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Michelle Holdsworth

Michelle Holdsworth
IRD- French National Research Institute for Development

Professor
Professor Michelle Holdsworth is currently a Research Director at the IRD, Montpellier, France

About

187
Publications
95,379
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12,357
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Introduction
Prof. Holdsworth has >20 years postdoctoral experience of interdisciplinary research working with partners in the Global South, particularly at the interface between nutrition, public health and social/policy sciences and has published >100 peer reviewed publications and 4 books. Her research uses a range of methods to identify public health policies/interventions that will work best to promote healthy food environments that prevent multiple forms of malnutrition

Publications

Publications (187)
Article
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Background The double burden of malnutrition (DBM) during adolescence is associated with growth and developmental impairment and risk of non-communicable diseases. There is limited evidence on adolescent’s dietary patterns (DPs), and how they contribute to DBM in urban low income contexts in sub Saharan Africa. This study assessed DPs of adolescent...
Article
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Background The Ghana School Feeding Programme (GSFP) provides public primary school pupils with a free daily meal. Each meal is expected to follow set menus, providing 30% of children’s’ (6-12 years) energy requirements. This study assessed the nutritional quality and diversity of planned and provided GSFP meals, engaging school caterers to identif...
Preprint
Full-text available
Background: Marketing of ultra-processed foods (UPFs) can influence purchase intentions and consumption of such foods, especially among children. There is limited evidence on the extent to which UPFs are marketed around schools in low- and middle-income countries (LMICs), including Kenya. We assessed the extent, content, and type of advertising of...
Conference Paper
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Complementary feeding is crucial to promote healthy nutrition in infant and young children (IYC) and prevent malnutrition. Mothers, families, and healthcare professionals (HCPs) are crucial in helping IYC develop healthy eating habits. However, limited access to adequate nutritional information and health services impacts children’s nutrition, espe...
Article
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National lockdowns and containment measures to control the spread of COVID-19 led to increased unemployment, lower household incomes and reduced access to affordable and nutritious foods globally. This study aimed to examine changes and correlates of household food insecurity experience and mitigation strategies adopted in peri-urban Peru during th...
Article
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Multiple forms of malnutrition coexist in infants and young children (IYC) in Peru. The World Health Organization has proposed double-duty actions (DDAs) to simultaneously address undernutrition and overweight/obesity. We assessed current implementation of- and priority for- government-level actions to tackle multiple forms of malnutrition in IYC i...
Preprint
Full-text available
Background The Ghana School Feeding Programme (GSFP) provides public primary school pupils a free daily meal. Each meal is expected to follow set menus to provide 30% of recommended dietary allowance for children (6-12y). This study assesses the nutritional quality and diversity of GSFP meals planned at the district level and provided at the school...
Article
Full-text available
Introduction Nutrition during the complementary feeding period (6–23 months) is critical to ensure optimal growth and reduce the risk of diet-related disease across the life course. Strategies to reduce multiple forms of malnutrition (stunting, overweight/obesity and anaemia) in infants and young children (IYC) are a key priority in low-income and...
Article
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Objective This study assessed stakeholder readiness to address unhealthy food and beverage marketing and availability in/around Public Basic Schools (for children 4–15 years) in Greater Accra Region, the highly urbanised administrative capital of Ghana. Design The community readiness model was used to conduct in-depth mixed methods interviews with...
Article
Multiple forms of malnutrition coexist in Peru, especially in peri-urban areas and poor households. We investigated the magnitude of, and the contribution of, dietary and socio-demographic factors to the double burden of malnutrition (DBM) at maternal (i.e., maternal overweight/obesity with anaemia) and dyad (i.e., maternal overweight/obesity with...
Article
The paper is a revised version of a research brief produced for the World Food Summit as Moustier, P., Holdsworth, M., Dao The Anh, Pape Abdoulaye Seck, Renting, H., Caron, P., Bricas,N. 2021. Priorities for urban food systems transformations in the global South. United Nations Food Systems Summit 2021 Scientific Group. This brief will be published...
Chapter
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This chapter is concerned with identifying: (i) challenges to food systems in Africa, Asia, and Latin America caused by urban development, (ii) how existing food systems respond to these challenges, and (iii) what can be done to improve their responsiveness. The chapter is based on the authors’ published research complemented by additional literatu...
Article
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Non-communicable diseases (NCDs) disproportionately affect African migrants from subSaharan Africa living in high-income countries. Evidence suggests this is largely driven by forces that include migration, globalisation of unhealthy lifestyles (poor diet, physical inactivity and smoking), unhealthy food environments, socioeconomic status and popul...
Article
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Background Consumption of unsafe foods increases morbidity and mortality and is currently an issue, particularly in low- and middle-income countries. Policy actions to ensure food safety are dominated by mitigation of biological and chemical hazards through supply-side risk management, lessening the degree to which consumer perspectives of food saf...
Article
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Aim This study assesses community readiness to prevent overweight/obesity among Ghanaian immigrants in Greater Manchester, England. Subject and method The Community Readiness Model (CRM) was applied using a semi-structured interview tool with 13 key informants (religious and other key community members) addressing five readiness dimensions. A maxi...
Article
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Background Intake of unhealthy foods is linked to the onset of obesity and diet-related non-communicable diseases (NCDs). Availability of unhealthy (nutritionally poor) foods can influence preference, purchasing and consumption of such foods. This study determined the healthiness of foods sold at modern retail outlets- supermarkets and mini-marts i...
Article
Background: Africa is contending with unhealthy food environments that are, in part, driving increasing rates of overweight, obesity and diet-related non-communicable diseases, alongside persistent undernutrition. This current paradigm requires expanded efforts - both in the volume and nature of empirical research, as well as the tools and capacit...
Article
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Objective: To explore communities' perspectives on the factors in the social food environment that influence dietary behaviours in African cities. Design: A qualitative study using participatory photography (Photovoice). Participants took and discussed photographs representing factors in the social food environment that influence their dietary b...
Article
Full-text available
Introduction The advertising of energy-dense, nutrient-poor foods and beverages is a common feature in obesogenic food environments. Such advertising, within and around settings where children live, learn, and play, negatively affects their food acquisition and consumption. We examined the extent and nature of food and beverage advertising around p...
Article
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Evidence on the individual-level drivers of dietary behaviours in deprived urban contexts in Africa is limited. Understanding how to best inform the development and delivery of interventions to promote healthy dietary behaviours is needed. As noncommunicable diseases account for over 40% of deaths in Ghana, the country has reached an advanced stage...
Article
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Objective Unhealthy diets resulting in overweight and obesity and diet-related non-communicable diseases are of increasing concern in Ethiopia, alongside persistent undernutrition, and have been linked to unhealthy food environments. Little is known about the policy response to unhealthy food environments in Ethiopia. The objective of this study wa...
Article
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Background Malnutrition affects many adolescents in Ethiopia. Over one-third of adolescent girls and two-thirds of boys are thin. Overweight and obesity in Ethiopia is mostly a concern in urban populations of higher wealth quintiles. Urbanization and globalization of diets is shifting food environments. The objective of this study was to assess whe...
Article
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Food-based dietary guidelines (FBDGs) are important tools for promoting healthy eating and nutrition education at the population level. Currently, more than 100 countries worldwide have developed FBDGs with majority of existing FBDGs in high-income countries. However, there are a few countries in Africa which have developed FBDGs. This review descr...
Article
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The COVID-19 pandemic may impact diet and nutrition through increased household food insecurity, lack of access to health services, and poorer quality diets. The primary aim of this study is to assess the impact of the pandemic on dietary outcomes of mothers and their infants and young children (IYC) in low-income urban areas of Peru. We conducted...
Article
Over the last two decades, many African countries have undergone dietary and nutrition transitions fueled by globalization, rapid urbanization and development. These changes have altered African food environments and subsequently, dietary behaviors, including food acquisition and consumption. Dietary patterns associated with the nutrition transitio...
Article
Full-text available
Over the last two decades, many African countries have undergone dietary and nutrition transitions fueled by globalization, rapid urbanization and development. These changes have altered African food environments and subsequently, dietary behaviors, including food acquisition and consumption. Dietary patterns associated with the nutrition transitio...
Article
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Both food safety and dietary behaviors are major contributors to the global burden of disease, especially in rapidly urbanising environments. The impact that food safety concerns have on dietary behaviors in low- and middle-income countries (LMICs) is insufficiently documented. Therefore, we examined whether food safety concerns influence consumer...
Article
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Multiple recent global nutrition initiatives have recommended actions to transform food systems to improve food environments and food choice. This study aimed to identify actions recommended by these initiatives and understand their similarities and differences. Twelve global nutrition initiatives were reviewed, collectively spanning 13 action them...
Article
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We identified factors in the physical food environment that influence dietary behaviours among low-income dwellers in three African cities (Nairobi, Accra, Ho). We used Photovoice with 142 males/females (≥13 years). In the neighbourhood environment, poor hygiene, environmental sanitation, food contamination and adulteration were key concerns. Econo...
Article
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Background: This study describes the rationale, adaptation, and final protocol of a project developed to address the increase in obesity and nutrition-related non-communicable diseases (NR-NCDs) in Ghana. Code-named the Measurement, Evaluation, Accountability, and Leadership Support for NCDs (MEALS4NCDs) project, it aims to measure and support publ...
Article
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Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30...
Research
The objective of the present review was two-fold: i. to provide an overview of the current state of the art of the concept of “evidence-informed decision-making” (EIDM) for nutrition policy through an understanding of what is meant by “evidence” in nutrition science (in contrast with public health or medical “evidence”), and ii. to explore the epis...
Technical Report
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Food environments – the interface between people and the food system – play a critical role in shaping what we eat. Yet, they typically fail to make nutritious food a reality for most people. Consequently, to improve diets and nutrition-related health outcomes, there is an urgent need for policies and related actions to radically improve these food...
Article
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This study developed, validated, and evaluated a framework of factors influencing dietary behaviours in urban African food environments, to inform research prioritisation and intervention development in Africa. A multi-component methodology, drawing on concept mapping, was employed to construct a framework of factors influencing dietary behaviours...
Article
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From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in di...
Article
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From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in di...
Article
Full-text available
Objective To synthesise evidence on body size preferences for females living in Africa and the factors influencing these. Design Mixed-methods systematic review including searches on Medline, CINHAL, ASSIA, Web of Science and PsycINFO (PROSPERO CRD42015020509). A sequential-explanatory approach was used to integrate quantitative and qualitative fi...
Article
Full-text available
Background: Obesity and nutrition-related non-communicable diseases (NR-NCDs) are increasing throughout Africa, driven by urbanisation and changing food environments. Policy action has been limited - and influenced by high income countries. Socio-economic/political environments of African food systems must be considered in order to understand what...
Article
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This systematic review synthesized the qualitative evidence on factors influencing obesogenic behaviours in adolescent girls and women of reproductive age in low-and middle-income countries (LMICs). This qualitative evidence synthesis followed the framework synthesis approach to extract, analyse and synthesize data. Electronic searches were conduct...
Article
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Background Healthy and sustainable dietary practices offer a possible solution to competing tensions between health and environmental sustainability, particularly as global food systems transition. To encourage such dietary practices, it is imperative to understand existing dietary practices and factors influencing these dietary practices. The aim...
Article
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In sub-Saharan Africa (SSA), rapid urbanisation coupled with the high prevalence of infant and young child (IYC) undernutrition in low-income settings means that interventions to support IYC nutrition are a priority. Little is known about how urbanisation influences IYC feeding (IYCF) practices, and evidence-based interventions to improve IYC healt...
Article
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Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled ana...
Article
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Growing urbanisation in Africa is accompanied by rapid changes in food environments, with potential shifts towards unhealthy food/beverage consumption, including in socio-economically disadvantaged populations. This study investigated how unhealthy food and beverages are embedded in everyday life in deprived areas of two African countries, to ident...
Preprint
Full-text available
Background Like most other countries, Ghana is experiencing an increase in obesity and nutrition-related non-communicable diseases (NR-NCDs). The need to adopt effective and comprehensive interventions/approaches to address this burden at global, regional, and national levels has been recognized. However, there is limited contextualized evidence on...
Article
Full-text available
Objective To assess factors influencing dietary behaviours of adolescents in Addis Ababa, Ethiopia. Design Using the qualitative participatory method Photovoice, participants received training on the basics of Photovoice and took photographs related to (un)healthy eating in their environment. Transcripts of individual interviews, focus group discu...
Article
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Introduction Unhealthy food environments drive the increase of diet-related non-communicable diseases (NCDs). Objective We aimed to examine healthy food environment policies in Kenya and identify priorities for future action. Methods Using the Healthy Food Environment Policy Index (Food-EPI) we collected evidence on the extent of government actio...
Article
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Objectives The aim of this study was to characterise the local foods and beverages sold and advertised in three deprived urban African neighbourhoods. Design Cross-sectional observational study. We undertook an audit of all food outlets (outlet type and food sold) and food advertisements. Descriptive statistics were used to summarise exposures. La...
Article
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Objective To identify factors influencing dietary behaviours in urban food environments in Africa and identify areas for future research. Design We systematically reviewed published/grey literature (protocol CRD4201706893). Findings were compiled into a map using a socio-ecological model on four environmental levels: individual, social, physical a...
Article
Full-text available
Nutrition-related non-communicable diseases (NR-NCDs) are a global health problem, increasingly recognised as driven by unhealthy food environments. Yet little is known about government action to implement food environment-relevant policies, particularly in low-and lower-middle income countries. This study assessed government action, implementation...
Article
Dietary change is needed to improve health and reduce the environmental burden of food production and consumption. Using an Intervention Mapping approach, this study aimed to explore the views caterers and customers held towards point-of-choice interventions that promote healthy and environmentally friendly (EF) food and beverage choices at the Uni...
Article
The importance of nutrition in the prevention and treatment of disease and the maintenance of good health is being increasingly recognised. Nutrition is an area that all health professionals need to be aware of and yet one in which few are specifically trained. However it is now becoming a valued topic in many curricula. The Oxford Handbook of Nutr...
Article
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Objective To synthesise evidence of urban dietary behaviours (macronutrients, types of foods, dietary diversity and dietary practices) in two African countries in relation to postulated changes in the context of nutrition transition. Design Systematic review and meta-analyses, including six online databases and grey literature, 1971–2018 (Protocol...
Article
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Objective: This study examined the role of migration and acculturation in the diet of Ghanaian migrants in Europe by (1) comparing food intake of Ghanaian migrants in Europe with that of Ghanaians living in Ghana and (2) assessing the association between acculturation and food intake. Design: Data from the cross-sectional multicenter study Resea...
Article
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The threat of climate change and population growth has led to calls for the adoption of environmentally sustainable diets; however, concerns have been raised over the nutritional quality of low Greenhouse Gas Emission (GHGE) diets. This study examined the relationship between measures of environmental sustainability and nutrient content of sandwich...
Article
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Background Ghana has reached an advanced stage of nutrition transition, contributing to an increase in nutrition-related non-communicable diseases, particularly amongst urban women. Community involvement is an important factor in the success of efforts to promote healthy eating. The readiness of populations to accept a range of interventions needs...
Technical Report
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Like other African countries, Kenya is experiencing rapid urbanisation, accompanied by increasing levels of obesity and other diet-related non-communicable diseases (NCDs); with higher levels among urban residents and women in particular. The overconsumption of unhealthy diets that are energy-dense and nutrient-poor is implicated in the onset of di...
Article
In the UK, ethnic minority groups tend to have higher levels of poverty than the white British population and therefore may be at high risk of food insecurity. Ghanaians, living in Ghana or as migrants are thought to have a high level of social support in their communities, but the role of this resource in relation to food security is unknown. We e...
Article
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Uganda is undergoing dietary transition, with possible environmental sustainability and health implications, particularly for women. To explore evidence for dietary transitions and identify how environmentally sustainable women’s dietary patterns are, principal component analysis was performed on dietary data collected using a 24 h recall during th...
Article
Africa is currently experiencing rapid urbanisation impacting on people's food environments and dietary habits. Such changes are associated with higher prevalence of obesity coexisting with undernutrition. The present paper provides an overview of the healthiness of African urban food environments. We discuss the ways that food environments can be...
Conference Paper
Africa is currently experiencing rapid urbanisation impacting on people's food environments and dietary habits. Such changes are associated with higher prevalence of obesity coexisting with undernutrition. The present paper provides an overview of the healthiness of African urban food environments. We discuss the ways that food environments can be...