and Population out-
comes for the poor (3).
Multiple programs have been implemented in the
world to alleviate hunger, hidden hunger, and food inse-
curity. However, most programs have targeted food inse-
curity without addressing the emerging issue of obesity
among the poor. Although food insecurity has decreased,
obesity has increased epidemically. Although originally
not intended for noncommunicable diseases, the phrase
“other diseases” in the sixth Millennium Development
Goal (“combat HIV/AIDS [human immunodeficiency vi-
rus/acquired immune deficiency syndrome], malaria, and
other diseases”) will need to encompass those diseases
associated with overnutrition, such as diabetes, coronary
artery disease, arthritis, and certain types of cancer.
In the United States, several programs have been im-
plemented to alleviate food insecurity. These include the
Special Supplemental Nutrition Program for Women, In-
November 2007 ● Journal of the AMERICAN DIETETIC ASSOCIATION
fants, and Children (WIC); the National School Lunch
and Breakfast Programs for children; the FoodShare
(Food Stamp) Program for individuals and families; and
the Older Americans Act nutrition programs (congregate
meals and home-delivered meals). These programs are
important in helping participants meet nutrient needs,
but to be most effective they must include nutrition edu-
cation and poverty eradication so that appropriate
choices are made to promote optimal health. Intervention
efforts need to reverse observations that white bread is
consumed more often than its whole-grain counterpart.
As countries improve overall general health, popula-
tions will age and the continuum of nutritional risk as it
relates to chronic disease will be more manifest. Improv-
ing nutrition and physical activity at each life stage is
important to decrease preventable deaths caused by non-
communicable diseases (37). This continuum is illus-
trated by the distribution of weight-for-age in a small
survey of children entering the WIC program, which was
not a characteristic bell-shaped curve but resembled a
U-shaped curve (38). Thirteen percent were less than the
10th percentile and 16% were more than the 90th per-
centile of weight-for-age. These findings suggest that
more than one quarter of the children eligible for this
program were at higher risk of being undernourished or
overnourished rather than being of normal weight (ie,
only 13% were between the 40th and 60th percentile). In
adult women, a positive relationship has been observed
between Food Stamp Program participation and increas-
ing body weight (39,40).
Understanding the ramifications of
having a diet that provides adequate
or excessive energy yet insufficient
diversity and nutritional quality is
important as we set our professional
education, research, and policy
Furthermore, hunger and food insecurity are real is-
sues in the elderly, and programs focused on comprehen-
sive food and nutrition services are important. However,
universal access is limited (37). Older adults need to
adopt dietary and lifestyle practices that prevent chronic
conditions and ensure successful aging (37). Some have
advocated that the food choices in government programs
(eg, FoodShare, congregate meals, and home-delivered
meals) should be better defined and more restricted to
promote a healthful eating pattern (41). However, it is
almost impossible to truly tease out the effect of the food
program from the influence of poverty on obesity.
School feeding programs are being implemented in
multiple countries. A program in Jamaica (started with
assistance from the US Agency for International Devel-
opment, the European Economic Community, and the
Canadian International Developmental Agency) provides
a midday meal to children in primary and secondary
schools. In an evaluation in which schools with programs
were compared with control schools, school feeding, in
addition to alleviating hunger, resulted in improved
arithmetic scores, which persisted after controlling for
school attendance (42). Furthermore, providing breakfast
to students at school improved cognitive functions, par-
ticularly in undernourished children (43,44).
According to the Mexican 2006 National Health and
Nutrition Survey, more than 70% of the adult population
is either overweight or obese (14). The largest and more
comprehensive incentive-based welfare program is the
Program for Education, Health, and Nutrition, now called
Oportunidades. It includes 5 million urban- and rural-
dwelling families (approximately 20% of all Mexican fam-
ilies). Inputs include cash transfers, food coupons, food
supplements for preschool children and pregnant women,
and medical services (28). Assessment of the program
shows an association with improved height and lower
rates of anemia (45). Another governmental program to
combat undernutrition and hidden hunger in Mexico is
Liconsa. Since 1944, milk has been distributed to low-
income urban families with children younger than 12
years old, and now the milk is fortified with multiple
nutrients (28). Effectiveness and efficacy of the fortified
milk have been assessed, and a reduction in anemia over
a 6-month period was documented (46,47). A national
school breakfast program has increased the mean height
of schoolchildren, but due to the high prevalence of over-
weight in children and adolescents, the program needs to
be redirected. New initiatives to address the double bur-
den of disease are being implemented. Examples include
an integrated health program with a nutrition and phys-
ical activity component by the Mexican Institute of Social
Security (a program known as PrevenIMSS), and a Min-
istry of Health program that emphasizes prevention of
non-communicable chronic diseases through specific ac-
tions such as the self-assessment of waist circumference
OUR RESPONSIBILITIES AS PROFESSIONALS
We have several responsibilities as nutrition educators,
dietetics professionals, health care providers, research-
ers, and policymakers to understand and address the
consequences of food insecurity, hunger, and malnutri-
tion (49). The eighth Millennium Development Goal is to
“develop a global partnership for development” (1). This
begins with educating ourselves and others about the
complexities of poverty, obesity, and the double burden of
malnutrition. Understanding the ramifications of having
a diet that provides adequate or excessive energy yet
insufficient diversity and nutritional quality is important
as we set our professional education, research, and policy
promotion efforts. Billions of dollars are spent on health
care expenses associated with chronic disease states that
could be prevented by a healthful diet and lifestyle at all
stages of life.
As we build global coalitions, promoting grassroots ef-
forts to increase intake of nutrient-dense fruits, vegeta-
bles, and whole-grains among the impoverished, food-
insecure, and hungry is essential to improve optimal
health of individuals and the community. Promoting
healthful lifestyle changes that include diet and physical
activity must begin with our children, and nutrition ed-
ucation should be part of elementary school curricula
November 2007 Volume 107 Number 11
along with physical activity programs. The second Mil-
lennium Development Goal is to “achieve universal pri-
mary education” (1), and it is our opinion that nutrition
needs to be part of this initiative.
Across all income and education levels, healthful eating
can be improved. Doing our part on the international
agenda to diversify diets is our duty as well-rounded
practitioners in our discipline. Complex problems such as
poverty, food insecurity, and hunger require comprehen-
sive multidimensional approaches instead of unilateral
interventions. The income gap in many countries contin-
ues to widen, and as a consequence so does nutritional
adequacy and health status. To elicit change, helping the
current generation of nutrition students understand the
nutritional implications of poverty, food insecurity, and
hunger (ie, undernutrition and overnutrition) is of para-
mount importance. As professionals, we need to actively
participate in influencing public policy, research, and pro-
“Poverty should not leave us with a comfortable feel-
ing” (D. Hora-Schwobe, nutrition educator to Native
Americans, personal communication, January 2007).
This article is part of an extension-outreach project sup-
ported by the National Research Initiative of the USDA
Cooperative State Research, Education, and Extension
Service, grant number 2003-35200-05377 (S.A.T.); Har-
vestPlus contract numbers 2005X217.UWM, 8029, and
8037 (S.A.T.); and NIH K23 RR 021979-03 (A.M.H.).
This article was written by the International Commit-
tee of the Dannon Nutrition Leadership Institute Alumni
Association, which was formed in March 2006. The goal of
the committee is to foster intercontinental communica-
tion to build awareness concerning issues facing commu-
nity nutrition globally.
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