Nutrition change strategies: the new frontier

Objective: To advance understanding of nutrition change dynamics and strategies needed to tackle complex global nutrition challenges. Design: Two frameworks, a descriptive framework of orders of change and a change model (Theory U), are introduced to advance understanding of how to promote effective action on a complex social problem like nutrition. The descriptive framework explores the types of change pursued by four current global nutrition initiatives and the strategies they use to achieve their goals. Theory U provides a conceptual model to help understand breakthrough or transformative change, i.e. change that shifts the entire system. Setting: The focus is on global and regional nutrition initiatives. Results: Using the criteria of desired outcomes, purpose, participation and process, the orders of change framework categorizes programme strategies according to the levels of change likely to be achieved. Such a framework can help to structure conversations among actors about prerequisites for, and the likelihood of, transformative change. Theory U provides a conceptual framwork to facilitate transformative change by providing insight into change processes and levers for action. Conclusions: Nutrition is a complex social issue, and not only a biological or technical challenge. But nutritionists seldom inquire into the nature of changes required to achieve goals or the processes through wihch change occurs. Lack of understanding and failure to address such change processes directly mean that nutrition policies and programmes continue to fall short. There is a need to understand the dynamics of change in nutrition; to learn from current change experiences; and to create dynamic learning communities.