Obesity gains ground as a global killer

It’s a bitter truth to swallow: About every fourth person on Earth is too fat. Obesity is fast becoming one of the world’s leading reasons why people die.

In an astonishing testament to globalization, this outbreak of girth is occurring just as doctors everywhere but sub-Saharan Africa are winning the fight against infectious diseases from smallpox to malaria.

Now a new enemy is emerging in the 21st century — our appetite. Around the globe, about 1.7 billion people should lose weight, according to the International Obesity Task Force. Of those who are overweight, about 312 million are obese — at least 30 pounds over their top recommended weight.

Already, a third of all deaths globally are from ailments linked to weight, lack of exercise and smoking. And perhaps most worrisome is obesity’s spread beyond wealthy western nations.

From the glaciers of Iceland to the palm-fringed beaches of the Philippines, there are now more fat people in the world than hungry people. And in extreme cases, people who are heavy since childhood could die as much as five to 10 years early.

"The developing world in particular is going to bear the enormous brunt of this weight gain," said Neville Rigby, policy director of the IOTF.

"We’re even seeing obesity in adolescents in India now. It’s universal. It has become a fully global epidemic — indeed, a pandemic."

Certainly the United States — home of the Whopper and the Super Big Gulp — remains a nation of scale-busters, with two of every three Americans overweight.

But there are a dozen places even worse.

South Pacific islands such as Tonga, Kosrae and Nauru, where traditional meals of reef fish and taro are replaced by cheap instant noodles and deep-fried turkey tails.

Greece, birthplace of the Olympic Games. Kuwait and other wealthy, oil-soaked Gulf States.

Soon China will be the world’s biggest country in more ways than sheer population, experts predict. It’s a stunning reversal from the Mao Zedong era when as many as 40 million people starved in the Great Leap Forward famine of 1958-61.

When university student Li Guangxu was a baby, rice was rationed. Now he eats cookies for breakfast.

Shopping at a CarreFour supermarket in western Shanghai, Li fills a shopping cart with cookies, chips, soda and beer.

"I like these things. They taste great," Li said. "I don’t have time for anything else. Older folks don’t eat this stuff, but we do."

And a food fix always is within arm’s reach. Almost no one can resist.

"I compare the propensity to eat as somewhere between the propensity to breathe and the propensity to have sex," said Stephen Bloom, chief of metabolic medicine at the University of London’s Imperial College. "It’s much worse than stopping smoking."

Type 2 Diabetes is the illness most directly linked to obesity. A condition that often leads to heart disease and kidney failure, it is blamed for more than 3 million deaths a year. It afflicts 154 million people — nearly four times the number who have HIV or AIDS — and the WHO forecasts more than twice as many people will develop diabetes in the next 25 years.

Obesity can triple the risk of heart disease. One-third of all deaths globally — about 17 million — are blamed on heart disease, stroke and related cardiovascular problems, WHO figures show.

Countries with extensive health care have stalled the onset of heart disease into old age. But in much of the world, fatal heart attacks and strokes are much more common among working age adults. Over the next 30 years, the trend is projected to worsen.

Researchers from Columbia University’s Earth Institute examined Brazil, China, India, South Africa and the Russian republic of Tartarstan. They found that the heart disease death rate for adults ages 30-59 was up to twice as high as the U.S. rate, and in Russia the rate was up to five times higher

Obesity was cited as a primary factor, along with smoking, lack of exercise and untreated high blood pressure. The researchers described the influence of unhealthy diets as "surprising."

Obesity also plays a significant, if poorly understood, role in many cancers. WHO data shows cancer accounts for about 12.5 percent of the world’s deaths, and that rate is expected to increase dramatically, mostly in developing countries.

The global trend toward weight gain and its associated illnesses is not restricted to the well-off. High-fat, high-starch foods tend to be cheaper, so poor people eat more of them.

In Mexico, 40 percent of its 105 million people live in poverty. Yet two-thirds of men and women there are overweight or obese.

Many factors contribute to the widening of the world’s waistline.

For starters, there is cheap, plentiful food. Even in poor nations, the relative cost of eating is declining.

And the consumption of oils and fats used in processed foods has doubled over the last 30 years.

"One year they had very expensive butter and the next year edible oil came on the scene," said Barry Popkin, who heads nutrition epidemiology at the University of North Carolina and serves as a WHO adviser. "All of a sudden for very little money you could make your food taste better."

Nutritionists say cheaper sugar is another factor, despite the industry’s strenuous denials.

James E. Tillotson, director of Tufts University’s Food Policy Institute, calculates the average American drinks the equivalent of a 55-gallon drum of soda every year, compared to 20 gallons of sweetened beverages a year in 1970.

Increases almost as dramatic have occurred in Europe, and soft drink factories are increasingly popping up in developing countries.

"We never thought people would abuse them," said Tillotson, who developed fruit-based drinks for Ocean Spray in the 1980s.

Another factor is how food is promoted and distributed.

In 1990, no more than 15 percent of food bought in Latin America came from supermarkets. Now, 60 percent is from six supermarket chains.

There are demographic changes, too. In many nations, women in the work force created a demand for convenience foods.

"We already are tired from working and we buy only packaged foods," said Bertha Rodriguez of Mexico City. The 61-year old great-grandmother supports herself by frying quesadillas in a streetside stand.

People spend more time sitting in the car, at the computer and especially in front of the television — an average of 1,669 hours a year in the United States, a habit that is extending internationally.

With such low activity levels, as little as 100 extra calories a day translates into 10 pounds in a year.

Technology is changing activity levels even in the poorest nations.

"Telephones, cars, computers all come from the freedom from hunger and fear," Bloom said. "But it’s had a bad side effect."

Some governments are taking steps.

Singapore schools have added physical activities and replaced soft drinks with bottled water. Brazil is making school lunch programs serve fruits and vegetables.

But it’s a battle against human nature.

"It would be a huge public health achievement if we simply stopped the weight gain where it is now," said Stephen Blair, research director at the Cooper Institute of Aerobics Research in Dallas.

"I think that’s what we’re stuck with."

Copyright ©2004 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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