[Paleopsych] NYT: As America Gets Bigger, the World Does, Too

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Health > Fitness & Nutrition > As America Gets Bigger, the World Does, Too
    By [1]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
    young people.

    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,
    she said.

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