The Global Obesity Epidemic

Until very recently in the history of the world, food has been necessary for survival however not available to every person, everyday.  In fact, it was not uncommon for many people to have food scarcity problems during specific seasons of the year when crops or animal resources became depleted.  With changes in technology such as refrigeration, improved long-term food storage and sanitation, food security became the norm in developed countries.  Due to a consistent food supply and the demand of fast-paced lifestyles, developed nations have also become quite reliant on the fluid supply of faster foods, which tend to include high-energy, low-nutrient ingredients.  In addition, some countries like the United States have policies that permit, and somewhat encourage, the uncontrolled production of crops.  The result is an extreme excess of calories available per person, almost twice the necessary amount (Dorfman, 2008).   With the “Western World” as a model, developing nations are rapidly obtaining more stable and secure food supplies, as well as increasing the prominence of the fast food industry.  On the upside, the advancements in maintaining food security have enabled developing nations to struggle less with problems of chronic hunger and malnutrition.  We must examine, however, the implications of this constant and extreme excess (Caballero, 2007).

The shift to higher food security may be immediately thought of as great progress for our world, and in many ways it has been.  Yet it is becoming more and more clear that we are falling to the other extreme of having too much food and energy per capita, causing a new burden of disease and a massive increase in the world’s weight.  In the developing parts of the world, we have jumped from a greatly malnourished population to a largely obese one, in a matter of a few years.  The “nutrition transition”, as described by Popkin and Mendez (2007), specifically describes how the people in developing nations are undergoing a severe change in disease burden from malnutrition to complications from obesity-related diseases.  In comparison to the increasing obesity rates of developed nations, the developing parts of the world are having exponentially growing numbers of overweight and obese people (Popkin and Mendez, 2007).  The disease burden is quickly leading to stunted economic growth, dependency on unstable healthcare systems, and many years of life lost to disability and mortality.

This obesity epidemic that is invading the world has spread from developed places like the United States and the United Kingdom, to developing countries such as China, India, and Mexico.  The most apparent causes have remained fairly constant include a complex mix of several factors.  Heightened food security allows for each person to have more access to a larger amount of food each day.  Additionally, the newly imported foods that are entering countries worldwide are providing diets higher in fats from edible oils and animal fats, lower in healthy carbohydrates and fiber, and high amounts of processed foods.  Each of these components separately can induce weight gain, and the combined effect can be quite severe.  Therefore, one step in helping to inhibit the spread of obesity is to address the types of foods that people are eating, as well as the quantity.

But the increase in weight around the world cannot only be attributed to food; our obsession with technologies and advancements has given us the excuse to be sedentary and lazy.  All the technologies that we develop are intended to make life easier by reducing the amount of work that is put into a task.  In terms of efficiency, these lead to wonderful developments, however when we look at the effects these have on our health, it is evident that having to do a little work can go a long way in terms of maintaining healthy weight.  Today, many people (worldwide, not only in developed nations) use personal or public vehicles to transport them instead of walking, have occupations that result in more sitting and less physical labor, and spend their leisure time doing sedentary activities instead of being active.  In fact, it has been found that Chinese men and women that owned a vehicle had extremely higher odds (80%, p <0.05)>  Therefore, the careful energy balance that our bodies evolved to survive with has become completely skewed.  Instead, we have grown accustomed to excessively high energy intakes and extremely low relative energy expenditures.  

So what?  Well, the obesity epidemic would not be such a large problem if our bodies could evolve as fast as we are fattening up.  However, since we cannot cope physiologically with the excess fat, chronic diseases related to obesity are skyrocketing globally.  Type 2 diabetes, cardiovascular disease, osteoporosis, asthma, non-alcoholic fatty liver disease, and polycystic ovary syndrome are all examples of how our bodies are poorly coping with the extra weight.  These chronic diseases are very severe, costly to diagnose and treat, and reduce the effective number of work-years that an individual is able to contribute to society (Goran, 2009).  Furthermore, as the problem of obesity becomes more of a pediatric burden, we will see these chronic illnesses much earlier in life.  The result: an aging population that must continue to work much past their productive years in order to support the medical and social service needs of the fat youth. 

As public health professionals, we know that the best approach in healthcare is evidence-based practices, based primarily on disease prevention.  The global problem of obesity is no different, and a large focus to solve the issues we are seeing is to prevent more obesity.  Medically treating those who are already obese is very costly and has a low effectiveness rate.  Preventing obesity from occurring, on the other hand, is an effective and wise investment.  One method to improve obesity prevention is to embrace the things that have made us fat and attempt to harness their power for the betterment of the world.  We should transform “fat makers” into “fat breakers”, as has been done with the following examples.  Active or extreme video games require its users to move and do physical activity for the duration of the game.  Thus, the usual sedentary video gamers suddenly become very active, burning the extra energy that they are most likely accumulating throughout the day.  In Barcelona, like many European cities, people can check out “public transit” bicycles for commuter use within the city limits for an affordable rate.  Although the initial intent was for pollution purposes, this government service will have clear positive reductions in obesity by increasing commuters’ amount of physical activity.   Finally, fast food places like McDonald’s have begun to offer healthier options like salads, apple slices, and milk as alternatives to the high-calorie counterparts such as the Big Mac, French fries, and soda.  Again, although the intent behind these changes may have been geared towards profitability of the companies, public health professionals can use these environments as catalysts for obesity prevention.

Public health professionals need to look at the obese-causing world with a new perspective, harnessing the fanaticism that encompasses the trends that are making us fat to use them as positive influences on the health of the world.  We should be lobbying to ensure that national and international policies are enacted place to protect the consumer’s health, both in the items that are sold, as well as the way that foods are marketed (Dorfman, 2008).   It is equally as critical that policies be implemented to assist the consumer to make informed decisions about what they decide to eat, through education on marketing ploys and food labeling (Mello, Studdert, & Brennan, 2006).  Most of all, it is essential that governments lead the change to create opportunities and incentives for the people to be more physically active, eat more nutritiously, and have a general individual responsibility for their long-term health.

References

Caballero B.  The Global Epidemic of Obesity: An Overview. Epidemiologic Reviews 2007; 1-5.

Dorfman L. Interview with Marion Nestle.  Health Promotion Practice, 9(1): 16-18, 2008.

Goran M. Overview of Childhood Obesity.  Presentation observed at the University of Southern California, January 27, 2009.

Mello MM, Studdert DM, Brennan TA.  Obesity – The New Frontier of Public Health Law.  The New England Journal of Medicine, 354(24): 2601-2610, 2006.

Popkin BM, Mendez M. The Rapid Shift in Stages of the Nutrition Transition: The Global Obesity Epidemic.  Globalization and Health 2007; 68-80.