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Obesity rising to alarming levels around the world
FEATURE
Obesity rising to alarming levels around the world
1412
Technology has also advanced in factories and in agriculture, so that much less intensive physical labour is needed for productivity. In some countries, improved transportation systems and high pollution levels also contribute to decreased activity.
Rights were not granted to include this image in electronic media. Please refer to the printed journal. Obesity epidemic is spreading
Among middle-class workers, computers and television soak up many sedentary hours a day, and email has signalled the end of message-carrying and getting up to talk to colleagues. Given that a decrease in activity equivalent to only 10 kcal a day can add a pound in weight a year, these shifts can be significant. Such small imbalances as these between energy intake and expenditure are enough to explain the epidemic, says Reynoldo Martorell (Emory University, Atlanta, GA), but current methods of measurement could be too imprecise to detect them. “Serial data of these types do not exist in most settings”, he said. Incidence and prevalence data are being collected in a number of research surveys. The results show that more than half the world’s cases of diabetes newly diagnosed every day come from India and China. Some 50% of Egyptian women are overweight, and Egypt now has a diabetes rate equal to that of the USA. Diabetes is also just as high in Mexico, where the rapidity of the increase in obesity has been remarkable, according to Martorell. He highlighted a report by Juan Rivera of Mexico’s National Institute of Public Health, which showed that overweight and obesity among Mexican women was 35·2% and 24·4%, respectively. Martorell noted that “what was also remarkable is that these increases took place across the fabric of society at nearly equal rates, in all regions of the country, including the indigenous south, in urban and rural areas, and in low, middle, and high socioeconomic groups”. Even in some of the poorest countries of sub-Saharan Africa, such as
Panos Pictures
he “nutrition transition” is a rather benign-sounding name for a striking and fast-moving phenomenon: a global epidemic of obesity. Long considered a by-product of modern life in rich, developed countries, obesity is spreading into developing countries as well, creating what Gail Harrison (School of Public Health, University of California, Los Angeles) refers to as “the worst of both worlds—the double burden of incompletely solved undernutrition and the rapidly emerging epidemic of obesity and related diseases”, including diabetes, hypertension, cancer, and cardiovascular disease. Blame for this situation has often been laid at the feet of “globalisation”, but Barry Popkin, an economist and nutrition epidemiologist (University of North Carolina, Chapel Hill), told The Lancet that the proliferation of high-sugar, high-fat products from the Coca-Colas and McDonalds of the world could be the cause in some countries but is not the main underlying cause of the worldwide trend. For example, China has seen a tripling of overweight among men in the past 8 years, and a doubling among women, with hypertension rates similar to those in the USA. But while there are about 80 McDonalds in Beijing alone, Popkin said, only a very small percentage of the total daily intake there comes from foods prepared outside the home. Increasing global access to fast food thus accounts for only a tiny fraction of an enormous problem. More likely culprits come from complex developments in food supply, processing, and manufacturing. Long-term agricultural and trade policies of the USA, South Africa, and other countries have led to low prices for the export of sugar, which manufacturers happily and cheaply add to foods to make them taste better. And new technologies, developed during the 1950s to 1970s, enabled the extraction of edible oils from a variety of seeds, including corn, soy, and cotton. In Asian and African countries, extra calories added to the daily diet come largely from these oils. These changes, “part of a shift in food technology”, Popkin said, which have made food cheaper, more available, and more plentiful, are coupled with “a basic desire of human existence”, to work less and have more leisure time. Equally important in this shift toward increased obesity is the technology of work and leisure.
T
Tanzania, the incidence of obesity and diabetes is rising. And since these countries cannot afford to provide the drugs and medical care needed to treat these problems, the underlying environmental changes must be understood so governments can engage in large-scale changes in the ways people work and eat. And working adults are not the only ones at risk. Obesity in schoolchildren is also rising rapidly. Osman Galal, Secretary General of the International Union of Nutritional Sciences (School of Public Health, University of California, Los Angeles), said he has observed high rates of obesity in children in Egypt, where consumption of edible oils, subsidised by the government, is high. Furthermore, expansion of the school day has meant cutbacks in time for recreation and physical activity. And even if there were time, there is no space: sports and play areas have given way to buildings. Where Galal went to medical school, real estate once occupied by swimming pools, running tracks, and basketball courts has been taken over by laboratories and other facilities. Galal wants to raise awareness of the need to get moving, and, especially among teachers, of the links between nutrition and academic performance. He has learned that teachers have little understanding of the relation between nutrition and cognitive function, so he has created a programme for them. “We don’t want to educate them to be nutritionists”, he said. “We just want them to be aware of these relationships.” Paralleling the campaign for teachers is a school lunch programme, which has three basic functions: it compensates for nutritional deficiencies, of course, but it is also a laboratory for teaching children about nutrition, and it gives them a diet that protects them not only from obesity, but also from cardiovascular disease, hypertension, and diabetes. As Galal noted, “obesity is a first step, a gateway, to the rest of the chronic diseases”. Some prevention programmes have been successful. But Harrison warned that although “prevention strategies have to be locally tailored, a common agenda for prevention on a global basis, with the associated development of policy, expertise, and infrastructure, is essential”. Faith McLellan
THE LANCET • Vol 359 • April 20, 2002 • www.thelancet.com
For personal use. Only reproduce with permission from The Lancet Publishing Group.
Obesity rising to alarming levels around the world
1412
Technology has also advanced in factories and in agriculture, so that much less intensive physical labour is needed for productivity. In some countries, improved transportation systems and high pollution levels also contribute to decreased activity.
Rights were not granted to include this image in electronic media. Please refer to the printed journal. Obesity epidemic is spreading
Among middle-class workers, computers and television soak up many sedentary hours a day, and email has signalled the end of message-carrying and getting up to talk to colleagues. Given that a decrease in activity equivalent to only 10 kcal a day can add a pound in weight a year, these shifts can be significant. Such small imbalances as these between energy intake and expenditure are enough to explain the epidemic, says Reynoldo Martorell (Emory University, Atlanta, GA), but current methods of measurement could be too imprecise to detect them. “Serial data of these types do not exist in most settings”, he said. Incidence and prevalence data are being collected in a number of research surveys. The results show that more than half the world’s cases of diabetes newly diagnosed every day come from India and China. Some 50% of Egyptian women are overweight, and Egypt now has a diabetes rate equal to that of the USA. Diabetes is also just as high in Mexico, where the rapidity of the increase in obesity has been remarkable, according to Martorell. He highlighted a report by Juan Rivera of Mexico’s National Institute of Public Health, which showed that overweight and obesity among Mexican women was 35·2% and 24·4%, respectively. Martorell noted that “what was also remarkable is that these increases took place across the fabric of society at nearly equal rates, in all regions of the country, including the indigenous south, in urban and rural areas, and in low, middle, and high socioeconomic groups”. Even in some of the poorest countries of sub-Saharan Africa, such as
Panos Pictures
he “nutrition transition” is a rather benign-sounding name for a striking and fast-moving phenomenon: a global epidemic of obesity. Long considered a by-product of modern life in rich, developed countries, obesity is spreading into developing countries as well, creating what Gail Harrison (School of Public Health, University of California, Los Angeles) refers to as “the worst of both worlds—the double burden of incompletely solved undernutrition and the rapidly emerging epidemic of obesity and related diseases”, including diabetes, hypertension, cancer, and cardiovascular disease. Blame for this situation has often been laid at the feet of “globalisation”, but Barry Popkin, an economist and nutrition epidemiologist (University of North Carolina, Chapel Hill), told The Lancet that the proliferation of high-sugar, high-fat products from the Coca-Colas and McDonalds of the world could be the cause in some countries but is not the main underlying cause of the worldwide trend. For example, China has seen a tripling of overweight among men in the past 8 years, and a doubling among women, with hypertension rates similar to those in the USA. But while there are about 80 McDonalds in Beijing alone, Popkin said, only a very small percentage of the total daily intake there comes from foods prepared outside the home. Increasing global access to fast food thus accounts for only a tiny fraction of an enormous problem. More likely culprits come from complex developments in food supply, processing, and manufacturing. Long-term agricultural and trade policies of the USA, South Africa, and other countries have led to low prices for the export of sugar, which manufacturers happily and cheaply add to foods to make them taste better. And new technologies, developed during the 1950s to 1970s, enabled the extraction of edible oils from a variety of seeds, including corn, soy, and cotton. In Asian and African countries, extra calories added to the daily diet come largely from these oils. These changes, “part of a shift in food technology”, Popkin said, which have made food cheaper, more available, and more plentiful, are coupled with “a basic desire of human existence”, to work less and have more leisure time. Equally important in this shift toward increased obesity is the technology of work and leisure.
T
Tanzania, the incidence of obesity and diabetes is rising. And since these countries cannot afford to provide the drugs and medical care needed to treat these problems, the underlying environmental changes must be understood so governments can engage in large-scale changes in the ways people work and eat. And working adults are not the only ones at risk. Obesity in schoolchildren is also rising rapidly. Osman Galal, Secretary General of the International Union of Nutritional Sciences (School of Public Health, University of California, Los Angeles), said he has observed high rates of obesity in children in Egypt, where consumption of edible oils, subsidised by the government, is high. Furthermore, expansion of the school day has meant cutbacks in time for recreation and physical activity. And even if there were time, there is no space: sports and play areas have given way to buildings. Where Galal went to medical school, real estate once occupied by swimming pools, running tracks, and basketball courts has been taken over by laboratories and other facilities. Galal wants to raise awareness of the need to get moving, and, especially among teachers, of the links between nutrition and academic performance. He has learned that teachers have little understanding of the relation between nutrition and cognitive function, so he has created a programme for them. “We don’t want to educate them to be nutritionists”, he said. “We just want them to be aware of these relationships.” Paralleling the campaign for teachers is a school lunch programme, which has three basic functions: it compensates for nutritional deficiencies, of course, but it is also a laboratory for teaching children about nutrition, and it gives them a diet that protects them not only from obesity, but also from cardiovascular disease, hypertension, and diabetes. As Galal noted, “obesity is a first step, a gateway, to the rest of the chronic diseases”. Some prevention programmes have been successful. But Harrison warned that although “prevention strategies have to be locally tailored, a common agenda for prevention on a global basis, with the associated development of policy, expertise, and infrastructure, is essential”. Faith McLellan
THE LANCET • Vol 359 • April 20, 2002 • www.thelancet.com
For personal use. Only reproduce with permission from The Lancet Publishing Group.