Obesity in low- and middle-income countries: the unexpected side of a global epidemic

by Silvia Monetti

futurediets1A story of paradoxes

In a world where 870 million people still don’t have access to sufficient and nutritious food, over 1.3 billion people are overweight and 600 million obese. More than half of the world adult population experiences this condition. Obesity and overweight, the other face of malnutrition, have been rising particularly fast in low- and middle-income countries –so rapidly that the World Health Organization has started talking of a “global epidemic”.

Shares are higher in some parts of Latin America, the Middle East, North Africa and the Pacific, and lower in other regions of Africa and in Asia. In North Africa and the Middle East over two-thirds of the women are overweight or obese, while about half of them are affected in Latin America and the Caribbean.

Changing dynamics

According to the report “Future diets” of the Overseas Development Institute,

“what has changed is that the majority of people who are overweight or obese today can be found in the developing, rather than the developed, world”.

As a result, such countries face a “double burden” of disease: on the one hand, infectious diseases, undernutrition and the related problems – such as damages to the mental and physical development of inffuturediets-2ants and children, harming their life perspectives; on the other hand, increasing obesity and overweight, equally serious threats to public health: they increase the likelihood of diabetes, hypertension, coronary heart disease, premature death, stroke, some types of cancer and other serious chronic conditions. Severely obese people die 8-10 years sooner than those of normal weight, and this condition is globally linked to more deaths than underweight. All of this is very costly for the whole society, weighing onto health expenditures and economies in the medium- and long-term.

Deep roots

The primary cause of obesity and overweight is an energy imbalance between the calories consumed and those expended – people simply eat more food than they need. In developing countries, increasing income and urbanization are leading to a higher food intake, particularly of animal origin and processed foods that are richer in salt, fat, sugar and caloric sweeteners than the traditional ones. At the same time, increasingly sedentary occupations, transformations in the modes of transportation and the proliferation of urban settings diminish the level of physical activity. Such dietary changes are not necessarily negative. An increase in consumption of animal origin food, for example, can considerably improve the nutritional profile of poor individuals’ diets – but an excessive consumption determines a too high intake of saturated fat and is linked to many different serious diseases. Healthy diets include a high proportion of fruits and vegetables. However, as a country’s economic development improves, grains, vegetables, starchy staples and fresh fruits become increasingly expensive. Junk foods, at the same time, become relatively cheaper. An example: between 1990 and 2012 the price of fruit and vegetables has increased by up to 91% in Brazil, China, Korea and Mexico. Conversely, that of ready meals has dropped by up to 20%.

icecreamGlobalization and changes in the food system, like the diffusion of new technologies for food production, transportation, distribution and marketing, are other key drivers of the epidemic. Fresh markets are being replaced by supermarkets and megastores – promoting safety standards but also enhancing the access to cheaper processed foods high in fat, added sugar and salt. The liberalisation of trade and investments has allowed international companies to set up processed food factories or open fast-food franchises worldwide. In Brazil, the consumption of “ultra-processed” ready-to-eat drinks and foods has risen from 80 kg per person per year in 1999 to around 110 kg per person per year by 2013. In South Africa, the cost of a “healthy diet” is 69% higher than that of a typical one.

Fighting the epidemics

Effective policies have to act on multiple fronts, addressing at the same time individual choices, through information, education and economic instruments, and the food industry, through better regulations of food production and marketing. Sure, this is easier said than done: nutrition is a field particularly difficult to tackle. Governments and international agencies have to deal simultaneously with powerful lobbies and a sensitive, primarily private sphere. Still, in 2014, Mexico – a country where 33% of children and adolescents and over 70% of adults are overweight or obese – introduced a 10% tax on sugar-sweetened beverages. Their consumption had grown parallel to obesity rates. In just one year, taxed soft drinks’ purchases diminished by 12%. Find out more about effective policies for preventing obesity here !


Milan Urban Food Policy Pact: Which cities pursue sustainable systems?

The Milan Urban Food Policy Pact is one of the most important legacies of the Expo 2015 – the Universal Exposition with the theme “Feeding the Planet, Energy for Life!”. The city of Milan took advantage of its position in the global spotlight to propose an international protocol that engaged more than 100 global cities for the development of food systems, based on the principles of sustainability and social justice.

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We invite you to explore this interactive infographic – click on the country to see the geographic distribution, hover over the bar to see how many cities in each country are involved, and check out which global capitals are leading in efforts to create more sustainable food systems. What surprises you most? Is your country present? Is your city? Do you know of urban food policies that are already implemented?

For some inspiration, the e-book “Milan Urban Food Policy Pact. Selected Good Practices from Cities” gives 49 examples of urban food policies that tackle food security, the fight against hunger and obesity, waste reduction, youth education and fair trade purchase, amongst others, in order to shape responsible food communities. Download is free, check it out!