Most people tend to associate obesity with "being rich" -- as incomes rise, so too do opportunities to consume more. However, the causes of this growing public health problem are more complex, while finding solutions is a growing challenge.
According to a new study by the Asian Development Bank Institute (ADBI), Asia and the Pacific is home to the largest absolute number of overweight and obese people, about 1 billion or two out of every five adults in the region.
"The change in figures has been most dramatic in Southeast Asia, where the prevalence of overweight and obesity increased by almost 40% from 1990 to 2013," Matthias Helble and Kris Francisco wrote in their study titled Imminent Obesity Crisis in Asia and the Pacific: First Cost Estimates, by the ADBI.
One of the main consequences of economic growth and development, the study says, is that food becomes increasingly available at lower prices. In Asia, access to fattening foods such as sugary beverages, ice-cream and fast food is much easier than in the past. As well, urbanisation is creating a shift in eating patterns as it can mean more meals being eaten outside the home and longer commuting times for people.
Another important determinant of overweight and obesity is the shift from agriculture to manufacturing and, more recently, to services. Jobs in manufacturing and services typically require less physical activity.
(Overweight and obesity measurements are based on body mass index or BMI: a person's weight in kilogrammes divided by the square of height in metres. The World Health Organization defines overweight as a BMI of 25 or more, and obesity as a BMI of 30 or more.)
The rise of obesity in East Asia has been led by China, where the prevalence of overweight and obesity rose 111% between 1990 and 2013. The figure reflects an emerging middle class, open markets and more reliable access to food but insufficient knowledge of health awareness.
The government's Healthy China 2030 plan, which aims to increase life expectancy by nearly one year over the next three years and to add another year by 2030, is very ambitious and obesity will be one of the problems it has to confront. Officials are ensuring that packaged food sold in China meets US Department of Agriculture requirements for nutrition information on labels. Basic consumer guidelines for food consumption, especially fast food and sweets, are to be distributed across the country.
Moreover, a recent study by The Chinese University of Hong Kong also found a correlation between working night shifts and being overweight. The chance of becoming obese increases by as much as 29% for those working at night such as nurses, security guards, policemen and transporters, it said. As China becomes more urbanised, the need for shift work will likely increase.
Thailand has begun imposing higher tax rates on drinks with higher sugar content as part of a broader effort to combat obesity. Photo: Patipat Janthong
'DIABETES CAPITAL'
In India, the effect of obesity has resulted in the country being recognised as the "diabetes capital" of the world, with about 5% of the population suffering from this chronic disease. A recent study shows that 14.4 million children in India currently have excess weight. The National Family Health Survey (NFHS-4) indicated that 20% of Indian women aged 15-49 are overweight and most of them are in urban areas. The figure represents nearly a 60% jump from 10 years ago. Among Indian men, 18.6% in the same age group are obese.
The Indian experience shows that obesity is not only a serious problem in itself, but it can put society at a higher risk, especially with chronic conditions such as diabetes and heart disease which cannot easily be cured and need lifelong treatment.
Meanwhile, an Economist Intelligence Unit (EIU) report found out that apart from economic growth and the shift in eating patterns, cultural and social norms are also contribute to the obesity problem in Southeast Asia.
"Many nations in the region are still battling with poverty and tend not to consider obesity a top priority, which makes it an even greater threat. Moreover, there is also the related perception in some countries that fat children are healthier," the EIU report suggested.
Malaysia has the highest obesity level (13.3% of the population) with a 27% increase between 2010 and 2014, followed by 8.5% in Thailand (also up 27%) and 6.2% in Singapore (up 24%). Vietnam had the lowest obesity rate at 3.6% but with an alarming increase of 38% from 2010-14.
According to the EIU report, fat intake in Malaysia increased by 80% and sugar intake by 33% between 1960 and 2005. And only one-third of the adult population has ever exercised, with only 14% of those who do exercise performing at adequate levels. The EIU estimates that the fight against obesity would cost Malaysia $1-2 billion a year or equivalent to 10-19% of overall healthcare spending.
In Thailand, the Ministry of Public Health says that approximately 21 million citizens or nearly one-third of the country's population are overweight. Excessive sugar intake has long been a major public health concern as local food culture prizes sweetness.
As well, the shift from rural areas to cities has significantly reduced physical activity yet increased exposure to processed food and soft drinks. In response to this, the government began to impose excise tax on sugary drinks in September this year, and it will rise gradually over the next six years. Some local producers are already reducing sugar levels in some drinks in order to qualify for lower excise tax rates.
In Singapore, the Health Promotion Board (HPB) says the average Singaporean these days is heavier and more likely to overeat. Dr Annie Ling, the director of the policy, research and surveillance division at the HPB, analysed nearly 30 years of data and found that Singaporean children are putting on weight more and more but the biggest weight gain will start when they begin their working life.
"Singaporeans are, on average, three kilogrammes heavier today than they were 15 years ago. And even though Singaporeans are exercising slightly more these days, overeating still outweighs any benefits gained from their workout," she noted.
The HPB analysis indicated further that seven in 10 children who are overweight at the age of 7 will likely remain that way into their adult years. This finding is in contrast with the popular belief that chubby children outgrow their baby fat. As a result, the government is putting childhood obesity at the forefront of its healthcare agenda.
In Indonesia, a major cause of obesity is rooted in a love of sweet foods. Despite being one of the world's top sugar producers, Indonesia still cannot meet growing domestic sugar demand; it has overtaken China and the United States to become the world's largest importer of sugar. The average Indonesian consumes around 20 kilogrammes of sugar per year, much more than in other Asian countries. A fondness for foods that are deep-fried as well as those that contain coconut milk exacerbates the problem.
At the other end of the spectrum, Vietnam is one of the thinnest countries in region, with less than 4% of the population being obese. However, the National Nutrition Institute points to a nutritional imbalance as the majority of children who live in rural and mountainous areas are underweight. Meanwhile, about 1.2 million children in urban areas are now suffering from obesity. The proliferation of fast-food chains offering pizza, burgers and fried chicken, together with the popularity of soft drinks, has led to a simultaneous drop in the consumption of fruits, vegetables and milk.
Urgent actions are clearly required for the region to cope with its obesity problem. Governments, medical professionals and business leaders, especially those in food and beverage companies, must play a crucial role to ensure that people are adopting healthier lifestyles.
Likewise, structural changes are needed, such as the encouragement of physical activity by asking city workers to get up and move around more, rather than sitting in front of computer screens all day.
