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Improved human well-being is one of the modern era’s greatest triumphs. The age of plenty has also led to an unexpected global health crisis: two billion people are either overweight or obese. Developed countries have been especially susceptible to unhealthy weight gain, a trend that could be considered the price of abundance. However, developing countries are now facing a similar crisis.

Obesity rates have plateaued in high income countries but are accelerating elsewhere. The combined findings of UNICEF, the World Health Organisation and the World Bank showed that in 2016 Asia was home to half the world’s overweight children. One quarter were in Africa.

Residents of developing nation cities are increasingly susceptible to obesity, particularly amid the megatrends of urbanisation, globalisation, and industrialisation of food supply. According to India’s National Institute of Nutrition, over a quarter of urban-dwelling men and nearly half of women are overweight.

The majority of the world’s future urbanisation is projected to occur in developing countries, particularly in Asia and Africa. As rural dwellers move to urban areas, easy access to cheap and convenient processed foods lures them into unhealthy diets.

This crisis will test the political resolve of governments that have historically focused on ending hunger. These governments must understand that the factors making cities convenient and productive also make their residents prone to obesity. Intelligent, focused policies are needed to effectively manage this emerging crisis.

Urban lifestyles

Urbanites enjoy a variety of culinary options, ranging from aisles of processed goods in supermarkets to scores of short-order street vendors. Additionally, international fast food chains are flourishing in developing countries. This is shifting dietary habits away from healthier traditional fare and towards fried foods and sugary drinks.

The health risks of such diets are compounded by the sedentary lifestyles of urban dwellers. The most recent Indian nutrition survey found that city-dwelling men and women work an average of roughly eight hours a day. Most are engaged in sedentary office jobs. Only about one quarter exercise.

People’s leisure time is also being monopolised by passive diversions like television, movies, and video games in the growing number of households able to afford such technologies.

The alarming implication of these trends is that developing countries may become sick before they get rich. That sickness may, in turn, cripple health systems.

The yearly health care costs in Southeast Asia of obesity-related complications like diabetes and cardiovascular disease are already as high as US $10 billion. Obesity among China’s younger generation could cost US $724 billion in medical treatment by 2030. Such diseases are an added burden on countries already struggling to manage primary health care needs.

Policies related to taxation, urban design, education and awareness and the promotion of localised food systems may help control obesity at a lower cost than eventual medical treatment for an ageing and increasingly overweight population.

Direct interventions

Some governments have already experimented with direct interventions to control obesity, such as taxation on unhealthy foods and drinks. The US pioneered the soda tax movement. Thailand, Brunei, and Singapore have adopted similar measures. South Africa is likely to introduce a sugar tax beginning in April 2018.

Regulatory approaches have not stopped at taxation – or at sugar. In the United Kingdom, advertising rules prohibit the marketing of foods high in fat, salt and sugar to children younger than 16.

The city of Berkeley in California recognises that taxes alone are not enough to address obesity. Proceeds from the city’s sugar tax are used to support child nutrition and community health programmes. This underscores the importance of education and awareness.

There is also promise in broader-reaching initiatives. Urban design holds significant power to reshape lifestyle patterns and public health. Improving the attractiveness of public space, the “walkability” of neighbourhoods and the quality of cycling infrastructure can draw residents out of their cars and living rooms.

A recent study of urban neighbourhoods in Shanghai and Hangzhou found that middle-income residents living in less walkable neighbourhoods had significantly higher Body Mass Indices than both richer and poorer residents who lived in walkable neighbourhoods in urban China.

Finally, healthier lifestyles begin in grocery store aisles. Governments should encourage tighter connections between agricultural production systems, urban grocers and food vendors. Relationships with farmers in areas immediately adjacent to cities, in addition to the promotion of urban gardens, have been popular approaches in the US.

Such initiatives can also help urban residents better understand the mechanics of food sourcing. This raises awareness about the relationship between natural foods and healthy lifestyles. Even the preservation of culture around traditional foods can promote healthy alternatives.

Combining controls on unhealthy foods with policies that incentivise healthy eating and active lifestyles constitute a promising response to rising obesity rates. Addressing public health is a policy mandate for developing countries from both an economic and social point of view. To paraphrase the recent Global Nutrition Report, addressing obesity is a global imperative for releasing the brakes on development.

The world isn't getting smaller, it's getting fatter, according to a comprehensive report published Thursday in The Lancet.

Whether you're looking at men or women, children or adults, citizens of rich countries or poor ones, people were much more likely to be overweight or obese in 2013 than they were in 1980, the study found.

In 1980 – the year Pac-Man was unleashed on the world and John Lennon was assassinated – there were 857 million people on the planet who were either overweight or obese. Thirty-three years later, the comparable figure was 2.1 billion.It’s not just that the global population grew (and thus the number of people with too many pounds on their frames). The proportion of men who were overweight or obese rose from 28.8% in 1980 to 36.9% in 2013, while the proportion of women in that category increased from 29.8% to 38% during the same period, the report said.

In developed countries, 16.9% of boys and 16.2% of girls were overweight or obese in 1980. By 2013, those figures were 23.8% and 22.6% respectively. Even in developing countries, the prevalence of overweight and obesity among boys rose from 8.1% to 12.9% and the prevalence among girls grew from 8.4% to 13.4%, the researchers found.

All over the world, the passage of time was marked by bigger waistlines. "Successive cohorts seemed to be gaining weight at all ages, including childhood and adolescence," the researchers found. The most rapid period of weight gain came between the ages of 20 and 40.

A few extra pounds may seem harmless, but their cumulative effect is serious, public health experts say. The Centers for Disease Control and Prevention warns that being overweight or obese will increase your risk of such life-threatening conditions as coronary heart disease, Type 2 diabetes, stroke and certain types of cancer, among other problems. A 2010 study in The Lancet estimated that overweight and obesity caused 3.4 million deaths worldwide.

For the new study, dozens of researchers from around the world worked together to compile accurate statistics for 183 countries. They focused on rates of overweight (defined as a body mass index of 25 or greater) and obesity (defined as BMI of at least 30) in the years between 1980 and 2013. (The massive effort was funded by the Bill and Melinda Gates Foundation, which did not influence the study design or its findings.)  

Tonga had the dubious distinction of having a majority of the adult population considered obese. In addition, six other countries had obesity rates above 50% for women: Kuwait, Kiribati, the Federated States of Micronesia, Libya, Qatar and Samoa.

The United States earned special mention for its "high prevalence of obesity" – 31.6% of men and 33.9% of women. The researchers noted that 13% of the world's 671 million obese individuals live in the U.S. – more than any other country.

Indeed, more than half of the world's obese people lived in just 10 countries in 2013: The U.S., China, India, Russia, Brazil, Mexico, Egypt, Germany, Pakistan and Indonesia. China and India actually had "low" rates of obesity – only 3.8% of Chinese men and 5% of Chinese women were obese in 2013, along with only 3.7% of Indian men and 4.2% of Indian women. But both countries are so populous that they still came in at No. 2 and No. 3 on the worldwide list.

Perhaps this was the most depressing finding in the entire 16-page report: "No countries had significant decreases in obesity in the past 33 years."

In a commentary that accompanies the study, epidemiologist Klim McPherson wondered what it would take for the world to get serious about reining in weight gain and returning BMIs to levels to where they were 30 years ago.

"Public health efforts are leading to progress in tobacco control and cardioprotective diets in a slow and deliberate way. As a result, deaths caused by smoking-related diseases and cardiovascular diseases are decreasing," wrote McPherson, a visiting professor at the University of Oxford. "Can a similar success with weight ever happen?"

Probably not any time soon, he conceded. For policymakers, tackling obesity is like tackling climate change: Experts have a good idea of what needs to be done, but there is simply no political will to make such radical changes.

“Where is the international will to act decisively in a way that might restrict economic growth in a competitive world, for the public’s health?” McPerson wrote. “Nowhere yet, but … politicians can no longer hide behind ignorance or confusion.”






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