"Chronic Hunger and Obesity Epidemic Eroding Global Progress"
For the first time in human history, the number of overweight people rivals the number of underweight people, according to a new report from the Worldwatch Institute, a Washington, DC-based research organization. While the world^s underfed population has declined slightly since 1980 to 1.1 billion, the number of overweight people has surged to 1.1 billion.
Both the overweight and the underweight suffer from malnutrition, a deficiency or an excess in a person^s intake of nutrients and other dietary elements needed for healthy living. "The hungry and the overweight share high levels of sickness and disability, shortened life expectancies, and lower levels of productivity-each of which is a drag on a country^s development," said Gary Gardner, co-author with Brian Halweil of Underfed and Overfed: The Global Epidemic of Malnutrition. The public health impact is enormous: more than half of the world^s disease burden-measured in "years of healthy life lost"-is attributable to hunger, overeating, and widespread vitamin and mineral deficiencies.
"The century with the greatest potential to eliminate malnutrition instead saw it boosted to record levels," said Gardner. The number of hungry people remains high in a world of food surpluses. In the developing world, there are 150 million underweight children, nearly one in three. And in Africa, both the share and the absolute number of children who are underweight are on the rise.
Meanwhile, the population of overweight people has expanded rapidly in recent decades, more than offsetting the health gains from the modest decline in hunger. In the United States, 55 percent of adults are overweight by international standards. A whopping 23 percent of American adults are considered obese. And the trend is spreading to children as well, with one in five American kids now classified as overweight.
The specific consequences of hunger and being overweight can be very different. Hunger hits children the hardest, increasing their vulnerability to infectious diseases or conditions such as diarrhea, which often lead to permanent mental and physical impairment or even death. Excess weight gain, on the other hand, takes its greatest toll in adulthood, leading to chronic, but reversible, conditions such as heart disease and diabetes.
Both developed and developing nations are paying a high price for malnutrition. The World Bank estimates that hunger cost India between 3 and 9 percent of its GDP in 1996. And obesity cost the United States 12 percent of the national health care budget in the late 1990s, $118 billion, more than double the $47 billion attributable to smoking.
Surprisingly, overweight and obesity are advancing rapidly in the developing world as well. "Often, nations have simply traded hunger for obesity, and diseases of poverty for diseases of excess," said co-author Brian Halweil. In Brazil and Colombia, for example, 36 and 41 percent, respectively, of the population is overweight, levels that match those of many European countries. Still struggling to eradicate infectious diseases, many developing nations^ health care systems could be crippled by growing caseloads of chronic illness.
"While the myth persists that hunger results from a scarcity of food, inequitable distribution of resources and gender discrimination prevent most of the world^s hungry from getting enough to eat," said Halweil. Some 80 percent of the world^s hungry children live in countries with food surpluses, for example. The common thread that runs through nearly all hunger, in rich and poor nations alike, is poverty.
Since women, as farmers and mothers, are nutritional gatekeepers in many countries, boosting their status is a big step toward improving national nutrition. A 1999 analysis of malnutrition in 63 nations found that improvements in women^s education, access to health care, and living environment were responsible for 75 percent of the reductions in underweight among children.
And eliminating micronutrient deficiencies can produce rapid results for just pennies per person per year. The World Health Organization program to iodize salt in 47 countries between 1994 and 1997 cut the prevalence of iodine deficiency disorder from 29 percent to 13 percent.
Most countries simply do not make nutritional well-being a priority. But even countries struggling with difficult economic and political circumstances can significantly reduce the number of underweight people with the right policies. Cuba and the Indian state of Kerala, for example, have been remarkably successful at reducing malnutrition by targeting nutritionally vulnerable populations such as women and children for special attention. Both governments provide broad access to health care, an important partner to food intake in ensuring good nutrition.
In nations where overeating is a problem, policymakers need a different set of tools. All too often, technofixes like liposuction or olestra attract more attention than the behavioral patterns like poor eating habits and sedentary lifestyles that underlie obesity. Liposuction is now the leading form of cosmetic surgery in the United States, for example, at 400,000 operations per year. While billions are spent on gimmicky diets and food advertising, far too little money is spent on nutrition education.
"In the absence of a strong government educational effort on nutrition issues-in schools, on product labels, and through the regulation of food advertising-most people get their nutrition cues from food companies," said Gardner. "In the modern food environment, we^re like children in a candy shop, every day of our lives."
Improving nutritional literacy can begin in schools. In Singapore, the Trim and Fit Scheme has reduced obesity among children by 33 to 50 percent, depending on the age group, through changes in school catering and increased nutrition and physical education for teachers and children. School cafeterias in Berkeley, California, have gone organic, with some of the produce for meals coming from student-tended gardens on campus.
A serious effort to end overeating could be modeled on the successful campaign to discourage smoking, including the use of "high fat" or "high sodium" warning labels and taxes to deter purchases. Consumption of nutrient-poor foods could be further reduced using a tax on food based on the nutrient value per calorie, as advocated by Yale psychologist Kelly Brownell. Fatty and sugary foods low in nutrients and high in calories would be taxed the most, while fruits and vegetables might escape taxation entirely.
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Press Release for Worldwatch Paper 150, "Underfed and Overfed: The Global Epidemic of Malnutrition," by Gary Gardner and Brian Halweil.
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