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Globesity: What nation has the highest rate of obesity?

I always tell my clients who see me for weight loss that their weight may be an important number, but it doesn’t tell you everything.

Weight doesn’t always prove how healthy someone is — more important numbers include blood pressure — a critical number to measure — but blood pressure doesn’t always correlate with weight.

A new word has entered our lexicon, first recorded 2000-05. As reported by the World Health Organization, an escalating global epidemic of overweight and obesity — “globesity” — is taking over many parts of the world, paradoxically coexisting with under-nutrition and malnutrition in many countries. Globesity portends the suffering of millions from an array of serious health disorders — many, if not all of them, preventable.

Take this quiz to see how much you know about overweight and obesity around the world.

  1. Which of the following is true?
    • In developed countries, childhood obesity has stabilized
    • In developing countries, more men than women are obese
    • In both developed and developing countries, less educated women are two to three times more likely to be overweight or obese.
  2. In the U.S., what state had a statistically significant improvement in their obesity rate in 2017 from the year prior?
    • California
    • Colorado
    • Connecticut
    • All of the above
    • None of the above
  3. Which nation has the highest total number of overweight and obese people?
    • U.S.A.
    • Ecuador
    • Mexico
    • Finland
    • American Samoa
  4. Which nation has the highest percentage of adults and children with a BMI of 30 or greater (obese)?
    • U.S.A.
    • Ecuador
    • Mexico
    • Finland
    • American Samoa
  5. Which area of the world is experiencing the fastest and largest increase in obesity, especially in children and women?
    • North America
    • Europe
    • Middle East
    • South America

Answers

  1. In both developed and developing countries, less educated women are two to three times more likely to be overweight or obese. Education and socio-economic background affect obesity, and in turn, obesity contributes to reinforcing social inequalities. According to the OECD Obesity Update 2017, obese people have poorer job prospects compared to normal-weight people, are less likely to be employed and have more difficulty re-entering the labor market. Childhood obesity is considered one of the most serious public health challenges of the 21st century. The increase in obesity has disproportionately impacted women: in more than 20 countries in Latin America and the Caribbean, the rate of female obesity is 10 percentage points higher than that of men.
  2. None of the above. The Trust for America’s Health and the Robert Wood Johnson Foundation released The State of Obesity 2018: Better Policies for a Healthier America which shows that in the U.S. adult obesity exceeds 35 percent in seven states, 30 percent in 29 states, and 25 percent in 48 states, the highest obesity rates ever documented. The greatest obesity in the U.S. is in the South — West Virginia has the highest adult obesity rate 38.1 percent — Colorado the lowest at 22.6 percent. Not one state has experienced a decrease in obesity rates. Click here for an interactive map that tracks U.S. obesity from 1990-2017.
  3. USA. Only 5 percent of the world’s population lives in the United States, but 13 percent of the global total of overweight or obese people live there. More than 160 million Americans are either obese or overweight, almost three-quarters of American men and more than 60 percent of American women are obese or overweight. At least 30 percent of American boys and girls under age 20 are either obese or overweight, up from 19 percent in 1980.
  4. American Samoa currently estimates that 75 percent of their population is obese. Under colonial rule and the introduction of ‘Western diets’ to Pacific Islanders, obesity is booming. Pacific Islanders traditionally consumed fresh fish, meat, local fruits, and vegetables, but now it’s soda, packaged foods, sweets, and inactivity. These countries have obesity rates almost as high as the United State’s. Pacific Islanders on Nauru and the Cook Islands have the highest levels and fastest rate of obesity increases in the world — currently four times higher than the global average.
  5. Middle East. ‘Diabetesity’ — a word coined to describe the increase in type 2 diabetes that is attributed to the explosion in the rate of obesity, is expected to “explode” in the Middle East by 2045. As reported in the Khaleej Times, eight Middle Eastern countries — Kuwait, Qatar, Egypt, the Kingdom of Saudi Arabia, Bahrain, the UAE, Jordan, and Lebanon have obesity rates of 27 percent to 40 percent of the total population — adults and children.

In 2014, The Institute for Health Metrics and Evaluation, based in Seattle, Washington reported, “No country has successfully reduced obesity rates in 33 years.” And in 2019, most countries show no evidence of even reaching a plateau in adult obesity.

The United States currently has the greatest number of obese people in the world, but nations who formerly had malnutrition as their largest health problem such as China and India are catching up.

Top 10 Most Obese Countries (July 1st, 2017) in terms of population numbers

  1. United States of America – 109,342,839
  2. China – 97,256,700
  3. India – 65,619,826
  4. Brazil – 41,857,656
  5. Mexico – 36,294,881
  6. Russia – 34,701,531
  7. Egypt – 28,192,861
  8. Turkey – 23,819,781
  9. Iran – 21,183,488
  10. Nigeria – 20,997,494

Taking steps toward better health
Over 60 percent of children who are overweight before puberty will continue to be overweight as young adults. Some countries have put in place some public policy initiatives to at least slow the rate of childhood obesity.

For example, Chile is fighting back against the unfair advantage junk food manufacturers have — billions are spent yearly to push foods high in sugar, salt, calories, or saturated fat. Currently, packaged foods must carry warning labels resembling black-and-white stop signs, making it immediately clear to the consumer which foods are linked to obesity and other chronic diseases — in black and white. And even more importantly, foods carrying these warning labels are banned from being served in schools or advertised to children. As reported in Rand.org, labels are changing behaviors and nearly 40 percent of Chileans are using the symbols to help them decide what to buy.

Before and After: Targeted marketing implementation. Credit: Blooomberg Philanthropies

 

As reported in the Washington Post, Norway, Sweden, Britain, and South Korea have restricted junk food advertising, especially to kids. Some countries have enacted taxes on added sugars. Japan turned its rising obesity rate into the lowest in the world in part by enacting healthier school lunches.

In 2015 Dutch sugar consumption was found to be the third highest in the world, after the U.S. (highest) and Germany (the second highest). Although the Dutch are known for the 365 days-a-year bicycling culture, Amsterdam has a large percentage of immigrants from Suriname and other countries where biking and physical activity is not part of their culture.

Six years ago, almost one in five children in Amsterdam were found to be overweight or obese, which prompted a citywide initiative — first, change the schools. No more juices, sugary desserts, no more junk for birthday celebrations (which can be daily!) and schools consistently now schedule more physical activities. Overweight kids who may have been excluded or bullied for their weight are purposely included in a fun and supportive way. All kids are included in after-school activities including judo, basketball, and dance. The only beverages available are water and milk, instead of high-calorie juices, sodas, or so-called “energy” drinks. Kids attend classes to learn to read food labels and cooking classes too. Each month kids form a team and cook and sell one lunch for the school. As a result, the city has seen a 12 percent drop in overweight and obese children.

Amsterdam is successfully fighting fat by promoting tap water in its schools, along with healthy cooking classes and a ban on fast food sponsorship. Credit: TheGuardian.com

Throughout Latin America the increase in overweight and obesity in most countries is notable. Research in Ecuador (2014) based on a sample of 19,949 houses and 92,502 people found that obesity and overweight is rising and type 2 diabetes is the number one chronic disease.

In the providence of Azuay, where Cuenca sits, the rate of overweight/obesity among adolescents 12-19 (34.4 percent) surpasses the States. Alongside this is the double problem of malnutrition — with almost 20 percent of the population between 12-19 had stunted growth in 2012. See this videodocumentary about obesity in Ecuador. Made for the Minor Global Health 2017.

A local notable effort to combat childhood obesity is currently underway in Cuenca. The CEDEI School, under special projects director Mike Weber, project manager and coordinator Andrea Bermeo, and Mark Odenwelder (director of CEDEI) is in its fourth year of a project to educate students, teachers, and families about healthy lifestyle habits.

As reported, “Over 25 years of research has been committed to building and enhancing the Coordinated Approach to Child Health program (CATCH). CATCH promotes physical activity and healthy food choices in preschool through middle school aged children and their families. CATCH is based on the US CDC Whole School, Whole Community, Whole Child model in which health education and the creation of a healthy school environment, and family/community involvement work together to support youth in a healthy lifestyle.

CATCH curriculum is theoretically based in the Social Cognitive Theory of Behavior Change in which environmental influences and role modeling are seen as key agents of behavior change.

In 2014, CATCH expanded their efforts to make a global stride against childhood obesity by conducting a pilot program in Uruguay. Shortly after, in the Spring of 2015, a pilot project was formed in Cuenca, Ecuador in response to a recognized need by a local organization working in schools, CEDEI Foundation, and the Ministerio de Educación to address the mounting childhood obesity crisis in Ecuador. CATCH Global Foundation partnered with CEDEI and the Ministerio de Educación to introduce the CATCH program to seven schools in Cuenca. The goals of this initial pilot were to introduce three of the four components of the CATCH program to all of the schools (classroom curriculum, physical education curriculum, and family involvement.”

Currently, the CATCH curriculum is ongoing in 20 public schools in Cuenca, assisted by Peace Corps volunteers Douglas and Ana María Anderson. Check out CATCH in Cuenca’s Facebook page and see some of the fun educational activities, including the schoolyard garden project.

CATCH in Cuenca – Coordinated Approach to Child Health

The African proverb “it takes a village to raise a child,” means that it takes the entire community interacting with children in order for a child to experience health and grow in a safe environment.

And knowledge is power. Knowing that the processed foods companies spend billions on advertising junk food, while at the same time whole, fresh foods like fresh fruits and vegetables have no such mind-altering money behind them should make people angry enough to fight back!

What can you do? Vote with your pocketbook — it’s a start. You could boycott junk foods, learn how to read food labels, stay healthy in your own home and demonstrate your commitment to the next generation.

More about BMI, a simple calculation to assess body fat using a person’s height and weight. 

As described by the Centers for Disease Control and Prevention, researchers use Body Mass Index (BMI) as a simple and inexpensive and noninvasive measure of body fat.

BMI is a useful tool for epidemiologists to use when studying large groups of people and clinicians may use it as a screening tool. Studies show that BMI levels correlate with body fat and future health risks.

However, limitations must be considered, mostly because it’s a surrogate measure of body fatness and not an actual measurement. It doesn’t distinguish between excess fat, or muscle mass, or bone mass, or fat distribution.

The healthy range for BMI is 18.5 to 24.9; 25.0 to 29.9 is overweight; above 30 is considered obese.

The formula is BMI = kg/m2 where kg is a person’s weight in kilograms and m2 is their height in meters squared. This online BMI calculator will calculate either feet and inches or centimeters and kilograms — click here.

Sources
AAFP.org (American Academy of Family Physicians). New report shows U.S. obesity epidemic continues to worsen. Oct 15, 2018
American Journal of Clinical Nutrition. The double burden of undernutrition and excess body weight in Ecuador. Oct 29, 2014.
BBC.com. How Amsterdam is reducing child obesity.April 2, 2018
HealthCareGlobal.com. Why the Pacific Islands are the most obese nations in the world. April 21, 2015.
HealthData.org. The vast majority of American adults are overweight or obese, and weight is a growing problem among US children.May 28, 2014.
Independent.ie. This is how the Dutch are tackling childhood obesity — it’s simpler than you’d think. April 21, 2018.
KhaleejTimes.com. Region faces ‘diabesity’ explosion by 2045: Study. Dec 22, 2018.
OECD.org (Organization for Economic Co-operation and Development). Obesity update 2017.
PAHO (Pan American Health Organization). Overweight affects almost half the population of all countries in Latin America and the Caribbean except for Haiti. Jan 19, 2017.
ScienceDaily.com. Obesity in Pacific islands ‘a colonial legacy’ of settlers trying to civilize the locals. Sept 19, 2014.
WashingtonPost.com. How Japan’s revolutionary school lunches helped slow the rise of child obesity. Jan 28, 2013.
WorldHealthOrganization.org. Controlling the global obesity epidemic.


Susan Burke March, a Cuenca expat, is a Registered and Licensed Dietitian, a Certified Diabetes Educator who specializes in smart solutions for weight loss and diabetes-related weight management. She is the author of Making Weight Control Second Nature: Living Thin Naturally—a fun and informative book intended to liberate serial dieters and make healthy living and weight control both possible and instinctual over the long term. Have a question for Susan? Email SusanTheDietitian@gmail.com