“Viewpoints” | The Spread of Obesity in Developing and Transitional Countries
Obesity is increasingly becoming an epidemic in industrialized nations, particularly in the U.S. where one out of every three adults is obese. However, the U.S. is not alone in this emerging public health crisis. Increasingly, transitional nations – which have long fought to simply maintain adequate nutrition among their populations – are being forced to confront a rising tide of obesity among certain sectors of their populations.
I became interested in the rise of obesity in developing and transitional countries during my doctoral work at Indiana University. I was trained as a nutritional anthropologist and lived in Mali, West Africa in 1996. While there, I conducted fieldwork to understand the biocultural factors impacting severe undernutrition and stunting of growth in children and adolescents. Mali at the time was one of the poorest countries in the world and had some of the highest infant mortality rates, stunting, and wasting statistics.
In strange contrast to a lack of proper nutrition among many in Mali, it was there that I became aware of a completely different problem emerging, the rise of diabetes and cardiovascular disease only evident in wealthy individuals, and primarily in adults. The increase of these chronic diseases was blamed on wealthier neighboring African countries, including Cote D’Ivoire, which had helped introduce Mali to many unhealthy and addictive street foods like pommes frites (french fries). I saw no evidence of obesity among children and adolescents in Mali, but it became clear that the threat of obesity was not confined to the U.S. or just wealthy nations.
I later attended a conference on health and nutrition in the Caribbean and Central America and read a Pan American Health Organization report published in 1999 entitled “Obesity and Poverty” (2000) by Manuel Pena and Jorge Bacalloa which cited the recent rise of obesity throughout the PAHO region. The report indicated that the rise in obesity was primarily occurring in women of low socioeconomic status and men of high socioeconomic status. This was initially identified in Venezuela and in Brazil where wealthy women tried to remain thin as a sign of high social status, while among wealthy men being overweight signified greater wealth. Poorer women, on the other hand, had little access to healthy nutrient dense foods while working indoors and so they often consumed primarily calorie dense, low micronutrient filled foods. Even after seeing such a transition beginning to occur in Mali, it was shocking to read the PAHO reports that obesity was occurring and rapidly growing in areas stilled plagued with poverty and undernutrition.
The idea of this change from undernutrution to obesity has been coined “the nutrition transition” by epidemiologists and is officially defined as “population shifts in dietary patterns considered to increase the risks of obesity and related chronic diseases.” The nutrition transition is thought to be driven by demographic changes, urbanization, and changes in food production and marketing. With this nutrition transition, the global threat of obesity has become an even greater reality in the past ten years. The World Health Organization now estimates that about 28 percent of the world’s population, as well as 10 percent of the world’s children, are overweight or obese.
After my experience in Africa, I decided to investigate the problem of obesity in children and adolescents in transitional countries. My research took me to Nicaragua, Thailand, Chile, Costa Rica, and Mexico. While I have found obesity to be a growing problem in all these countries, the causes appear to be influenced by a variety of issues that are often specific to each region and culture. For example, in Thailand, parents reported that fewer children are walking to school because the roads are unsafe, there are few sidewalks, and there is considerable air pollution. Children have an almost endless supply of food, with street venders selling high calorie fried and sweet snacks across from the schools. Another factor contributing to the inactivity of Thailand’s children is that most families now have air conditioning in the home which discourages children from going outdoors to play in the hot and humid climate.
Policies aimed at curbing obesity in transitional countries are limited. Most of these countries are focused on continuing to end hunger, poverty, and infectious diseases, and are simply unprepared to tackle the diametrically opposite threat of obesity. This is a challenge that cannot be ignored, however. Obesity is well known to lead to severe chronic illnesses – like diabetes and heart disease – which can potentially cost already cash-strapped governments millions of dollars in future health care costs. In Europe, obesity has been found to account for 2-8 percent of healthcare costs and 10-13 percent of deaths in certain areas. In 2009, the Mexican government spent $3.24 billion to treat diseases linked to obesity such as diabetes.
Even faced with overwhelming challenges, transitional countries have begun taking limited steps to address the challenge of obesity. The Thai government has recently developed programs to prevent obesity-related chronic illnesses. These initiatives include the development of health promotion centers where local communities have access to gyms and karaoke rooms. While a start, these Thai initiatives sadly are lacking efforts focused on children and adolescents.
Mexico, which has one of the highest rates of childhood obesity in Latin America, has implemented a national public-private plan that is focused on improving eating habits among children by encouraging greater consumption of water, fruits, and vegetables; promoting physical activity; and providing weight monitoring services. Mexico’s national program is based on the French project EPODE and has been shown to be effective in reducing childhood obesity.
Chile has also implemented a “Global Strategy Against Obesity” with the primary goal of decreasing obesity across the country by the end of 2010. This health promotion strategy includes increased communications campaigns and increased regulation of marketing and advertising to limit unhealthy food choices and to encourage healthy eating habits and physical activity. The Chilean government is also calling for nutrition labeling of foods (modeling a U.S.-led initiative), additional training for health workers regarding problems associated with overweight and obese populations, and an increase in the research and extension services provided to communities in vulnerable populations.
The strategies in Costa Rica are similar to other transitioning countries’ approaches, and include an increased focus on advocacy and research, implementation of strategies for early identification of overweight and obese populations, and dietary and physical activity interventions.
As all of these initiatives suggest, many transitional countries are beginning to understand the threat of obesity and are attempting to address the problem. Unfortunately, only those countries that have adequate resources have been able to begin to confront the threat. Poorer countries, such as Mali, will be left out as they continue to struggle with the more basic public health issues of reducing morbidity and mortality caused by HIV/AIDS and other infections diseases.
Ironically, many governments in transitional nations have been looking to wealthier nations such as the United States as a model for dealing with obesity. Unfortunately, this has proven unproductive, as neither the U.S. (nor any other wealthy country for that matter) has been very successful in reducing obesity. The result is that many transitional nationshave few examples to follow. Additionally, my research in transitional countries suggests there isn’t one model that would fit every nation’s needs, since every country faces unique challenges based on its own culture and economy.
What is clear is that further investigation within specific populations is needed to develop more effective and culturally-relative policies aimed at reducing and preventing obesity. I also believe that the U.S. would be wise to learn the lessons of other nations who are beginning to see some success at reducing obesity, particularly those countries (such as Mexico) from which many immigrants to the states originate.
References
1. Aguirre, P. (2000) “Socioanthropological aspects of obesity in poverty” in Obesity and Poverty: A New Public Health Challenge eds. Manuel Pena and Jorge Bacallao. Pan American Health Organization, WHO.
2. Pena, M. and Bacallao, J. (2000) “Obesity among the poor: An emerging problem in Latin America and the Caribbean” in Obesity and Poverty: A New Public Health Challenge eds. Manuel Pena and Jorge Bacallao. Pan American Health Organization, WHO.
3. Kosulwat, V. (2002) “The nutrition and health transition in Thailand” Public Health Nutrition. 5(1A):183-189.
4. Sakamoto N, Wansorn S, Tontisirin K, Marui E (2001) “A social epidemiologic study of obesity among preschool children in Thailand” International Journal of Obesity and Related Metabolic Disorders: Journal of the International Association for the Study of Obesity. 25(3): 389-394.
5. Harnroongroj, T., Jintaridhi, P., Vudhivai, N., Pongpaew, P., Tungtrongchitr, R., Phonrat, B., Changbumrung, S., and Schelp, FP. (2002). “B vitamins, vitamin C and hematological measurements in overweight and obese Thais in Bangkok”. Journal of the Medical Association of Thailand. 85(1):17-25.
6. WHO. (2002). “Globalization, diets, and noncommunicable diseases”. WHO, Geneva Switzerland.
7. Miselem, S. (2010). “Mexico tackles record child obesity”. Agence-France Presse.
8. PAHO Today. (2008). “Chile Takes Aim at Obesity”.
9. Cerdas M. (2006). “Epidemiology and control of hypertension and diabetes in Costa Rica”. Renal Failure, 28, 693-696.
10. Martorell R, Khan LK, Hughes ML and Grummer-Strawn LM. (1998). “Obesity in Latin American women and children”. American Society for Nutritional Sciences. 128:1464-1473.
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