Obesity in the Middle Kingdom

On The Street — By Fred Badlissi on June 23, 2011 9:16 am

By Fred Badlissi
For ChinaInFocus

McDonald’s has been a fixture of China’s fast-food scene since 1990. Like many of its competitors, the burger chain has adapted some items to local tastes, like chicken McWings with spicy garlic sauce. But its flagship sandwich, the Big Mac, tastes the same in Beijing as it does in Boston, down to the two meat patties, special sauce and sesame seed bun.

The burger also retains its heft at 540 calories. In the United States, that’s more than a quarter of a person’s recommended daily caloric intake, according to the USDA. But China’s dietary standards have yet to be written, and the absence of standards is just one part of an obesity crisis that is suffocating the nation.

Obesity is one of China’s most pressing public health concerns, whose visibility has broadened as China’s standards of living surge. Quality of life has risen so quickly that British economist Paul French characterized China as going “literally [from] famine to feast in a relatively short time frame” in his 2010 book, “Fat China.”

In Shanghai, considered China’s most westernized city, a report released on June 22 from Jiao Tong University found that obesity had increased over 24 percent among children in the city over the past decade, due in large part to fast food availability and sedentary lifestyles. But the problem isn’t limited to urban areas, as 39 percent of all Chinese are now considered overweight, according to Chinese Body Mass Index (BMI) standards. In spite of the problem’s severity, there is little evidence that the central government has a public strategy in place to combat it.

The lack of initiative highlights an inconsistency in statistics on a national level. In an email exchange with nutritionist Carlynn Sze of United Family Hospitals in Beijing, Sze offered her most current numbers available, which come from a 2002 survey of Chinese health and nutrition. The survey found that 215 million Chinese are overweight or obese nationwide, accounting for approximately one-fifth of the population.

“From 1992 to 2002,” Sze said, “the prevalence of overweight adults increased by nearly 40 percent, and the number of obese adults doubled.” Even rural areas, which have not experienced the same degree of investment, are not immune. “Figures for rural Chinese adults account for more than 60 percent of the population,” she added, “[and their] figures have increased two- to three-fold over the same 10-year period.”

In spite of their age, these numbers appear to be China’s most recent obesity statistics, having appearing as recently as March 2011 in pieces for Xinhua News Agency and China Daily, the central government’s largest newspaper. Western news outlets, primarily based in the UK, cite a 2010 statistic of 100 million obese people in China, but this could not be confirmed before deadline.

So what is China’s best hope to stem the tide? The answer may not come easily.

In the period since the 2002 study, China revised its BMI criteria by adjusting the World Health Organization’s definition of “overweight” and “obesity” by changing the thresholds for each from a BMI rating of 25 to 24 and 30 to 28, respectively. A similar redefinition took place in the United States in 1998, which classified 25 million Americans as “overweight” when they were previously “healthy.” While Chinese health authorities sought to adapt the index to better suit the Chinese populace, the move may also complicate attempts to accurately quantify obesity in future studies.

The Beijing municipal government started a program called “Healthy Beijingers,” a decade-long project aimed at promoting health through online and televised outreach, said Sze. It stresses 34 points of well-being, including attention the use of the BMI.

But being well in a brave, new market-oriented society isn’t easy, according to Junpeng Zhuang, a resident at Ruijin Hospital in Shanghai. The root of many of China’s health problems is a structural one, he said, noting that keeping a population of 1.3 billion healthy can be frustrating, if not impossible. Spreading resources can also be problematic.

“Epidemic prevention programs are funded at the county level, but the programs themselves are responsible for finding 60 percent of their funding on their own,” Zhuang said.

While China’s central government hasn’t explicitly called obesity an epidemic, it was referenced as such in a piece from the state-owned Beijing Review in May of 2008 referencing a letter to the editor from Dr. Tsung O. Cheng, a professor of Medicine at George Washington University. “There is a price that developing countries must pay for modernization,” Cheng observers, but also pleads, “let the price the Chinese pay not exceed the benefits derived from modernization.”

Even “epidemic” classification might not be enough to prompt action from the central government. According to Zhuang, China spent 4.81 percent of its GDP on healthcare in 2009—an increase of less than one percentage point since 1991. China’s GDP increased from 2.1 trillion RMB ($325 billion) to 33.5 trillion RMB ($5.71 trillion) during the same period.

Zhuang also noted the absence of a standardized Chinese nutrition label like the ones suggested by the USDA or mandated by the European Union. Companies often translate and import the information from their host governments into Mandarin. American nutrition labels feature nutrition in terms of calories while letting food producers determine serving sizes, as most other industrialized nations follow servings per 100 grams or milliliters. Consumers can easily find both types in China.

Despite the slow changes and lack of healthier packaging, there might be hope for China’s obesity problem. China’s Ministry of Health announced guidelines for nutrition labels on May 13, and is scheduling their debut for April 2012, according to Sze. But labels alone won’t solve the issue, Sze added.

“Access to health education seems to be the biggest challenge to wellness,” she said.