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Obese Chinese boys exercise with a coach at a summer camp in Zhengzhou, Henan, in July 2017. Summer camps have sprouted up across the country in recent years to help fat children lose weight. Photo: Visual China Group via Getty Images
Opinion
Inside Out
by David Dodwell
Inside Out
by David Dodwell

Obesity is now a big fat global problem, especially for children

  • The face of the 1 billion-strong obesity epidemic is changing, with rates surging across the developing world and growing faster globally for the young than for adults
  • In Hong Kong, in particular, three years of lockdowns and school closures worsened obesity rates for children
David Dodwell
David Dodwell
Why you can trust SCMP
March 4 marks World Obesity Day, and a sobering moment to ponder the reality that more than 1 billion people worldwide are obese. The price tag linked to illnesses caused or aggravated by obesity is estimated to rise from around US$2 trillion a year to over US$4.3 trillion by 2035, according to the World Obesity Federation.
Long regarded as a problem concentrated in the wealthy Western economies, obesity has become endemic in the developing world and is increasingly a problem for children, according to a Lancet study released last week.

The study, undertaken by 1,500 researchers and conducted in collaboration with the World Health Organization, comprised 3,663 studies and 222 million participants. Tracking the progress of the obesity epidemic from 1990-2022, it calculates that one in eight people worldwide are obese (with a body mass index of 30 or more). Since 1990, the obesity rate has doubled for women (18.5 per cent) and tripled for men (14 per cent).

Alarmingly, the obesity rate has quadrupled for children and adolescents. Among those aged five to 19, 6.9 per cent of girls and 9.3 per cent of boys are obese. This growing population is at risk of the early onset of ailments from hypertension and cardiac problems to diabetes and cancers.

If there is any good news at all from the study, which also tracked the world’s underweight population (with BMI under 18.5), it is that the world’s underweight population has fallen to 532 million, down 127 million from 1990. This is no doubt due to falling poverty over the past three decades.

“We tended to think of obesity as a problem of the rich. Now [it’s] a problem of the world,” said Dr Francesco Branca, WHO’s director of nutrition and health, and a co-author of the study.

02:29

Chinese boy breaks 3 treadmills in weight loss journey

Chinese boy breaks 3 treadmills in weight loss journey
While obesity is growing most rapidly among the young, it is also surging in areas such as North Africa and the Gulf region. Massive economies including China and India have seen a rapid rise in childhood obesity in particular, at a compound annual rate of 7.5 per cent for China over 2000-2016, and 7.9 per cent for India, according to the World Obesity Atlas 2024. The common root? Economic development.

In short, wherever you find rapid economic growth, rising gross domestic product per capita and growing urbanisation, you find a decline in physical activity as people shift from hard labour to city jobs. “We have set up our societies in such a way that they don’t support good health,” said Louise Foley at Cambridge University’s Centre for Diet and Activity Research. “We haven’t really designed our cities to make activity an easy thing to do.”

In Hong Kong, the Covid-19 lockdowns over three years, which intensified bonds between many children and their smart devices smartphones, aggravated the obesity problem among children.

A recent study noted that during the pandemic, the prevalence of overweight and obese schoolchildren rose by 6.3 per cent for those in Primary 1-2 and by 2.7 per cent for those in Secondary 1-2. It attributed this to increased sedentary behaviour, more time spent online and a jump in the consumption of takeaway junk food. The increase in school closures also exacerbated things – children tend to put on weight during the school holidays when they stay at home more.

McDonald’s in Kowloon Bay on March 4, 2023. About one in two adults are considered overweight or obese in Hong Kong and the detection rates of overweight (including obesity) of primary and secondary school students were about 18 per cent and 20 per cent respectively. Photo: Xiaomei Chen

There is no shortage of alarming findings as the world grapples with an obesity epidemic. The World Obesity Atlas 2024, released on the eve of World Obesity Day, warns that we could have 1.9 billion obese people by 2035 – about one in four worldwide. It calculates that the obese and overweight together will account for over half of the world’s population, with the number of obese and overweight children doubling to around 770 million.

Even the World Obesity Federation’s projection of US$4.3 trillion in obesity-related economic costs by 2035 may be an underestimation. It is difficult to fully account for the economic toll of “weight stigma”, and research suggests that overweight women tend to earn less, with obese women taking as much as a 10 per cent income hit.

While unhealthy lifestyle changes linked to economic progress and urbanisation can play a big part in aggravating the obesity pandemic, the unaffordability of nutritious food – which pushes the poor towards junk food – is also a major contributor.

01:15

Malaysia imposes new tax on sugary drinks to fight obesity

Malaysia imposes new tax on sugary drinks to fight obesity
The research across the board is clear. There is much to do to tackle the obesity epidemic, especially among the young. Mothers should be encouraged to breastfeed their babies and for longer, the marketing of unhealthy food should be more strictly regulated, with transparent food labelling enforced and food prices geared to encourage healthier choices. The quality of school meals must also be monitored and physical activity encouraged, especially for children in schools.

As WHO director general Tedros Adhanom Ghebreyesus said: “Getting back on track to meet the global targets for curbing obesity will take the work of governments and communities, supported by evidence-based policies from WHO and national public health agencies. Importantly, it requires the cooperation of the private sector, which must be accountable for the health impacts of their products.”

“A global treaty would be fantastic but there’s not been a concerted political will behind that,” said Johanna Ralston, CEO of the World Obesity Federation. “Policies don’t often change until there’s an existential threat.” Perhaps the threat of a billion obese people across the world is not existential enough.

David Dodwell is CEO of the trade policy and international relations consultancy Strategic Access, focused on developments and challenges facing the Asia-Pacific over the past four decades

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