HOW OBESITY CAN DERAIL GROWTH IN CHINA
New York Dr. Cesar Chelala
Obesity in China, particularly in children, has become an important health concern that will seriously affect the health of future generations but also place a heavy economic burden on the country. While China’s GDP increased from US$2.75 trillion in 2005 to US$4.99 trillion in 2009, the number of obese people increased from 18 million to 100 million people, more than five times that amount, during that same period.
Of particular concern is the increasing incidence of child obesity. “China has entered the era of obesity,” Ji Chengye, a leading child-health researcher told USA Today.
To make the situation even more serious, China, as well as Vietnam, India, and many other developing countries, has to shoulder a “double burden”: the persistence of undernutrition, particularly among children in rural areas, and a rapid rise in overweight, obesity and related diseases such as cardiovascular disease, hypertension and stroke, Type II diabetes and certain forms of cancer.
Treatment for such diseases is highly expensive and is even more so because of the impact of sick people on the labor force. Obesity and its consequences accounts for a significant proportion of health care costs in most countries, and it can reach up to 7% of the total if obesity-related conditions are included in the calculations.
“What we are seeing in developing countries undergoing rapid economic transition is undernutrition, overnutrition and infectious and chronic diseases coexisting over long periods of time,” said Gina Kennedy, from the Food and Agriculture Organization (FAO).
Although the terms obese and overweight are sometimes used interchangeably, they have different meanings. Overweight is having a weight closer to normal than obese, and the difference between both terms is made using the body mass index (BMI) which is a way of determining the amount of body fat based on a person’s weight and height.
Overweight, however, is not only a problem in developing countries but in industrialized countries as well. In the USA, the number of overweight children has doubled and the number of overweight adolescents has tripled since 1980, according to the US Surgeon General.
In Chinese cities, according to official statistics, 8% of children 10- to 12-year old are considered obese and an additional 15% are overweight. A University of Southern California study carried out in 2006 found that the average body fat of Hong Kong children was 21 percent, an extremely high number.
The basic cause of obesity in children and adolescents is the energy imbalance between the calories they consume and the calories they expend through activity. But the increasing number of overweight and obese children and adolescents respond to many different causes.
There are several reasons to explain the increase in obesity in China. Traditionally, the Chinese diet included mainly cereals and vegetables, with few animal foods. As a result, the fat and sugar intake of the Chinese population remained low for a long time. However, as the country experienced an explosive economic development, fatty and sugary foods became much more widely available.
Due to the lack of knowledge in the general population of what constitutes proper nutrition, and about the harmful effects of fatty and sugary foods, their consumption has increased significantly in the last decades, and so did the problems associated with it. Because of past famines in the country, different foods, but particularly high fat foods, are now seen as a very attractive item. At the same time, consumption of cereals, fruits and vegetables has decreased.
Eating in fast food places, particularly American franchises of chains such as McDonald’s, Pizza Hut or Starbucks, where food is particularly high in fats and sugar, is becoming very attractive and is considered a status symbol. Although food in those places is expensive for Chinese standards, they offer an atmosphere of relaxation and luxury that attracts many Chinese, particularly young business people.
Attraction for fast foods is not going to disappear. Instead, a new trend is developing regarding these places. It started in Hong Kong, where McDonald’s restaurants offer what has been called “McWeddings” where they provide wedding receptions for young couples. McDonalds will open a total of 250 new restaurants this year and expects to have 2,000 restaurants across China by the end of 2013. China fast-food industry is now the fifth largest in the world.
Another important factor in the increase of obesity levels in the general population is inadequate physical activity levels as a result of increased use of TV, computers and passive leisure activities, lack of safe and adequate spaces for physical exercise, and increased motorized mode of transportation, among other factors. Cars have become not only symbols of wealth, but have led to drastically lower levels of physical activity.
To confront this problem that has so many serious implications, it is necessary to increase programs in schools aimed at cultivating healthy eating practices and teaching healthy lifestyles in children. It is also important to increase nationwide social and health programs on public nutrition through the mass media and the creation of community-based nutritional education programs.
Several countries have been experimenting with the use of fiscal measures to limit the consumption of foods high in fat, sugar and salt. Higher taxes on unhealthy foods can help improve health by changing eating habits, while at the same time generating important revenues that can be used for prevention efforts. These measures should be part of an integrated, multi-sectoral approach to deal with this problem.
The challenge for Chinese policy makers is how to develop effective programs and policies aimed at preventing and controlling what is fast becoming a serious public health problem, while at the same time allowing the population to enjoy the benefits of the country’s remarkable economic growth.
Dr. Cesar Chelala is an international public health consultant for several UN agencies and international organizations. He is also a winner of an Overseas Press Club of America Award.