Obesity is stalking poor countries

You might not notice it from the way that inflation, conflict and pandemic have driven up the cost of food in recent years, but the specter of hunger that has haunted humanity for millennia is moving closer to being vanquished.

In middle-income countries, the number of people undernourished fell by roughly a quarter, or 162 million, between 2006 and 2020. That’s more than enough to offset the 43 million increase in low-income nations, which are mostly in sub-Saharan Africa .

In China, home to most of history’s biggest famines, the prevalence of childhood stunting — a typical indicator of malnutrition — is now at levels comparable to the US. The shift in India has been just as dramatic. In 2006, more than a third of women were underweight. By 2019, that figure had been cut almost in half.

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There’s a worrying trend happening in this background, however. The share of Indian women who were overweight also nearly doubled to the extent that it now affects more people than does undernourishment.

The picture is the same among men. In the middle-income countries, where three-quarters of humanity live, the scourge of undernourishment is being replaced by a fast-rising epidemic of obesity, along with all the attendant problems of diabetes, heart disease and high blood pressure.

The world has yet to reckon with this emerging problem. In tackling hunger, there’s a global infrastructure. The World Food Program delivered 4.2 million metric tons of food in 2020. We have nothing comparable in place to deal with the coming epidemic.

Alleviating hunger in poor countries is paid for in part via rural subsides in rich nations. The US Farm Bills and the EU’s Common Agricultural Policy deliver income to farmers and generate food surpluses that are exported to the most needy places. Tackling the effects of a rising overweight and obese population in the developing world, however, will fall squarely on the shoulders of the countries where it occurs.

The success of the world in preventing hunger is often seen as a repudiation of the 19th century economist Thomas Malthus, who argued that mass starvation would inevitably result from populations growing faster than agricultural output. In fact, the rising tide of obesity is evidence that the hard limits to food production Malthus envisaged are more binding than many of us suspect.

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To the extent that developing countries have managed to capture extra nutrition to feed their populations over the past few decades, an outsize share has come from the lowest-cost calories — fats, sugars and cereals. The energy in dark green leafy vegetables costs about 29 times more than that in fats and oils, while the calories in vitamin A-rich vegetables such as pumpkin or mangoes costs about 10 times their equivalent in sugar.

Many of the countries where saturated fats make up the largest share of energy intake are not the wealthy ones, but poorer nations in southeast Asia, sub-Saharan Africa, and small islands. What’s happening, in both poor and rich countries, is that people are seeking out the lowest-cost calories to add to their diets. Those don’t tend to be the ones that make up a balanced diet — but they’re the ones that a finite world is most capable of supplying.

The effects are most visible in the rise of diabetes. Bangladesh, Egypt, Mexico and Pakistan have already overtaken the US in prevalence of the condition. The transition to a more sedentary, calorie-rich lifestyle is a key risk factor, according to Paul Zimmet, a professor of diabetes at Monash University in Melbourne.

The world is undergoing a similar transition to what he will witness in the early 1970s in the Pacific island of Nauru, at the time briefly one of the world’s richest countries due to a boom in exports of phosphate fertilizer. “There was sudden wealth that pitched them into a situation where there was buckets of food, but not much in the way of sports facilities,” he said.

Zimmet found that 20-30 per cent of the population had diabetes. “The money they had was invested in food and cars. People were going out of supermarkets with trolleys laden with rice and corned beef.”

As in the case of Nauru, the growth of diabetes around the world is a perverse sort of success story – it’s because the world has been remarkably successful in shifting from a situation of food scarcity to abundance.

With food prices at their highest levels since at least 1990 and Indonesia embargoing exports of palm oil to cool the cost of cooking fats, shortages of nutrition may seem the more pressing problem. Still, obesity isn’t so much the enemy of hunger as its sibling — another symptom of a world unable to provide its people with the nutrition they need to lead a healthy life. In the years ahead, that threat will only grow.

(Bloomberg Opinion)


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