Famine to Feast

HONG KONG – During the Cultural Revolution, the Chinese faced food shortages and starvation. Today, nearly 100 million people are obese in the world’s fastest-growing economy, more than five times the number in 2005. Obesity has become a serious phenomenon across Asia and amongst the younger generations. It is a major issue that China, especially, has to confront because it is increasing at an alarming rate and it will surely lead to crises in public health and economic loss.

China’s 2002 Nutrition and Health Survey underlines that between 1992 and 2002, more than 60 million people became obese[i]. According to the World Health Organization’s Global Info Database, 45% of males and 32% of females over 15 were overweight in China in 2010. Forecasts suggest that the rate will rise to 200 million Chinese by 2015[ii].

 The dramatic increase in the number of people affected by obesity in Asia is related to changing lifestyles and a shift away from traditional values and diets in the region.

Economic development has enabled Asian countries to significantly reduce the poverty rate and increase living standards. However, it has also led to side effects, namely unhealthy diets due to the plethora of global supermarket chains and the increased usage of high-calorie and cheap packaged foods. Yum! Brands, Inc. which licenses American fast food leaders such as McDonald’s, Pizza Hut and KFC, opened more than 500 restaurants in China in 2009. It says it opens about one new KFC every day in mainland China[iii]. A modern society built on materialism and over-consumption has further facilitated obesity with masses of advertising for high-fat food and sugars or refined carbohydrates.

Furthermore, the changing food consumption patterns in Asia have triggered a vicious cycle. The Westernization of Asian diets has, in return, transformed the agricultural and production systems[iv]. It has reduced the per capita consumption of rice and increased the per capita consumption of wheat and wheat based products. In addition, Asians eat nowadays more meat and fewer vegetables. The shift away from labour-intensive activities such as harvesting rice crops, towards water-intensive ones to raise animals, threatens the ecosystem because it places a serious strain on the Earth’s water supply.

Clearly, the remarkable increase of obese Asians is also the result of growing urbanization. The expanding sedentary way of living,  rapid motorization and the improvement in public transport networks have contributed to less physical activities. In spite of the obvious benefits of modernisation such as improved sanitation, hygiene and access to education, the overall impact on public health must be measured.

 Obesity has had a very high cost for Asian governments and its negative impacts are poised to increase. The health consequences include increased  risk of premature death and non-communicable diseases (NCDs) like stroke, hypertension and cancer[v]. Such illnesses are responsible for four out of every five deaths in the Asia-Pacific region[vi]. Besides, obesity has indirect costs, specifically low work productivity, absenteeism and unemployment. In China, the indirect effect of obesity and obesity-related dietary (what does this mean?) was 3.58% of GDP in 2000 and is projected to reach 8.73% in 2025[vii]. The health system has to grow in order to care for people with these conditions. Although China’s health care spending almost doubled between 1978 and 2002[viii], less than 25% of Chinese citizens are effectively covered by health insurance today[ix], as the 2006 China Health and Nutrition Survey highlights.

 The obesity crisis is, therefore, tremendously significant. Yet, the conundrum remains: What policies can Asian governments adopt to curb obesity?

Firstly, relevant strategies for the prevention and management of obesity must tackle the roots of the issue, namely children’s education. Boosting physical education in school curricula while also restricting children’s exposure to unhealthy food products would be a good start.

In Malaysia, for instance, which is the first South-East Asian country with woes derived from obesity[x], the National Plan of Action for Nutrition is aimed at promoting healthy and active lifestyles. In South Korea too, a 2008 Special Act of Safety Control on Children’s Food and Eating/Nutrition Environment was promulgated in order to prohibit TV commercials for “energy-dense and low nutritional quality food”. It also banned food advertisements within the immediate vicinity of schools that offer free toys. Similarly in Australia, the government recommended phasing out TV commercials that market such food products and beverages before 9 pm. But do these measures go far enough?

The issue is that statutory prohibitions of food marketing to children, like in Malaysia, take the form of government guidelines rather than laws, making its enforcement and implementation less effective. Moreover, many of the actions Asian countries are taking rely on self-regulation. Clearly, there cannot be self-regulatory codes or pledges by companies to reduce obesity because of the advertising and food industries’ vested interests in fostering consumption without necessarily respecting public health standards.

Thus, Asian states must intervene in these areas so as to enforce regulations and avoid, by all means, the path of the  US where powerful fast-food lobbies pressure the government not to adopt WHO dietary recommendations.

 Secondly, government regulators must enact legislation to subsidize healthy food – fruits and vegetables, to make them more affordable and encourage their consumption through public awareness campaigns, whilst heavily taxing packaged food and calorie-dense drinks. A key success factor is to build infrastructure such as storage to facilitate the transportation of fresh food to markets. In supermarkets or restaurants, a salad simply should not be twice the price of a snack, just as bottled water should not be more expensive than a soda. Products that have an unhealthy amount of calories may be labelled “FAT” along with pictures illustrating the  consequences of eating unhealthy food, in much the same way cigarette makers are required to do in most countries. There must also be a reform of the manufacturing sector calling for smaller portions and more nutritious foods. Asians should also be able to have fresh fruits and vegetables delivered home at a reasonable price, just as fast-food home deliveries have proliferated at a low price. This highlights the important role that the media should play in deconstructing harmful notions that link modern lifestyles with unhealthy eating habits.

 Thirdly, modernization has to be accompanied by an increase in physical activities to balance caloric intake. A 2011 study published in Transport Policy[xi] stresses the direct relationship between driving trends and adult obesity rates. Hence, Asian governments must (re)design transport systems to encourage people to walk more and allocate space for more recreation spaces (parks, trails, greenways, etc.) instead of for fast-food venues. For instance, A policy that taxes car ownserhip above one vehicle per household could encourage more active lifestyles. In addition, local Asian governments could set up 24-hour terminals in convenient urban and rural locations for citizens to rent bikes at a price lower than subway or tram tickets, like in France.

 Lastly, Asian policy-makers must invest in health care systems so that a public health workforce supports people, especially low-income communities, in making healthy choices. There could be, for example, free and engaging programmes that educate people on the nutritional values of the food they eat.

As Asians get richer they should also become healthier, breaking from the unhealthy (and now life-threatening) lifestyles that have taken hold in the West. Yet, some Asian societies have preserved cultural beliefs that contribute to the growth of obesity. Traditionally, in many Asian countries being fat has been a sign of wealth and prosperity. In China, the one-child policy has in part led to obesity amongst young people because family members spend lavishly on their “little emperors” and empresses, expressing their affection through trips to McDonalds, the latest video games, and other unhealthy treats .

 To engage in the struggle against obesity, Asian politicians must be patient, creative and committed. Let us keep in mind the war on tobacco in the West, which epitomises the efficiency and effectiveness of taxation, prohibition of advertising and legislation for smoke free environments.