The Developing World is… Fat?

Obesity, and the negative health consequences associated with it has conventionally been regarded as the problem of rich and prosperous nations, an issue of plenty, not scarcity. Bizarre as it may seem, according to the World Health Organization’s Global Database on Body Mass Index, the obesity epidemic which has become commonplace here in the U.S and other developed nations, is actually a pandemic of global proportions. Labeling it “globesity”, WHO maintains that this epidemic of overweight and obesity is swiftly becoming a major global health problem “paradoxically coexisting with under nutrition”.

"Globesity" -Courtesy of grist.com

Using the Body Mass Index (BMI), a scale measurement based on an individual’s height and weight, the World Health Organization classifies overweight and obesity in adults and populations: a person with a BMI equal or greater than 25 is considered overweight, a person or individual with a BMI equal or greater than 30 is considered obese. WHO’s latest approximation from 2005 estimates that there are currently 1.6 billion adults worldwide who are overweight, and at least 400 million who are obese. WHO further projects that by 2015, an estimated 2.3 billion adults will be overweight and more than 700 million will be obese. While we’re on the topic of fat numbers, according to a paper by Cecchini and colleagues, among OECD countries obesity rates have doubled or tripled in the past twenty years, and 50% or more of the population is now overweight. In Mexico, the prevalence of obesity has risen to 30.4%; in China, overweight rates have doubled from 13.5% in 1991 to 26.7% in 2006; in urban areas of western India overweight rates approached 40%; and in South Africa a third of women and a tenth of men are obese. In all, the world -developed and developing alike- is generally getting fatter.

As we are told here in the U.S, being overweight or obese is correlated with many chronic and non-communicable diseases (NCDs) including diabetes, cardiovascular disease, stroke, hypertension and certain cancers. According to WHO, cardiovascular disease is already today’s number one cause of death, killing 17 million annually. WHO also projects that in the next ten years, diabetes induced deaths will have increased by 50% worldwide. According to a Lancet  paper by Lock and colleagues, the increasing burden of chronic disease is affecting low-income countries disproportionately, with 80% of all deaths in low-income countries occurring from chronic disease.

For many developing nations, obesity has emerged as a more serious health threat than hunger. Counterintuitive as it may seem, there is a clear connection between poverty and obesity. According to a 2007 article in Scientific American by Dr. Barry Popkin, countries with a GDP greater than $2,500 per capita (which consequently includes most developing countries, with the exception of sub-Sahara Africa), obesity rates are higher for poor women than those with a higher socio-economic status. Additionally, in studies of more than 157,000 women in 39 developing nations, women in urban areas are more likely to be overweight than women in rural areas. Popkin attributes the rise in obesity in urban settings to the adoption of modern habits without access to education, healthier foods or recreational activities. WHO too notes the paradox of this neglected “epidemic”, which often coexists with malnutrition.

Increasingly, middle and low-income countries (LMICs) are facing a double burden of infectious disease and under-nutrition, as well as the onset of NCD risk factors of overweight and obese populations, particularly in urban settings. Jeremiah Norris, Senior Fellow at the Center for Science in Public Policy at the Hudson Institute, reported that the burden from chronic disease will only increase with time: by 2020, NCDs are projected to cause seven out of 10 deaths in the developing world. Despite the significant evidence which acknowledges NCDs as a leading cause of global mortality, they remain woefully underfunded in the global development arena. In addition to the significant human loss associated with NCDs, heavy losses in economic production can also be expected. According to a paper by Abegunde and colleagues, for 23 LMICs, an estimated 250 million deaths and $84 billion of lost national output are expected from 2006-2015 if nothing is done to reduce the risk of chronic disease. Ironically enough, a similar paper demonstrated that a mere investment of $1-2 per person in key intervention strategies could reduce losses in economic output by $8 billion and prevent 32 million deaths over the same period.

WHO has attempted to “sound the alarm” through public awareness campaigns, in addition to developing strategies which make healthy choices easier. The United Nations General Assembly has also called a special assembly on Non-Communicable Diseases, scheduled for next September, where hopefully NCDs, and their causes such as obesity, will gain some traction.

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