French fries and fat kids – Asia’s next epidemic

Asia has a new epidemic on its hands – obesity – and the food industry should accept some of the blame. Now, governments need to respond to protect their citizens, says Roger Tatoud, but questions whether they have the courage to challenge big business.

Popular belief has it that obesity only affects wealthier societies where food is plentiful: the curse of the developed world epitomized by hulking Americans that struggle to order their king-size Big Mac, French Fries and Coke without breaking sweat.

Obesity is no longer exclusive to the developed world

The reality is a very different. Obesity and its associated diseases – diabetes, hypertension and kidney diseases – respect neither wealth nor class and strike instead into the heart of every society where there is easy access to convenience food, low physical activity and ubiquitous advertisements for sugar-fat-salt-rich food.

Heart disease, stroke, cancer and other chronic diseases associated with poor diet and low exercise have now made serious inroads into the lives of people in poor and middle-income nations. In total, these accounted for 80% (28 million) of the cases of chronic illness in 2005, according to the World Health Organisation (WHO), which fears that a further 388 million people will die from such illnesses over the next ten years.

Across South East Asia, cases of chronic disease are also high, accounting for 54% of all deaths during 2005. The situation in Thailand is particularly serious, says the WHO, which estimates that the number of obese 5-to-12 year olds increased from 12.2% to 15.6% in just two years. Obesity is generally associated with older age groups, but has yet to permeate into poorer areas where the price of convenience food associated with the epidemic is prohibitive.

China, too, has an emerging epidemic with one or two pockets of high incidence. Overall, obesity levels range from under 5% to almost 20% in some areas, according to regional surveys conducted during 2003. Most concerning, however, is high prevalence among the young. In Wuhan Province 8.9% of 10-12 year-olds were classified as obese by the study. Some areas, such as Beijing, also suggest that there is a gender perspective to the epidemic. In the capital more than 10% of 10-12 year old boys were obese – more than three times the rate for girls in the same study.

Responsibilities are divided

The existence of a genetic predisposition to obesity would provide a straight-forward explanation for the world’s growing stock of rotund individuals, but the precise causes of obesity are multiple.

Changing diets have clearly contributed to the development of the pandemic, driven by the move towards food processing that relies heavily on high injections of sugar and salt. Recent research by The Thai Health Promotion Foundation, for example, found that more than 90% of its sample of 700 pre-packed foods to contain excessive levels of sugar, fat and salt – a cocktail that can lead to diabetes and hypertension as well as obesity.

Choice, of course, enables informed individuals to avoid (or moderate their consumption of) foods that are known to have damaging health effects, but bad labelling, the study suggests, does not help in the decision-making process. Just one third of the sample in Thailand, for example, managed to provide adequate nutritional information on their packaging or list ingredients. Where available, say researchers, labels also tended to use small fonts and present information in a way that is difficult to understand. At least part of the blame, therefore, lies with the food industry itself.

Children are most at risk

For now, young Thais have refrained from overindulgence in burgers and chips on account of taste. But tastes are changing and so is the food industry. Pizza Hut (aka Pizza Company in Thailand) has already rewritten its menu to include a Tum Yum Kung (spicy prawn soup) variety. Western convenience food, which contains 3 or 4 times more fat, sugar and salt than healthier local Thai snacks, is now thought to pose one of the greatest dangers to a country of “snackers.”

Catering to oriental taste in order to boost market share is only one dimension of the corporate weaponry. Intensive marketing activity now mostly targets children and changing cultural values now mean that a visit to see Ronald McDonald has become a symbol of growing affluence and status. The price of a Big Mac in Bangkok (the equivalent of USD 1.5 or Baht 60) may cover the food costs of one meal for a family of four, but younger Thais are prepared to splash out on junk-food if it means impressing friends – especially girlfriends. Similar trends are noted throughout many of China’s larger central and eastern metropolises. Shopping malls in Cambodia also house fashionable western eateries that only the privileged can afford.

Obesity ought not to be a problem affecting children, but cases as young as 3 are not exceptional. And for those that then become obese adults the risks (particularly in developing countries) have alarming potential – an increasing susceptibility to illness coupled with reliance on fragile health care systems that may not be able to offer or afford treatment. In China, there is only a very basic social safety net and hospitals are run like profit-making concerns: Only those that can afford treatment receive treatment

Child obesity is expected to soar worldwide according to the International journal of Pediatric obesity, and could start to erode health gains in many countries. Both morbidity and cases of premature death are expected to rise over the next decade costing the economies of China, India and Russian billion of dollars according to the WHO. China alone will lose $558 billion over the next 10 years of its national income due to heart disease, stroke and diabetes. And other important Asian economies – Thailand, Malaysia, Indonesia and others – are fast reaching western levels of development and consumption.

An incomplete response

Political will and increased public awareness will decide whether obesity is here to stay or go, according to Prof. Philip James, the chair of the London-based International Obesity Task Force (IOTF).

“It is noticeable,” he says, “that the public and Ministers readily accept the problem of obesity in adults…..then often and very conveniently blame the individual for their predicament rather than questioning whether their obesity reflects the impact of deliberate policy and industrial developments over the last few decades.”

While the political elite ponder their next move a coalition of five international non-governmental organisations (NGOs) – known as the Global Prevention Alliance – has already pledged new action worldwide to combat obesity-driven chronic diseases. Obesity, the alliance says, ranks alongside HIV/AIDS in terms of importance and impact.

“Cutting death rates alone will not be enough,” according to Prof. James, adding that “No health system or economy can afford the cost of spiralling cases of chronic disease. The only way to address this is to recognise the need to revolutionise our approach to delivering healthier diets and reducing consumption of the foods high in fats, sugar and salt.”

Obesity is a new challenge for countries like China, which suffered a major famine in 1961, suffered routine food shortages until the mid-70s and received food aid from the World Food Programme until 2005. But a solution is not out of reach. As many as 80% of the cases of premature heart disease, stroke and type-2 diabetes could be prevented by a healthy diet according to the WHO. Missing only is the political will to legislate, educate and take on the powerful Food Industry.