Barry Popkin, in the latest issue of Health Affairs, looks at the impact of economic and other globalization trends on the prevalence of obesity in China. He notes that between 1989 and 2000 the number of overweight adult males tripled, and among adult females it doubled, in China - a rate of change that is among the most rapid in the world - and far larger than in the US. By 2004, nearly a quarter of all Chinese adults were overweight.
His analysis of data from several sources suggests that some of this change is attributable to major dietary changes fueled by tax and import policy changes that increased cheap, plentiful edible oils and the availability and consumption of lower cost animal-source foods. He also sees a shift toward energy-dense diets.
What may be most startling to the conventional wisdom about the increase in obesity is that he does not link it to a Westernization of the food supply and eating patterns. Indeed, it is changes in food marketing that he points to. Many scholars have suggested that the consumption patterns, featuring fast food chains and soft drink consumption, that are dominant in the United States will become a global issue. However, this does not appear to be the pattern of change in China. The major changes one sees in China are in the food marketing landscape. Throughout Asia as in Latin America, the food marketing landscape is becoming dominated by supermarkets, particularly large superstores. In China, Carrefour and Wal-Mart supermarkets are not only expanding rapidly but are also being matched by domestic clones.
This observation should be a reminder to social marketers and others who are attempting to solve what they perceive to be the problems underlying the obesity epidemic - people's 'bad' behaviors and slick advertising (communication and promotion). Creating solutions to the obesity epidemic must tackle fundamental issues relating to the products (the increasing number of foods and selection), prices (affordability) and places (accessibility, opportunity). The challenge is for policy makers and public health professionals to understand that obesity prevention is a marketing issue - not a behavior change and communication one.
And that the greatest increases in obesity are among the world's poor should give many in the development world a second thought as to what the priorities must become in the years ahead.