Perspectives in Health Magazine
The Magazine of the Pan American Health Organization
Volume 7, Number 3, 2002

A global race

The spread of the obesity epidemic to a growing number of countries and the rapid rates of increase in recent years are what have public health advocates worried. Last year the Washington-based World-Watch Institute reported that, for the first time in history, estimates of the number of overweight people in the world rival estimates of those who are malnourished. In its 2002 World Health Report, the World Health Organization (WHO) ranked obesity among the top 10 risks to human health worldwide.

The epidemic has been well documented and extensively studied in the United States, where as early as the 1960s nearly half of Americans were overweight and more than 13 percent were obese. Today some 64 percent of U.S. adults are overweight and 30.5 percent are obese. That is double the obesity rate of two decades earlier and one-third higher than just 10 years ago.

But the United States is not even the leader in the global race to national corpulence. That distinction is held by Samoa, where two-thirds of all women and half of men are obese. In the Americas, Canada trails somewhat behind the United States, with 50 percent of adults overweight and 13.4 percent obese. But data from Argentina, Colombia, Mexico, Paraguay, Peru and Uruguay show more than half of these countries’ populations are overweight, and more than 15 percent are obese.

Even more disturbing, the trend is growing among the Region’s children. Twice as many U.S. children are overweight now than were two decades ago. In Chile, Mexico and Peru, an alarming one in four 4- to 10-year-olds is overweight.

Walmir Coutinho, professor of endocrinology at the Catholic University of Rio de Janeiro and coordinator of the Latin American Consensus on Obesity, notes that rates of childhood obesity increased 66 percent in the United States during the last two decades, but a whopping 240 percent during the same period in Brazil.

"Obesity and overweight are increasing much faster in Latin America than in North America or Europe," he says. "They are fast replacing hunger and malnutrition as contributors to mortality."

The growing body of public health literature on the "globesity" epidemic places the bulk of the blame not on individuals but on globalization and development, with poverty as an exacerbating factor.

In what experts term the "nutrition transition," societies everywhere are moving away from traditional local foods and methods of preparation to mass-produced processed foods that are generally higher in fat and calories and lower in fiber and micronutrients, particularly iron, iodine and vitamin A.

The issue is not just junk food. A large part of the problem is economic. In general, mass-marketed foods are getting cheaper, particularly in urban areas, while fresh foods are becoming more expensive.

"In Latin America, maybe you can go to the jungle and pick your own fruit, but in the city, in supermarkets, fruits and vegetables are expensive," says Enrique Jacoby, an expert on obesity at the Pan American Health Organization (PAHO). Flipping through pages of country data, he observes: "In lots of countries, you can see the increases in consumption of cooking oils, sugar, sweetened drinks and cereals, primarily rice and noodles, while consumption of fruits, vegetables and legumes is going down. Having a big wallet makes a difference. The poor are forced by their limited resources to eat less healthy foods."

Along with this nutrition transition, improvements in technology and the evolution of the modern metropolis have created an "obesogenic environment" in which new patterns of work, transportation and leisure have people around the world leading less active, more sedentary lives.

"Even lower income groups have growing access to conveniences such as television, telephones and cars," says Coutinho. "These predispose people to sedentary habits and are leading to dramatic changes in lifestyle that contribute to the problem."

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