A “Wicked Problem”: Combating Obesity in the Developing World

| October 19, 2011 | 0 Comments

Many developing countries now have obesity rates that exceed those in the developed world. Issues of starvation are being replaced with devastating NCDs, which are directly caused by obesity. Data from the International Association for the Study of Obesity.

An obesity epidemic has replaced the specter of starvation in many developing nations.  Described as a “wicked problem” [1] by the UN general assembly, obesity is a precursor state to several devastating non-communicable diseases (NCDs): diabetes, cardiovascular disease and certain types of cancer.  With obesity rates skyrocketing in countries rich and poor, it is imperative that scientists, policymakers and activists work together to find solutions to this deadly health crisis. The economic impact of obesity on the developing world is particularly brutal; more effective prevention strategies are needed in order to stave off social and fiscal catastrophe.

With the acceleration of globalization and the availability of cheap and energy-dense, highly-processed foods, obesity is fast becoming the most costly challenge the developing world faces. On the basis of wide-ranging evidence, the World Economic Forum now ranks NCDs as one of the top global threats to economic development.[2] In India, one in four families that have a family member with cardiovascular disease incur catastrophic health-related expenditures. As a result 10% of these families are driven into poverty.[3] The devastating obesity epidemic has biosocial roots; it is directly caused by social and political choices.

In countries such as Tonga in the Pacific Islands (see figure), where starvation has been prevalent, obesity can be misinterpreted as a sign of health or financial success. Deliberate over-nutrition of children can establish lifelong eating habits that are extremely difficult to alter. This notion is a significant social barrier to prevention initiatives.

There are two policy approaches to tackling the obesity problem. The first relies on the introduction of health-awareness education to encourage individuals to alter their behavior and the second requires the imposition of government policy.  Overeating is under control of strong genetic and environmental influences that dominate behavior.  While this may seem an adequate solution to the obesity epidemic, it has been shown that simple awareness programs highlighting the health risks associated with over-nutrition have not provided large-scale benefits. A 1995 Cochrane review of 22 studies measuring interventions in children to prevent obesity showed that most interventions failed, and “successful” studies showed small gains.[4]

A more promising solution is that governments take actions to directly alter the obesogenic environment. These would include taxing unhealthy foods, mandating front-of-pack “traffic light” labeling, and restricting TV advertising of junk food to children, and providing affordable health food alternatives. As nations develop economically, traditional diets are supplanted by cheap, imported and obesogenic. Developing nations must balance the short-term economic stimulation introduced by the Western food industry with the long-term and costly health consequences caused by some of the products produced by this industry.  Lack of balance, in favor of corporations, is a major factor contributing to the global obesity epidemic.[5]

Reducing obesity prevalence requires sustained behavioral changes over long periods of time, and political willpower operates on a shorter horizon. The US lacks the gumption to enforce restrictions on fast food corporations in the developing world, as American economic interests weigh in the favor of industry support.[6]  Still, considering the impending economic and social catastrophe, the US and other developed nations have a responsibility to intervene on a global scale.  Governmental intervention to protect at-risk populations by providing healthy food choices must begin immediately.


Sources:

  1. Gortmaker S., Swinfburn B., Levy D. et al. “Changing the future of obesity: science policy, and action.” The Lancet, August 27, 2011.
  2. Bloom, D.E., Cafiero, E.T., Jané-Llopis, E. et al. (2011). The Global Economic Burden of Non-communicable Diseases. Geneva: World Economic Forum.
  3. Beaglehole R., Bonita, R., Horton R., et al. “Priority actions for the non-communicable disease crisis.” The Lancet, April 6, 2011.
  4. Research Directions in Childhood Obesity Prevention and Treatment, NHLBI, NIH, DHHS.” National Heart, Lung, and Blood Institute. 21 Aug. 2007. Web. 18 Oct. 2011. <http://www.nhlbi.nih.gov/meetings/workshops/child-obesity/index.htm>.
  5. Swinburn B., Sacks, G., Hall K., “The global obesity pandemic: shaped by global drivers and local environments.” The Lancet. August 27, 2011.
  6. Ludwig D., Nestle M., “Can the Food Industry Play a Constructive Role in the Obesity Epidemic?”  JAMA, October 15, 2008.

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