Obesity is in the rise. Photo credit: radio.uchile.cl

By Matthew Owens

Chilean children are the fattest in Latin America according to international research published today (Thursday) in the English medical journal The Lancet. The results of the study highlight a disturbing global trend of rising obesity for children and adults over the past 30 years. The paper calls for “urgent global action and leadership” to combat the epidemic.

In a released statement from the journal, study co-author Professor Gakidou said, “Unlike other major global health risks, such as tobacco and childhood nutrition, obesity is not decreasing worldwide. Our findings show that increases in the prevalence of obesity have been substantial, widespread, and have arisen over a short time.”

How much is too much?

You are usually considered overweight or obese if your body mass index (BMI) is greater than 25 (30 or more for obesity). Being either of these results in death for more than three million people every year and research shows that it is not only obesity that is the killer: just being overweight is enough to significantly increase the risk of serious health problems. Most fatalities are due to heart disease but the list goes on to include cancer, diabetes, osteoarthritis and chronic kidney disease. There are of course other non-fatal, psychosocial effects such as exclusion from social groups, bullying, low self-esteem and emotional problems.

How many are overweight?

Results from the latest research, funded by the Bill & Melinda Gates Foundation, show that the proportion of overweight people on the planet has increased at an alarming rate from 29% to 37% of men and from 30% to 38% of women, in the short period from 1980 to 2013.

Depressingly, none of the 188 countries in 21 regions saw a significant decline in obesity rates over these past 33 years. However, in developed countries, the rate had begun to slow from 2006, leaving room for optimism for future generations.

Additionally, the authors note a trend for younger generations to gain weight more slowly than in the past. Yet scepticism remains as to whether the 2013 World Health Organization commitment to halting the trend by 2025 has any real hope of being met.

“Our analysis suggests that the target to stop the rise in obesity by 2025 is very ambitious and is unlikely to be achieved without concerted action and further research to assess the effect of population-wide interventions, and how to effectively translate that knowledge into national obesity control programmes.”, Gakidou said.

Young people and Latin America

The global prevalence of overweight and obese children (under 20 years) is particularly troubling, increasing as it has dramatically over the period, in both developed (a rise of 7% in both boys and girls) and developing countries alike (up by 5%).

While it is true that many people in Latin America are still undernourished, obesity has now become the region’s most important public health concern. In terms of regional data, Latin American rates in the study were among some of the highest recorded anywhere. Boys, for example, in Southern Latin America and women in Andean Latin America, had the highest overweight levels of any of the 21 regions. These results chime with recent findings reported by Mexican researcher Professor Rivera that show that around 25% of young people in the region are overweight.

There are limitations to the newly published work however. The authors note perhaps the most important of these, the variation that may have been obscured by not looking in more detail at subnational regions. So, for example, there are likely to be large differences between urban and rural areas.

Ricardo Uauy, Professor of Public Health at the London School of Hygiene and Tropical Medicine makes a similar point:

“…it [the study] does have the strength of providing a global and national perspective and applies the same methodology to all countries alike however the specifics of every country, trends, determinants etc. require a more careful analysis.”

Causes

Although the Lancet study was not designed to tackle the issues of causes of obesity the authors point to the increase in calorie intake and decrease in physical activity. In a commentary to the article, Dr McPherson from the University of Oxford suggests that,

“Together with the technological revolution in food science and the sale of junk food, modern lifestyles and increasing disposable income play a part in this problem. Although appetite is necessary for survival, increased exposure to processed food is overwhelming people.”

Chile

The stats certainly don’t get any better when turning to the national level data for Chile. As the editoral on the Rivera article suggests, Chile (and Mexico) are among the world’s “fattest nations”. Thirty seven percent of boys are overweight or obese and 12% weigh in as obese, the largest proportions in Latin America, while rates for girls were 32% and 12%, respectively.

Chilean men are the most overweight in the region (68%) with 22% additionally classified as obese. Not a patch, however, on the likes of the USA (32% of men and 34% of women obese) or pacific islanders Tonga, where a whopping 52% of men and 67% of women are obese. ‘Only’ 64% of Chilean women were ‘overweight or obese’ and 30% obese, placing them further down the regional table.

What is to be done about this epidemic?

In Chile and Latin America, public policy is only starting to get underway. In 2012, the Chilean National Congress passed a law on food labeling and advertising, the first of its kind in Latin America, which should help inform the public, allowing them to identify risky foods. The legislation also facilitates the banning of advertising of certain foods to children.

More broadly though, a concerted effort is going to be necessary to make any dent in the problem. Interventions may have some beneficial effect although this may in reality be small. Changes at the policy level will have to be sweeping in order bring about the change needed to improve quality of life for what amounts to about a third of the world population. “To prevent unsustainable health consequences, BMI needs to return to what it was 30 years ago. Lobstein calculated that to reduce BMI to 1980 levels in the UK would require an 8% reduction in consumption across the country, costing the food industry roughly £8·7 billion per year. Is this possible in a neoliberal competitive world?” commented McPherson.

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