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)

Lu Zhihao, 4, Foshan, Guangdong province March 28, 2011, Photo: REUTERS/Joe Tan

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

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WASHINGTON, D.C. – At midnight on December 31st the world retired 2014 to make way for 2015. For many it marked a night of festivities, parties, and insouciance. For others, like me, it was the day which marked the resetting of health insurance premiums, deductibles, and prescription coverages which would inevitably result in increased costs.

In the days prior, I frantically traveled to doctor's offices and pharmacies to get all of our prescriptions refilled before January 1st. In one instance, my son's pediatrician wouldn't authorize refills for his asthma medications without an appointment. Thankfully we were able to be seen by him on an emergency basis on the morning of December 31st. It was with grateful relief that he wrote all of the prescriptions needed and that I was able to get them filled before the pharmacy closed.

Unfortunately the insurance company would not authorize the refill of one of my son's most expensive medications until after the new year. One might think, with the figures I am about to report, that the medications to which I am referring are 'Brand Named' versus 'Generic.' However, this is not the case. In 2014, before I met my plan deductible, the generic version of one of his medications was $250 for a 30-day supply, while the cost for the brand name was $491. After I met my annual deductible, the costs of this medicine was reduced significantly to $50 for a 30-day supply of the generic which was a great costs savings for our household.

This reduction from my perspective directly correlated with the enactment of The Affordable Care Act (ACA) which was passed in 2010. The ACA, also known as 'Obamacare' made health coverage mandatory and also provided the means for the uninsured to purchase affordable insurance through exchanges which would help regulate the market prices. For me it was a blessing because it reduced my premiums and enabled me to purchase 'individual/self-pay' insurance without having to pay exorbitant premium fees because of 'preexisting' condition as defined by insurance companies such as Asthma, Cancer, Heart Disease, etc.

The cost to maintain this insurance is expensive, but compared to what I paid for COBRA Continuation Health Coverage in 2012, the 33 percent reduction in premium costs was a welcomed relief. I went from paying $1,660 per month to just over $550 per month for better coverage. The only catch was that my prescription costs increased significantly and thus the net/net was actually more like a 20 percent reduction in costs once this was factored in. However, providing the best healthcare for my son was non-negotiable and often meant that bills remain unpaid, and in some instances I didn't refill my medication or go to see the doctor when I needed.

Then, on November 14, 2014, The New York Times reported that "The Obama administration on Friday unveiled data showing that many Americans with health insurance bought under the Affordable Care Act could face substantial price increases next year — in some cases as much as 20 percent — unless they switch plans." Proponents of ACA asserted that this demonstrated that the legislation was working while Republican opponents pointed to these increases as proof that it is not.

As a parent and someone who is directly impacted by the ACA, I can categorically state that without it neither my son nor I would have insurance coverage. I couldn't have afforded to pay $3,000 a month in premiums and prescription costs because of 'preexisting conditions.' From my perspective the 2015 rate increases coupled with inflation in costs for generic medicines is a ploy devised by the insurance companies and pharmaceuticals to incite an already cash strapped American consumer to work against their own best interest. The premise that healthcare for average Americans was better prior to the passing of the ACA is ludicrous.

Me and millions of other Americans remember the heartache and pain of having to watch one's child suffer because an insurance company informed you that your child's healthcare costs would no longer be covered because of an "annual or lifetime" dollar limit. Other parents were faced with the necessity of mortgaging their homes, working several jobs, and making other sacrifices so that they could pay for expensive cancer or heart disease medicines. We all thought these days were behind us, but it turns out that 'we' have become collateral damage in what has been advertised as a war between the Republicans and President Obama.

In reality it is about greed. Providing access to affordable healthcare and prescriptions is not a luxury, it is a need. Parents like me are not 'lazy ne'er-do-wells' seeking to sponge off of the government. We are hard-working individuals who make difficult choices so that our children may live and grow up to be healthy contributors to society. The ACA provided us with hope for such a future, but insurance companies and pharmaceuticals have found a new way to game the system.

Anecdotally, it appears that since insurance companies are forced to insure people who may cost them money, they will make insurance available but the quality of that service is dependent on one's ability to pay for it. Thus, the better the insurance the greater the costs. However, this doesn't help them to recoup their losses (i.e. executives can't buy a new yacht, jet, exotic car, or mansion), so they turn to the pharmaceutical companies to further pressure consumers into lobbying for the dissolution of Obamacare.

When the media first began to report that generic medicine prices would increase substantially I worried but not much. Then, The Chicago Tribune reported on the rising cost of generic drug prices, and I became concerned but couldn't imagine an increase greater than a few percentage points. Then on January 3rd when I asked the pharmacists to fill the one prescription remaining from 2014, I was shocked to learn that the price increased from $50 for a 30-day supply to $391 for a 30-day supply. That was for GENERIC not brand name! I contacted my insurance company and was given a clearly ridiculous story that the cost of manufacturing the drug had increased.

Asthma can be a life-threatening condition and not taking his medication for a few days though not recommended, is not going to kill him. The same cannot be said of parents who have children with a terminal illness like cancer, in which treatment consists of multiple medications and a single prescription can cost upwards of $1,500 per month. Thus, the title of this article seeks not only to grab your attention, but also to help people understand that by taking away our ability to purchase life-saving medicine so that a pharmaceutical company can increase it's profit margin is immoral, reprehensible, and absolutely inhuman; and like it or not the choice to drastically increase the cost of generic drugs is tantamount to 'killing citizens.'

Follow Nahmias Cipher Report on Twitter Twitter: @nahmias_report Editor-in-Chief: @ayannanahmias