A global commission led by a prominent Kiwi health researcher wants leaders to take a hard line against "Big Food" in tackling the joint pandemics of obesity, undernutrition and climate change.
Its key recommendation was to launch a new global treaty on food systems that limited the political influence of powerful commercial interests.
Malnutrition in all its forms, including undernutrition and obesity, was by far the biggest cause of ill-health and premature death globally.
Both undernutrition and obesity were expected to be made significantly worse by climate change.
Over the past two decades, obesity, undernutrition and climate change had been viewed as separate.
The commission also found that policy responses had been unacceptably slow due to reluctance of policy makers to implement effective policies, powerful opposition by vested commercial interests, and a lack of demand for change from the public.
"The exact same policy inertia applies to obesity and climate change – known, evidence-backed, widely agreed policies are not being implemented because of policy inertia due to industry opposition, government reluctance and public apathy," Swinburn said.
Undernutrition was also declining too slowly to meet global targets, and no country had reversed its obesity epidemic, and comprehensive policy responses to the threat of climate change had barely begun.
"Until now, undernutrition and obesity have been seen as polar opposites of either too few or too many calories," Swinburn said.
"In reality, they are both driven by the same unhealthy, inequitable food systems, underpinned by the same political economy that is single-focused on economic growth, and ignores the negative health and equity outcomes.
"Climate change has the same story of profits and power ignoring the environmental damage caused by current food systems, transportation, urban design and land use."
Swinburn said the dichotomy of "too few calories versus too many calories" led to separate programmes and policies to patch each of them up.
"A focus on food quality and variety and re-orienting the systems towards healthy and sustainable food rather than ultra-processed foods and agriculture that is damaging the environment is needed," he said.
"Adding in climate change may make the problem seem too big - but it may also allow us to see the double or triple duty actions that address obesity, undernutrition and climate change."
Among the actions recommended, the commission called for the establishment of a new framework - similar to global conventions for tobacco control and climate change – to restrict the influence of the food industry.
Economic incentives had to be redesigned, with trillions of dollars in government subsidies to fossil fuel and large agricultural businesses globally redirected towards sustainable, healthy, environmentally friendly activities.
Further, the commission said a billion-dollar, global philanthropic fund should be set up to support civil society in advocating for change.
"We need to reduce vested interest power over policymaking, fortify governments and lift the voice and pressure from civil society for action."
At home, Swinburn said New Zealand could be drawing on its strengths of being a small, smart, wealthy and innovative nation, with a government serious on climate change and reducing inequities.
But New Zealand had its challenges: while being our biggest export earner, food remained the biggest cause of ill health and premature death, a major cause of inequities, and accounted for half our greenhouse gas emissions.
Swinburn argued there was still far too much commercial influence on government policy development, and little international consensus on how to include agricultural emissions in emissions reduction policies.
New Zealand could make strides by thinking about obesity and climate change together, so the underlying causes were obvious; develop sustainable dietary guidelines and invest in educating consumers about healthy, sustainable diets; lead the world on policy approaches to include agriculture in emissions reduction efforts; and have a minister overseeing food in all its dimensions.
Further, Swinburn said, the Government should curb commercial influence, invest more in public transport, apply its "Wellbeing Budget" concept more widely, and include the costs of the damage that harmful products do to health and the environment into the sale price.