‘We can all agree that . . . all children should have the basic nutrition they need to learn and grow and to pursue their dreams, because in the end, nothing is more important than the health and well-being of our children.’
Michelle Obama1
OUR PLANET IS fat and getting fatter. We are living in the midst of a global obesity pandemic, a pandemic which began some thirty years ago in industrialised countries, before rapidly spreading to the developing world.2 Today an estimated 1.46 billion adults worldwide are overweight and 671 million are obese.3 And it’s not just adults who are affected, of course. In some countries over a quarter of children are too fat to be healthy, more than double the proportion at the start of the 1970s.4 Worldwide, around 170 million children under the age of eighteen are now either overweight or obese.
In the UK, dubbed ‘the Fat Man of Europe’ by the Academy of Royal Colleges, the number of obese adults has risen by 300% over the past three decades.5
In 1966, just under 80% of adults were in the ‘healthy’ weight range, with only around one in seven (13%) men being overweight and one in a hundred (1.2%) obese. Among women, just one in ten (9%) was overweight or obese. By 1996, those in the healthy range had declined to 28% of men and 38% of women. At the same time, the proportion of both overweight and obese people had risen significantly. Almost half of all men (49%) and a third of all women (36%) had become overweight, while about a quarter of both sexes were obese (23% of men and 26% of women).6
In the decade and a half since then, these differences have become even greater, with two thirds of adult males and more than half of adult females now either overweight or obese. Half a century ago, the average British woman could wear a UK dress size 12 comfortably. By 2006 she would have needed a size 14. Today, almost half (47%) would struggle to squeeze into anything smaller than a size 16 or even larger. If this trend continues, by 2030 there will be 11 million more obese men and women in the country.7
Obesity rates are predicted to rise as rapidly throughout Western Europe as they have in the UK. Laura Webber, from the UK Health Forum, predicts that by 2030, 80% of adults in Spain, the Czech Republic and Poland, and 90% of adults in Ireland will be overweight or obese.8
The story in the US is even worse. Over the past three decades, America has become famous for its fatness. Despite having a greater awareness of obesity than almost any other nation, two thirds (68%) of American adults are overweight and a third (34%) obese. Between 1960 and 2004, the proportion of men aged between twenty and forty who fell into these categories rose from 45% to around 70%. In twelve states, more than 30% of the population are obese, and not a single state has an obesity rate lower than 20%.9 The prediction here is that, by 2030, there will be an additional 65 million obese people in the US.
But despite our tendency to think of obesity as a problem largely confined to wealthier countries, in actual fact there is nowhere where the problem of weight gain is happening faster or more dangerously than in the developing world, where healthy, traditional diets are being replaced with far more energy-dense, less nutritionally sound, Western-style eating habits.10 The process of globalisation and foreign direct investment into food processing has been directly linked with the shift in diets amongst emerging economies.11 In India, for example, almost 75% of Foreign Direct Investment goes towards highly processed foods. The shift in diets is referred to as ‘nutrition transition’, which serves as a euphemism for the disastrous consequences that obesity will spell for the developing world.12
China provides an important case study in this regard. It has only been within the last twenty years that the Chinese have had access to a ‘Western’ diet and the consequences have been disastrous. While obesity was never traditionally a problem in Asia, today there are around 350 million overweight and 60 million obese people in China.13 This is around one quarter of the population. At the same time, roughly a hundred million are undernourished – a stark contrast, which goes to show just how warped our current food systems are. It has become increasingly common to find obesity coexisting with malnutrition, sometimes even within the same household.14
If the pattern set by China and other developing countries continues to be followed, and traditional foods continue to fall out of favour, then obesity and the ill health that accompanies it will become a crippling societal norm.
What is particularly troubling in this general increase in weight we are seeing across the world is how severely children are affected.
In Britain, obesity is rising twice as fast among children as among adults. Today more than one in seven (16%) youngsters aged between 6 and 15 are obese, a percentage that is three times higher than ten years ago. It is conservatively estimated that, within six years, a quarter (23.5%) of boys and a third (32%) of girls will be either overweight or obese. By comparison, only 4% of French children are obese. A third of all obese children in Europe are now British.15
In the US, the largest industrialised country on the planet, obesity rates in children are far worse, and are still skyrocketing. Between 2009 and 2010, 32% of children between the ages of 2 and 19 were overweight or obese.16 If these trends continue, experts warn that by 2030 there will be 65 million more obese adults in the USA. Whether this is a reflection of an inherent biological tendency towards the development of obesity in certain nations, or the consequence of socio-economic conditions, is still up for debate (though the latter seems more likely).
Regardless, with a deluge of processed cereals and fatty, sugary foods now being made available in developing countries, it is hardly surprising to learn that childhood obesity rates are already on the rise globally, with a 60% increase in childhood obesity since 1990. 17 Patterns of weight gain, similar to those present in the developed nations, can now be found among children and teenagers in developing countries. Over the past ten years, the percentage of those who are overweight or obese has risen from around one in ten for both boys (8.1%) and girls (8.4%) to one in eight (12.9% for boys and 13.4% for girls).18
This additional weight has a direct impact on the health of the individuals concerned. The ‘metabolic syndrome’ is a term used to describe a cluster of health problems that arise when people become excessively overweight. These include an increased risk of high blood pressure (hypertension), cancer, cardiovascular disease, dementia, infertility, painful joints, depression, raised blood sugar and cholesterol levels and, above all, Type II (adult onset) diabetes.
In the UK, over three million adults (representing 6% of the population, or 1 person in 17) were diagnosed with diabetes in 2013. 19 In the USA, researchers predict the number of sufferers will have risen from 11 million in 2000 (4.0% of the population) to 29 million in 2050 (7.2% of the population).20 Many doctors, on both sides of the Atlantic, believe these numbers significantly underestimate the extent of the problem, since there are likely to be many more individuals whose diabetes has yet to be diagnosed.
Claire Wang, from the Department of Health Policy and Management at the Mailman School of Public Health, warns that if these trends continue, within five years there will be ‘an additional 6–8.5 million cases of diabetes, 5.7–7.3 million cases of heart disease and stroke, 492,000–669,000 additional cases of cancer and 26–55 million quality-adjusted life years forgone in both the USA and UK combined.’21
Another recently identified health problem affecting overweight or obese women is an increased likelihood of developing rheumatoid arthritis later in life. According to Bing Lu and his colleagues, from Harvard University’s medical and public health schools in Boston, the risk of developing the condition is a third higher (35%) for women who are overweight at the age of eighteen or older. Furthermore, the chances of their developing a more severe form of rheumatoid arthritis, known as seropositive RA, increases by almost 50%.22
Obesity is not only linked to a decline in physical health, but also in mental health; the association between obesity and depression is well established. Yet, there may be an even more worrying consequence of excessive weight. Excess adipose tissue is now also known to cause inflammation in key areas in the brain directly related to appetite control, including the hypothalamus.23 It’s not just physiological dysfunction in the form of heart disease or cancer that is associated with excess weight; rather, we are beginning to see a pattern of cognitive decline that is associated with obesity. For example, we now know obesity presents a major risk factor for the development of Alzheimer’s Disease, a condition doctors are now calling Type III diabetes.24
The overall picture is clear: the whole world, rich and poor, young and old, is gradually getting fatter. The consequences of this, both for individual sufferers, and at a wider societal level, will be severe. If we continue eating ourselves sick, billions will suffer ill health and shortened lives. The financial and social costs will become unsustainable and our planet uninhabitable. While there can be no easy answers to what is – as we will show – a complex and multifaceted problem, there are certain practical steps that individuals, companies and governments can and must take to bring the obesity pandemic under control.
These are the issues which we will address in this book.