[Paleopsych] NYT: As America Gets Bigger, the World Does, Too
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Tue Apr 19 13:08:43 UTC 2005
Health > Fitness & Nutrition > As America Gets Bigger, the World Does, Too
By JANE E. BRODY
[My BMI is 19 and so I'm not worried.]
It's no secret that Americans are overweight. But obesity is a
growing problem worldwide, even in countries whose populations have in
the past been enviably lean, as new research reports make clear.
In China, for example, about 18 million adults are obese and another
137 million are overweight, according to a study of 16,000 people
published last week in The Lancet. Another report, in The New England
Journal of Medicine, noted that in developing countries, "as many as
60 percent of households with an underweight family member also have
an overweight one."
In a recent report, the World Health Organization warned of "an
escalating global epidemic of overweight and obesity - 'globesity.' "
"In 1995, there were an estimated 200 million obese adults worldwide
and another 18 million under-5 children classified as overweight," the
report said. "As of 2000, the number of obese adults has increased to
over 300 million."
The W.H.O. finds itself struggling to develop a global strategy to
counter obesity, even as it tries to combat the hunger and
undernutrition that remain a major concern in much of the world. In
the next few years, the organization estimates, noncommunicable
diseases that are related to diet, physical inactivity and consequent
obesity, like heart disease, stroke, diabetes and hypertension, will
become the principal causes of disease and death globally.
The organization's International Obesity Task Force, whose chairman is
Dr. W. Philip T. James of London, maintains that different strategies
will be needed in different countries, but that failing to develop
effective national strategies will ultimately result in economically
disastrous health crises.
The obesity issue is not limited to industrialized countries. "In
developing countries, it is estimated that over 115 million people
suffer from obesity-related problems," the W.H.O. has noted.
In fact, recently published data suggest that there is hardly a
country in the world outside sub-Saharan Africa in which the average
body-mass index, or B.M.I., an indication of fatness, has not been
rising to levels that increase the risk of serious chronic diseases.
In Asia, this rise in fatness, though hardly to the level that has
occurred in the United States, is threatening to cause a major
epidemic of Type 2 diabetes, according to information presented in
Minneapolis last fall at an international symposium on obesity. The
Lancet report found high rates of major risk factors for
cardiovascular disease in Chinese adults.
Worldwide, rising weight is becoming one of the most important risk
factors for chronic disease and rising health care costs.
In the Britain, for example, obesity now accounts for 18 million sick
days, 30,000 deaths a year, 9 lost years of life expectancy and an
added annual cost of almost $1 billion to the National Health Service,
Dr. Jacob C. Seidell, professor of nutrition and health at the Free
University of Amsterdam, reported at the Minneapolis symposium.
In many countries, the worst increases in obesity have occurred in
While fewer than 1 percent of the children in Africa suffer from
malnutrition, for example, 3 percent are overweight or obese,
according to Dr. Francine Kaufman, a pediatric endocrinologist at
Children's Hospital Los Angeles.
Perhaps the most distressing data come from Asia, where the measure of
being overweight used in Western counties may underestimate the
seriousness of weight-related health problems faced by Asians.
In Japan, for example, obesity is defined as an index level of 25 or
more, not 30 as it is in Western countries. But Japanese health
officials report that a B.M.I. of 25 or more is already causing high
rates of diabetes. At a level of 30 or higher, most of the population
would have diabetes, Japanese health officials told Dr. Seidell.
According to Dr. Kaufman, "By 2010 more than half the people in the
world with diabetes will be Asians."
Traditionally, in developing countries, the poorest people have been
the thinnest, a consequence of hard physical labor and the consumption
of small amounts of traditional foods. But when people in poor
countries migrate to cities, obesity rates rise fastest among those in
the lowest socioeconomic group, Dr. Seidell reported.
Dr. Mickey Chopra, public health specialist at the University of
Western Cape, South Africa, attributes the rise in obesity in
middle-income and lower-income countries to dietary shifts "toward
highly refined foods and toward meat and dairy products containing
high levels of saturated fats, together with reduced energy
In other words, as people in developing countries trade their
traditional diets, heavily based on vegetables and grains, for
processed and animal foods, and expend less energy to move themselves
and do their daily work, it is all too easy to overconsume calories.
China is a prime example. Urbanization has led to changes in diet and
increasingly sedentary lives, replete with sugary soft drinks, cheap
vegetable oils, motorized vehicles and televisions in the home. In the
last eight years, the proportion of Chinese men classified as
overweight, with a body mass index over 25, has risen to 15 percent
from 4 percent, and the proportion of overweight Chinese women has
doubled to 20 percent from 10 percent.
"Dietary transitions that took more than five decades in Japan have
occurred in less than two decades in China," Dr. Chopra wrote in The
Bulletin of the World Health Organization.
He attributed this rapid shift largely to the growth of multinational
food companies that have added sugar, fats and oils to agricultural
products. The market value of these processed foods is now three times
as great as the farm value, and foreign exports to countries like
China represent a major source of income and growth for food
Similar trends have been noted elsewhere. "Mexicans now drink more
Coca-Cola than milk," Dr. Chopra noted.
Dr. Adam Drewnowski, director of the Center for Public Health
Nutrition at the University of Washington, said, "Food is becoming
globally cheaper, and what's becoming cheapest is calories,"
especially calories from sugar and fat.
In Brazil, for example, "It costs a mere 4 cents to produce a pound of
sugar," Dr. Drewnowski said. "You can consume 50,000 empty sweet
calories for just $1."
In Asia, he noted, foods are being "drenched in oil."
Oil makes food taste better and people are "naturally predisposed
through evolution to select and consume energy-dense foods," he said.
Since more nutritious, less energy-dense foods, like salads, fruits
and vegetables, tend to be more expensive, to help stem the growing
epidemic of global obesity, subsidies for vegetables and fruits and
international campaigns to promote their consumption are needed, he
At the same time that caloric consumption is rising, activity levels
are falling. For example, Dr. Drewnowski said: "In Vietnam 20 years
ago, people got around on foot. Five years ago they used bicycles. Now
they're using motorcycles and scooters, and five years from now these
will be replaced by cars."
Dr. Shiriki Kumanyika, an epidemiologist at the University of
Pennsylvania, said not enough attention was being paid to the decline
in physical activity, especially in developing countries. As the
amount of activity required for daily routines declines, she said, it
is easy to miscalculate food intake by as much as 1,000 calories a
day, especially for people in developing countries who migrate to
urban areas where the cheapest foods are calorically dense.
Still, Dr. Kumanyika told the symposium, rising levels of obesity
worldwide cannot be blamed on just one or two factors. Certain global
factors "are difficult to control even at the national level," like
the globalization of markets and industrial development, which changes
how people earn a living and who produces foods and prepares meals,
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