China begins to throw weight around

One unfortunate side effect of nation's new-found wealth is its growing obesity problem

China has seen its combined rate of overweight and obesity rise dramatically over the last 30 years to a point where it is second only to the United States.

The prevalence, however, remains among the lower end of the international spectrum at about 27 percent of the population. In the US, the figure is about 69 percent.

A study by the University of Washington's Institute for Health Metrics and Evaluation (IHME) found that 46 million Chinese adults are obese with a further 300 million overweight.

Although China has a problem with obesity, it is still way behind the US, which accounts for 13 percent of the world's obesity. China and India together represent 15 percent.

Nevertheless, the report uncovered an alarming rise in child obesity, with 23 percent of Chinese males under 20 classified as overweight or obese. The comparable figure for girls was 14 percent.

Childhood obesity has severe health effects, such as diabetes, cardiovascular disease and various types of cancers, says Marie Ng, the study's lead author and assistant professor of global health at IHME.

The high percentages in China are "especially troubling", Ng says, adding: "We need to be thinking now about how to turn this trend around."

In 2013, the State General Administration of Sports said in a survey that 34.4 percent of Chinese between the ages of 20 and 69 were overweight and that 12.7 percent were obese. The survey questioned more than 43,000 people in 10 provinces, autonomous regions and municipalities.

There were 120 million obese people in China under the age of 18 in 2010, according to a report by the Chinese Center for Disease Control and Prevention. A national survey in 2010 found that the obesity rate for people over 18 years old was 12 percent and that 30 percent of people in the country were overweight.

Matthew Crabbe, co-author of Fat China: How Expanding Waistlines are Changing a Nation, describes China's surging rate of obesity as "a ticking bomb" underneath the country's future economic growth and public healthcare system.

Much of the problem is said to be due to the prevalence of fast and processed foods in China.

Western fast-food chains such as KFC, McDonald's and Pizza Hut have made major inroads into China in recent years and helped China's upwardly mobile middle class to pile on the kilos. Local food companies are following suit.

China's $300 billion 'informal eating out' market is expanding at an annual rate of 10 percent, compared with 2-3 percent in the US, the World Bank stated in its April report, The Fat Face of 'Development'.

According to the report, China is McDonald's fastest-growing global market. McDonald's has more than 60,000 employees in around 1,100 outlets in the Chinese mainland after 20 years in the country. There are plans to double that to 2,000 or more outlets over the next three to five years.

And Hamburger University (HU), located just outside of Shanghai, aims to have 5,000 graduates over the next five years. "HU courses may earn college credit and graduates use such schools as a springboard to pursue college degrees," the World Bank said.

It also quoted the university's dean, Susanna Li, as saying: "We will do our best to be the Harvard for our industry."

In many cities around the country, the bicycle has been tossed aside for cars and public transport while homemade meals using fresh produce have been replaced with takeout.

Rob Moodie, professor of public health at the Melbourne School of Population Health, University of Melbourne, says China is the last frontier for many global fast food companies.

"What we are seeing in China today is exactly the same as we saw in Australia, the US and parts of Europe 30 years ago," he says.

"Business suffers as productivity falls due to workers taking time off due to sickness caused by obesity-related diseases.

"And the public health system feels the added burden of having to treat rapidly rising cases of diabetes and heart disease," he says.

The Fat Face of 'Development' reported that the prevalence of diabetes among Chinese children is already higher than in some high-income countries.

Mark Wahlqvist, emeritus professor of medicine at Monash University in Melbourne, explains that obesity levels in China are rising, but not at the same rates throughout the country.

Wahlqvist is also a member of the World Health Organization's nutrition advisory panel and a director of the Fuli Institute of Food Science and Nutrition at Zhejiang University in Hangzhou. "You will find obesity in pockets all over China but those pockets are quite large."

"In Hangzhou, where I have been coming since 1986, obesity is a relatively small problem," he says.

"Less than 5 percent of the population in Hangzhou are overweight or obese. In Beijing, however, it is around 40 percent."

He says the reasons for such a low incidence of obesity and being overweight in Hangzhou are varied.

"Like a lot of places around China, Hangzhou has good governance and a good healthcare system basically it is well organized," he says.

It also has the benefit of being less polluted than some other parts of China, has many parks, and enjoys a a strong cultural and food tradition.

"It is the place where tea was first developed and is still an important beverage," he says. "It also produces lots of fruit and vegetables. So its food culture, if you like, is less vulnerable than other places in China and these things add up to a less vulnerable community."

Wahlqvist says that another factor for the low incidence of obesity in the area was probably that a lot more fresh vegetables, in particular beans, are consumed than in the north of the country.

"Here we go back to dietary diversity, and by that I mean fresh fruit and vegetables. Together they reduce the risk of those diseases commonly associated with obesity and being overweight," he says.

"This part of China, Shanghai included, has a high intake of fresh fruit, vegetables and fish when compared to Beijing, which is not near the sea and doesn't have an adequate supply of fresh fruit and vegetables."

This has meant that people in Beijing have tended to drift toward fatty foods. But the obesity problem is not just about diet. Another problem is the lack of exercise among many Chinese people. It has become a status symbol to own a car, although the bicycle is still popular.

"We have 45,000 students at Zhejiang University in Hangzhou and I would guess maybe 44,000 of them, including myself, ride bikes," Wahlqvist says.

"On the whole, people here are a lot healthier than in the north of China. They value their food culture here and see fast and processed foods as being an attack on their culture."

He acknowledges that obesity is a growing concern in China, but says that it is still in pockets in the country albeit large ones and he believes that it is not too late to address the problem.

"There is a real opportunity to spread the ongoing traditional use of minimally processed foods and beverages along with daily exercise to maintain healthy weights among Chinese people."

karlwilson@chinadailyapac.com

(China Daily Africa Weekly 07/25/2014 page24)