Will China Defeat Obesity?

Say what you will about the Chinese, but they know how to make wholesale changes, and sometimes those changes are inarguably for the good. As noted in an editorial in the Lancet last week, the life span of the average person in China in 1950 was 40 years; by 2011 it was around 76. (The average life span in the United States in 2011 was 79.)

The causes of this near doubling of life span are no secret: China has developed public health programs that have reduced communicable diseases to a manageable level. This is certainly good news. But it means that people are now dying of noncommunicable diseases, or chronic diseases that are largely preventable. These diseases, most common in wealthier nations, are caused not by malnutrition in the classic sense but by overconsumption of disease-causing foods as well as lack of exercise and environmental dangers.

Because things are moving so fast in China, and because that country can learn from the example of the United States and others, perhaps it can pull off a public health leapfrog and avoid the West’s fate of a rapid and tragic increase in obesity levels and the diseases with which they’re associated.

And there’s hope: The authors of the Lancet editorial wrote that Li Bin, China’s new minister of health and family planning, “has the political will, together with the support of international colleagues, to meet the urgent challenge” of these noncommunicable diseases and the problems they pose for China’s future.

In high-income countries, excess weight is the third-leading risk factor in death. The importance of addressing this was brought home again last month with the publication of a new study and editorial, also in the Lancet. The work looked at 22 different cancers in Britain and their association with body mass index (B.M.I.), a simple but more effective measure of obesity than weight alone. The conclusions of the study, which involved a whopping 5.24 million people, were both notable and not entirely unexpected: When adjusted for factors like age and smoking, a higher B.M.I. was associated with a large increase in risk of cancers of the uterus, kidney, gallbladder, and liver, and smaller risk increases for at least six other types of cancer.

Most people are aware of the links among obesity, diabetes, and heart disease, but cancer is only occasionally discussed. And although that association is not news precisely, there are a couple of aspects of the new study that make it notable. The sheer size and carefulness of the study add credibility to the obesity-cancer link. And by showing that the more obese a person is, the greater the likelihood of his developing certain cancers, it’s powerful.

The ways in which obesity makes an individual more prone to cancer are far from well understood. Finding those ways may lead to more successful treatment of cancer, and it’s important and continuing work. But identifying what kind of policy might work to reduce obesity—regulations, taxes, subsidies for nonfattening foods, education about better diets, and so on—is, or should be, the primary work of public health officials, activists, and forward-thinking politicians.

With a staggering 70 percent of our adult population overweight or obese, the United States was until recently the world’s leader in this unenviable race. Recently, Mexico (71.3 percent) took our place. (In China, the combined obesity-overweight rate is hovering at under 30 percent, still frightening.) Yet Mexico, which many Americans and Europeans haughtily consider primitive, was the first major nation in the world to institute significant soda and junk food taxes. That law went into effect early this year, and the results are already positive: Sales of soda are slipping.

In the 21st century, it is inevitable that nearly every citizen of the world has been and will continue to be affected by the scourge of junk food and liquid candy. Even though intelligent proposals abound, few countries have attempted to curb their marketing or sales. Without limits, the consumption of unhealthy foods will result in higher rates of obesity, and therefore an increase in associated diseases and premature deaths.

If we know how to diminish needless human suffering and mortality, why would we not? As Mexico has shown, it’s the responsibility of government to protect its population from hyperprocessed food.

China has the potential to apply the lessons learned not only from its own positive experience dealing with communicable disease, but from the tragic mistakes made by so-called developed nations. It has a chance to turn the tide against disease-causing diets before it’s too late. Sadly, we may need its example to wake up to our own problems.

SEPTEMBER 2, 2014