The Obesity Epidemic: A Global Health Priority

Introduction to the Obesity Epidemic

The world is shifting at an alarming rate from infectious diseases to chronic non-communicable diseases. Without concerted action, 388 million people worldwide will die of one or more chronic diseases in the next 10 years (Daar et al., 2007). The number of deaths from these diseases is double the number of deaths that result from a combination of infectious diseases, maternal and perinatal conditions, and nutritional deficiencies (Daar et al., 2007). Chronic diseases will also have a huge negative economic impact. Over the next 10 years, China, India, and the United Kingdom are projected to lose $558 billion, $237 billion, and $33 billion respectively due to reduced economic productivity (Daar et al., 2007).

By 2020, it is estimated that two thirds of the global burden of disease will be attributable to chronic diseases, most of them strongly associated with diet (Chopra et al., 2002). The nutrition transition towards refined foods, foods of animal origin, and increased fats plays a major role in the current global obesity epidemic and is due to several factors: urbanization, changes in income and food price changes, modern technology, and globalization (Popkin and Mendez, 2007 and Popkin, 2006). Obesity is a precursor to many chronic diseases, including cardiovascular disease, type 2 diabetes, arthritis, and respiratory complications, which in turn have become major factors in the current healthcare crisis in the United States (Butchko and Petersen, 2004). Results from the 2002 NHANES survey indicate a doubling in obesity prevalence rates in adults and a tripling in prevalence rates among adolescents over the past two decades (Butchko and Petersen, 2004).

Because of these rapid changes, priority in a crowded global health agenda should go to addressing the forces that contribute to the obesity epidemic. It is especially important to act now as rates are increasing in developing countries since it is possible to intervene and prevent these countries from seeing levels of chronic diseases comparable to that of the United States and other developed countries. In this essay, we will review some of the main forces behind the obesity epidemic: decreases in physical activity with concurrent increases in technology, shifts in the food system, and the subsequent effects of globalization of transnational corporations. Addressing this epidemic and progressing towards possible solutions requires a multidisciplinary approach and coordinated efforts on a global scale.

Physical Activity and Technology

Technological forces at the community and individual levels that increase the level of comfort in everyday life also greatly contribute to the lower levels physical activity. The introduction of the automobile revolutionized way people traveled and extended the distances to which people can travel (Choi et al., 2005). Many children no longer walk to school, and people are able to commute longer distances for work. In China, about 14% of households acquired a motor vehicle between 1989 and 1997 and television ownership skyrocketed (Popkin and Mendez, 2007). Modern machines at home and in the workforce decrease the need for direct human efforts. Washers, dryers, and dish washers take away the opportunities of old-fashioned household physical activities (Choi et al., 2005). There is an increase of sedentary jobs due to the mechanization of the service sector (Popkin, 2006).

In addition to the luxuries that technology provides, children are influenced by the forces that they encounter in schools and in their neighborhoods. In many schools, physical education is removed from the curriculum due to budget cuts while vending machines with unhealthy snacks are still available. Due to the rise in crime rates in some neighborhoods, there is a perception that the streets are unsafe. Many parents do not allow their children to go outside and play in the parks or playgrounds and as a result, the children become hooked onto TV, games, and computers (Choi et al., 2005).

Shifts in the Food System

One of the most significant shifts in the food system relates to the marketing and sales of food (Popkin, 2006). Through advances in technology, the amount of processed foods has increased, and the subsequent fall of food prices has enabled the food and beverage industries to expand their markets abroad. The global value of food trade grew from $224 billion in 1972 to $438 billion in 1998, and this was accompanied with the consolidation of agricultural and food companies into large transnational corporations, which in turn developed global brand names and marketing strategies with adaptation to local tastes (Chopra et al., 2002). As these corporations penetrate new markets, they often use the strategy of purchasing large shareholdings in local food producers, wholesalers, or retailers (Chopra et al., 2002). For example, in China, transnational corporations significantly invested in local companies to produce, distribute, and retail both global and locally adapted products (Chopra et al., 2002). As commodity prices decrease and incomes increase, people tend to increase the diversity of their diet and shift into higher priced commodities and processed convenience foods (Popkin and Mendez, 2007).

Globalization and Obesity in Developing Countries

Until recently, obesity and the associated risk of chronic diseases have been perceived as problems of developed countries. However, the problems of overnutrition are increasing even in countries where hunger is endemic (Chopra et al., 2002). Many developing countries are experiencing shifts in food imports due to the increase in direct foreign investment in the food industry, especially through supermarkets and fast food restaurants (Popkin and Mendez, 2007). For example, between 1989 and 1998, sales by U.S.-owned food processing affiliates in Asia increased from $5 billion to $20 billion (Popkin and Mendez, 2007).

Urbanization has also played an important role in the obesity epidemic. Globalization has been associated with occupations that involve spending more time away from home, and the consumption of processed food and fast food meals have greatly increased (Popkin and Mendez, 2007). In general, people living in urban areas consume higher levels of fats and animal foods, along with lower consumption of vegetables (Popkin and Mendez, 2007). Even this, however, has begun to change as rural development increases (Popkin and Mendez, 2007). As a result of these various forces, people in the developing world are abandoning traditional diets that are rich in fiber and grain for diets that include increased levels of sugars, oils, and animal fats (Chopra et al., 2002).

Underlying the corporate expansions into and investment in developing countries is the principle of the rules of trade, set forth by the World Trade Organization (WTO). The WTO enforces and addresses these rules to facilitate increased global trade (Popkin and Mendez, 2007). The two key principles addressed are 1) a benefit that is granted to one Member State is required to be granted to all Member States and 2) the imported and domestically produced goods, services, and intellectual properties are allowed the same competitive advantages in the markets of importing countries (Popkin and Mendez, 2007). While these rules were designed to achieve non-discrimination, it inadvertently allows the WTO to assist with the market penetration and global advertising in developing countries (Chopra et al., 2002).

Future Efforts

The fundamental science behind the obesity epidemic is quite simple: dietary changes are exacerbated by a parallel decline in energy expenditure associated with reductions in daily physical activity (Chopra et al., 2002). However, what makes this epidemic so difficult to address are the additional forces that exist at various levels of society to provide the underlying currents to this epidemic. Although we are slowly becoming more aware of the magnitude of this problem, we need to act now and increase our efforts in order to address this complex yet pressing issue. Many researchers believe that since obesity is a multifaceted problem, it will take a multifaceted and long-term approach from all key stakeholders to solve it (Butchko and Petersen, 2004). However, the two most important fronts to start with include the community level and the national and international levels.

Efforts at the community and individual levels should include increasing education and awareness about the risks for obesity. People must be made aware that there is a problem in the first place before they can decide whether or not they want to change their habits. Since people generally go for the quick fix than use the approaches may require personal sacrifices and lifestyle changes, prevention and intervention programs should be customized for each individual so that they would be able to continue the different strategies long after they have completed these programs (Choi et al., 2005). For those people that are aware of the problem yet have no control over the types of food or exercise facilities available to them, that is where the policymakers come in.

Efforts at the national level are incredibly important as governments and policymakers have the largest potential to make a difference and spearhead efforts towards addressing obesity. Even though individuals have the right to make their own choices as to what they feel is best for them, they do not have control over forces such as globalization, marketing, and corporate investment. However, instead of fighting against the food and beverage industries, we would be even more efficient if we partner with them and work together. Governments should reiterate to these industries that the goal is not to take over their businesses, but instead to work towards a common goal to benefit the greater good. Governments can use subsidies or other incentives to promote corporate investment in poorer areas to ensure that fresh fruits and vegetables are affordable and help to promote healthier food choices (Popkin and Mendez, 2007). Price manipulation, public education, and clear food labeling are also effective strategies that can be implemented (Chopra et al., 2002). Governments could also work with the private sectors to focus on creating social environments that encourage physical activity, walking, and more nutritious food choices (Choi et al., 2005). This is especially relevant in the workforce where employees may not have access to healthy cafeterias or facilities to exercise in.

Since globalization is contributing to the rising rates of obesity in developing countries, efforts at the international level are crucial to prevent this epidemic from getting worse. Governments and organizations need to work together on a global scale in order to achieve national objectives for the protection and promotion of public health (Chopra et al., 2002). One way to garner support for addressing obesity is through the creation of non-binding legal documents to promote global support for this issue (Chopra et al., 2002). Non-binding legal documents, which can be classified into intergovernmental resolutions and intergovernmental codes of conduct, have the advantage of flexibility while binding legal documents have the advantage of ensuring compliance (Chopra et al., 2002). The idea is to start with non-binding legal documents and then progress to the development of binding legal commitments (Chopra et al., 2002). Currently, the World Health Organization is promoting non-binding legal instruments through the resolutions of the World Health Assembly, but it is not planning on developing binding mechanisms yet (Chopra et al., 2002). Although introducing legal documents may seem a bit extreme to some, it may just be the driving force that is needed to unite international efforts and attention toward obesity.

Even though strategies at the community and national and international levels are necessary starting points, long-term goals require a multidisciplinary approach in order to coordinate efforts to increase the progress towards solving the obesity epidemic and subsequently to slow the spread of chronic non-communicable diseases. It is predicted that countries will lose billions of dollars and millions of lives over the next 10 years due to chronic diseases, so taking immediate action to address one of the biggest risk factors of these diseases will be worth it.

References
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Choi, B.C.K., Hunter, D.J., Tsou, W., and Sainsbury, P. 2005. Disease of comfort: primary cause of death in the 22nd century. Journal of Epidemiology and Community Health 59:1030-1034.

Chopra, M., Galbraith, S., and Hill, I.D. 2002. A global response to a global problem: the epidemic of overnutrition. Bulletin of the World Health Organization 80(12):952-956.

Daar, A.S. et al. 2007. Grand challenges in chronic non-communicable diseases. Nature 450:494-496.

Popkin, B.M. 2006. Global nutrition dynamics: the world is shifting rapidly toward a diet l inked with noncommunicable diseases. The American Journal of Clinical Nutrition 84:289-298.

Popkin, B.M. and Mendez, M. The rapid shifts in states of the nutrition transition: the global obesity epidemic. In: Kawachi, I., Wamala, S., eds. Globalization and Health. New York: Oxford University Press. 2007:68-80.