For better-off families, the December/January Holiday Season is a period of traditional overeating, while the millions of people who suffer from chronic lack of food and the millions of children who die of malnutrition, worldwide, remain forgotten. Yet paradoxically, diseases once associated with opulent societies and wealthy people increasingly affect both rich and poor countries.

A worldwide epidemic

Being overweight and obese (fat) are among today’s leading health risk factors throughout the world, causing 4 million deaths every year. Obesity is often associated with high blood pressure, high blood glucose (diabetes), cardiovascular diseases and cardiac failure.

Until a few decades ago, obesity was considered a condition associated with high socioeconomic status. Indeed, early in the 20th century, most populations in which obesity became a public health problem were located in the developed world. Beginning in the United States and then spreading to Europe, obesity is now fast emerging as the new pandemic (or worldwide epidemic) of the XXIst century.  It affects both sexes and all age groups and has a disproportionate impact upon disadvantaged population groups. By 2030, for example, more than 50 per cent of the adult population in the USA will be obese.

Dramatic increases in some developing countries

Now, however, the most dramatic increases in obesity are occurring  in some developing countries. In poor countries, initially the higher socioeconomic strata of the population were primarily affected but a shift is taking place from the higher to the lower socioeconomic levels. So, while low childhood weight is still responsible for the death of over 2 million children every year, mainly in low-income countries, it is not uncommon to find households with an undernourished child and an overweight adult, often a woman. In 2010, the World Health Organization reported that more than 42 million children under the age of five were overweight or obese, and, of those, 35 million lived in developing countries. In addition, obesity goes hand in hand with inequality.  In any country, the higher the level of income inequality, the higher the numbers of obese people.

What is the cause ?

In the long run, the rise in obesity will reduce overall life expectancy, while it is already increasing short-  and long-term healthcare expenditures, contributing to making such expenditures unsustainable in national budgets.

What is the cause of this catastrophic global rise in chronic diseases related to obesity?

If you think that fat people are solely responsible for their condition because of their individual behavior, or that their obesity is not your problem, you are wrong!

Indeed, at the individual level, obesity is basically the consequence of the imbalance between energy consumption (physical exercise) and energy intake (what and how much you eat):  individual choices.  Yet choices are strongly influenced by and increasingly dependent on powerful external factors. Let’s analyze them briefly.

Change in the global food system

The process of globalization has transformed the global food system: traditional food production, feeding practices and behaviors have been abandoned or have profoundly changed.  Local agricultural production has become increasingly dependent on resources (such as fertilizers, pesticides, genetically engineered seeds) controlled by powerful transnational companies at the global level.

To maximize their profits those companies, which often control the entire production and distribution cycle, push for increased consumption of food by offering their consumers ample opportunities to eat throughout the day. Global fast food chains are strategically positioned everywhere offering low cost, palatable,  high-sugar, high-fat, high-salt food. Sugar is possibly addictive and salt causes thirst which pushes people to consume increasing quantities of sweetened beverages which are of no nutritional value. Highly processed food is pervasively and persuasively marketed.

Industrially processed foods

Globalized diets based on industrially processed foods (with added sugar, fats, salt, and chemical flavor enhancers) have progressively substituted traditional diets based on locally produced and individually home prepared foods.  Such diets are at the root of the dramatic increase in chronic diseases and obesity. Concurrent causes are urbanization (with reduced distances and availability of transport) and new technologies, which have revolutionized work and entertainment and dramatically reduced physical exercise:  think of children and young people sitting many hours a days in front of the TV or computer, typically consuming popcorn, sweet snacks and beverages!

In addition, the production and distribution cycle of industrially processed food is not environmentally sustainable and implies enormous environmental costs, adding additional long term consequences to health, including unpredictable genetic effects.

Food waste

Obesity in the industrialized world goes hand in hand with food waste. Rich and fat societies are also squanderers. Yearly, at the level of the consumer, rich countries throw away 222 million tons of food, an amount which is slightly less than the total net food production in sub-Saharan Africa (230 million tons), where malnutrition because of the lack of food is still widespread causing the death of millions of children.

In synthesis, obesity is a very serious global problem increasingly affecting populations everywhere which is linked to disease, high mortality, unfair distribution of resources and destruction of the planet!  But the trend can be reverted and we can do a lot both individually and as organized groups, acting locally, nationally and globally through appropriate networks.

Let’s reverse the trend!

Let’s start by modifying our individual nutritional behavior. Avoid as much as possible industrially processed food, including snacks and sweetened beverages. Avoid fast-food and adding sugar to your food. Privilege natural food rich in fiber, such as fresh vegetables and fruits, locally produced and prepared at home. Increase the quantity of vegetables and reduce the amount of meat in your diet (meat consumption is related to cancer and meat production implies enormous consumption of water; furthermore, to produce a kilogram of vegetable protein costs far less in inputs than production of a kilogram of meat protein). Keep active and do physical exercise on a regular daily basis.

If we organize ourselves in groups we can do more. Those who live in rural areas may engage in local production of food and apply the rules of biological cultivation and farming (avoiding chemical fertilizers and pesticides, using instead dung and compost and organic repellants!).

Those who live in an urban area can create a consumer association to buy directly from farms in the region that use biological agriculture and farming techniques. This will grant both to consumers and the farmer fair prices and reduce for the latter the higher business risks of biological agriculture.

By networking nationally and globally we may engage in advocacy for public health nutritional education campaigns.  We must especially push for public policies that regulate the production and marketing of unhealthy food. Scientific literature shows that health promotion programs do not address the underlying social and economic drivers of the obesity epidemic and that policy-led approaches (such as banning high fat and sugar food in canteens, strictly regulating unhealthy food marketing, or using fiscal leverages to reduce incentives to consume and produce unhealthy food) generally show greater cost-effectiveness than health promotion.

No corporate social responsibility without a strong social control

Transnational companies control much of what we eat. Exercising social control on the food industry, for example participating in watch-dog networks, is another possible way to engage in a movement for public health. Industries are extremely sensitive to social pressure which may put their profits at risk, and they may respond to public health concerns and consumer demands to change their products and portfolios.

Nowadays, companies often point out their Corporate Social Responsibility policies, but without strong social control from civil society organizations, that claim may remain just another way to attract consumers, showing the company’s good face, while perpetuating malpractice and the marketing of inappropriate and unhealthy food. Too often, food industries resists national and international public health attempts to modify current practices through legislative changes. Companies eventually by-pass regulations governing marketing strategies, or simply sacrifice their profits in industrialized countries and turn to developing countries where both institutional and civil society responses are often weaker, whereas social damage may be even greater.

The overall model of development is the threat

As you can see, obesity and chronic diseases share an underlying cause with many other threats to humanity: namely, the overall model of development in which we live. Young people are those most capable of embracing a future-oriented vision but, to be effective, they should take advantage of the experience of previous generations and lessons learned. Obesity is another good indicator of the urgent need for a paradigmatic shift from today’s development model. To that end, let’s reduce inequalities, maximize health rather than profit, promote and sustain local knowledge, local production and local consumption, while enjoying our experience and sharing it with others!

Eduardo Missoni