CHINA - There is a big problem - one which has only gotten bigger in recent years. For the first time, researchers have confirmed that China is facing an ever-growing problem with obesity, an epidemic that has typically only plagued Western nations such as the United States. According to reports, China which previously ranked second among countries with rising rates of obesity finds itself in the unenviable position of surpassing the US in terms of percentage of obese citizens. “A new Gallup survey published on Friday shows that the obesity rate among adults surged in 2015 to a new high of 28 percent, or a 2.5 percentage point increase since 2008. That means the ranks of dangerously overweight Americans increased by 6.1 million adults over that seven-year period.” (Source: The Fiscal Times)

In many countries, especially those with emerging economies, obesity is associated with economic prosperity. For instance, in Mauritania, a practice called ‘gavage,’ the force feeding of girls to make them fat, is still practiced despite the obvious health risks. This practice is a consequence of societal norms of beauty which arose from the association of weight with affluence.  In this North African country where famine and starvation historically resulted in women being vastly underweight, being overweight signified the converse. Thus, obesity became alluring despite the grave health risks associated with it. However, in the affluent nation such as the U.S., obesity is the result of a complex confluence of factors, including stress, lack of exercise, smoking cigarettes, eating processed or genetically modified foods, or other known ‘fat’ culprits such as high fructose corn syrup.

Those less in tune would find the trend of obesity on the rise in China incomprehensible. From a Western perspective, a country with nearly 1.4 billion citizens is certainly unable to adequately support, much less provide enough food to feed these many people. Thus, it is a conundrum how the plague of obesity has beset a nation in which many of the country's oldest residents vividly recall a time in which the opposite was true. It was during the brutal era of the great famines of China. This tragic part of China’s history is rarely discussed, nor do many young and modern citizens recall the horrendous circumstances in which 45 million people died. Following the Communist Party’s take over in 1949, a deadly combination of natural disasters and ill-conceived government policies resulted in farms being forcibly taken or farmers being ordered to produce food well beyond the capacity of their lands. These farmers were not allowed to consume the food they produced, and if they protested against this mistreatment they were maimed, tortured, or killed.

Shockingly, within less than 70 years, China has managed to go from one extreme to another. It has transformed itself from a nation torn apart by a cultural and political revolution, to one which churns out an astronomical number of exports to the tune of “US$2.282 trillion in 2015.” The top 10 products which the U.S. and other nations purchase from China include, “Electronic equipment, Machines, engines, pumps, Furniture, lighting, signs, Knit or crochet clothing, Clothing, Medical, technical equipment, Plastics, Vehicles, Iron or steel products, and Footwear.” (Source: World’s Top Exports)  The affluence which China has experienced as a result of becoming one of the world’s leading manufacturer is reflected in improved economic stability and social ascendancy which many of its citizens now realize. 

With more discretionary income and leisure time, Chinese citizens are now experiencing a trend which was once unimaginable.  Unprecedented increases in the rate of obesity among its citizenry, particularly with the country's youth, and predominantly in its male population. Boys seem to be at highest risk for this endemic predisposition towards obesity. Recent findings have shown that as of 2014, a staggering 17% of boys and 9% of girls under the age of 19 were reported as being obese, up from just 1% of each when the studies were first conducted in 1985. In addition to the issue of obesity, there has also been an increase in corollary non-communicative illnesses.

• Juvenile Diabetes: According to a 6 April 2016, World Health Organization news release, “Unhealthy lifestyles are also putting China’s children at risk of developing diabetes: more than 4 in 5 adolescents 11-17 years do not get enough physical activity, and rates of overweight and obesity in children are increasing rapidly: from less than 3% in 1985 to around 1 in 10 in girls and 1 in 5 boys in 2010.”

• Adult Diabetes: The estimated prevalence of diabetes among a representative sample of Chinese adults was 11.6% and the prevalence of prediabetes was 50.1%. Projections based on sample weighting suggest this may represent up to 113.9 million Chinese adults with diabetes and 493.4 million with prediabetes. These findings indicate the importance of diabetes as a public health problem in China. (Source: ResearchGate, Prevalence and Control of Diabetes in Chinese Adults)

• Hypertension: In 2010, the prevalence of hypertension increased to 33.6% (35.3% in men and 32.0% in women) or 335.8 million Chinese adults based on the China Noncommunicable Disease Surveillance 2010, which was conducted in a nationally representative sample of 98 658 Chinese adults aged at least 18. (Source: Journal of Hypertension in China)

• Heart Disease and Stroke: The European Society of Cardiology presented to the 27th Great Wall International Congress of Cardiology Asia Pacific Heart Congress the fact that “40%, the mortality rate due to cardiovascular disease (CVD) in China is amongst the highest in the world¹ and has been rightly described as an epidemic. Its population faces a catalogue of CVD risk factor statistics that expose high levels of obesity, diabetes, cholesterol and blood pressure, and a smoking habit within males that is proving stubborn to address. (Source: European Society of Cardiology)

These many obesity-related factors are causing growing concern among Chinese government officials, who worry that it will put increased burden on China's healthcare system which currently lacks the elasticity to handle non-communicable diseases such as obesity which is largely preventable.  In China, as in the U.S., the drastic changes in weight gain among its citizenry is also linked to a growing popularity for high-sodium and fatty foods (such as fast food), which are both inexpensive and readily available. Additionally, China struggles with the cultural acceptance of cigarette smoking, which is another deadly factor that contributes to a host of long-term illnesses. In the U.S. smoking has been advertised as deleterious to one’s health, and many people, especially those who are health conscious, find the practice anathema.

However, smoking isn’t viewed with the same negative connotations outside of the U.S. In Europe, Africa, and the Middle East smoking is a integral component of social interactions, and the same can be said of China. Smoking among the younger generation is on the increase, and this coupled with decreased levels of physical activity are contributing factors to the rise of obesity.  Their decisions to relocate to major cities to pursue high paying job and educational opportunities are the very things which now disadvantaged them. They have replaced low wages and physical labor, with jobs where they work long hours in cramped office spaces, under stressful conditions, which they relieve by smoking or drinking alcohol, neither of which are little more than palliatives.

Officials in both countries are now racing against the clock to aggressively combat a crisis that is both socially and economically complex. One which will take the combined efforts of the citizens, scientists, food producers, and the health care system to develop a long-term strategy for tackling this problem. Steps have been taken by both nations to raise public awareness of the problem through advertisement, anti-smoking campaigns, instructing doctors to provide BMI information to patients in addition to their weight, as well as promoting programs designed to help people develop better eating and exercise habits. Additionally, the creation of educational programs throughout China, such as those sponsored by the Joint US-China Collaboration on Clean Energy (Source: JUCCCE), have achieved some success in teaching kids the importance of eating healthy.

Here in the U.S. similar programs have been implemented with the goal of encouraging Americans to make positive healthy lifestyle changes, however, it is as difficult for the government of the U.S. as it is for China to convince people to adjust social norms. For example, as Americans have become more obese, manufacturers make clothes in larger sizes to accommodate increased girths. Many of these clothes are made in China which produces them in accordance with consumer demand. Though this correlation is simplistic, one thing is for certain - China and the U.S. would greatly benefit from moving beyond a relationship governed solely by economic expediency to one which protects the health of the two most important resources of their economic ecosystem - laborers and consumers.

The epidemic of obesity which plagues both nations has far reaching repercussions both economically and societally. The levels of economic prosperity, the ease of modern living, plentiful goods and services, and access to functional and unburdened health systems, are all things which are threatened should each nation fail to stop this scourge. It is imperative that we remember in meeting this daunting challenge that real change is only accomplished through implementing strategies which promise long-term success.

Waging a successful ‘battle of the bulge’ will be a slow and arduous undertaking, one which could best be viewed in terms of dieting.  One can lose a lot of weight quickly and just as easily gain it back and then some, or one can implement a regime that takes longer and requires more discipline, but ultimately leads to a gradual return to optimal health. Thus, it is important for us to remain cognizant of the pitfalls of focusing all of our effort on a single aspect of this epidemic to the exclusion of all others, because to do so would be akin to winning the battle, but losing the war.

Contributing Journalist: @JonEizyk
LinkedIn: Jon Eizyk