Obesity in the Midst of Unyielding
Food Insecurity in Developing Countries
Despite the persistence
of food insecurity, food consumption has been
rising in many developing countries, and with
it has come higher rates of overweight and obesity.
Stacey
Rosen
Shahla Shapouri
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Income
disparity within and among developing
countries explains how there can be
obesity in the midst of undernutrition. |
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Rising
incomes, urbanization, global integration,
and more supermarkets have
contributed to increased consumption
of convenient, high-calorie foods among
the higher income population.
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Obesity-related
diseases have become more widespread
in developing countries. |
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For
more information . . . |
“Global
Diet Composition: Factors Behind the Changes
and Implications of the New Trends,” by
Shahla Shapouri and Stacey Rosen, in Food
Security Assessment, 2007, GFA-19,
USDA, Economic Research Service, July 2008.
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You may also
be interested in . . .
|
"Converging
Patterns in Global Food Consumption and Food
Delivery Systems,” by Elizabeth
Frazão, Birgit Meade, and Anita Regmi,
in Amber Waves, Vol. 6, No. 1, USDA, Economic
Research Service, February 2008.
Global
Food Markets Briefing Room.
Global
Food Security Briefing Room. |
The continued escalation of food
prices has again focused attention on global food
insecurity and its root cause, poverty. Despite
international commitments to improve food security
in low-income countries, progress has been limited.
For the 70 countries covered in ERS’s Food
Security Assessment, nearly 1 billion people were
estimated to be undernourished (food insecure)
in 2007. The persistence of food insecurity is
troublesome because it comes at a time when food
consumption in many developing countries has been
improving. In fact, the rising rate of overweight
and obesity in many developing countries is a growing
concern. While the economic and health consequences
of malnutrition and hunger have been studied extensively,
less attention has been given to the economic implications
of rising obesity rates in developing countries.
How can obesity exist in the midst of persistent
food insecurity and hunger? (see box, “Defining
Obesity”). The answer lies mainly in differences
in income levels among and within
countries. The range of per capita incomes among
developing countries is extremely broad: from $124
per year in Ethiopia to $24,000 in Singapore in
2005. Within countries, too, income levels vary
greatly. For example, in Guatemala, the poorest
20 percent of the population holds less than 3
percent of the country’s total income. The
wealthiest 20 percent of the population accounts
for 64 percent of the country’s total income.
This case is not an anomaly. On average, in 11
of the lower income Latin American and Caribbean
countries included in ERS’s Food Security
Assessment, the lowest income quintile holds a
little over 3 percent of total income, whereas
the highest quintile has just under 60 percent.
This disparity in income shares translates into
vast differences in income levels and, hence, purchasing
power, within a country. In Guatemala, for example,
the lowest income quintile consumed an estimated
75 percent of the daily nutritional requirement
in 2007, while the highest income quintile exceeded
the nutritional requirement by nearly 30 percent.
A number of forces have contributed to rising rates
of obesity among the upper income quintiles. Average
per capita food consumption in developing countries
increased 28 percent between 1970 and 2005, three
times the rate in developed countries.
The diets of people in the upper income quintiles
have changed as they moved away from some traditional
foods, such as root crops and vegetables, to higher
calorie foods. In addition to income growth and
declining food prices, urbanization is a key
factor behind the dietary changes. An urban lifestyle
means less physical activity and higher demand
for convenience foods. At the same time, expansion
and improvement of the global transportation systems
have facilitated trade in perishable foods and
opened markets. Many exporters were able to capitalize
on these changes by supplying a wider variety of
products in growing and evolving markets.
Rising Incomes, Declining Food Prices Boosted Calorie
Intake
Rising calorie intake per capita and the shift
toward higher calorie and more processed foods
have been observed in both developing countries
and the least developed countries. In both cases,
much of this diet transition can be attributed
to high per capita income growth, particularly
in large countries, such as China, Brazil, and
India. Developing countries’ per capita income
almost tripled between 1970 and 2005. Conversely,
per capita income in the least developed countries
increased only 20 percent during the 35-year period.
The recent, well-publicized runup in food prices
was preceded by several decades of declining real
food prices (adjusted for inflation). In 2000,
real world prices for rice, sugar, and soybean
oil were less than 40 percent of 1970 levels. Real
beef prices in 2000 were about half of 1970 levels,
while wheat prices were 60 percent. Although food
prices have increased since 2004, they remain below
1970 levels, in real terms.
Per capita consumption in developing countries
exceeded 2,722 calories per day in 2005, up from
2,134 calories in 1970. The Food and Agriculture
Organization (FAO) of the United Nations recommends
a minimum daily per capita intake of roughly 2,100
calories. Grains account for more than half of
the diet in developing countries, but the 8-percent
increase in grain consumption between 1970 and
2005 was much lower than the overall increase in
calorie consumption. Per capita consumption of
some higher valued food items soared; meat, eggs,
and vegetable oils increased roughly threefold,
while sugar increased 66 percent. Meat, however,
still accounted for only about 7 percent of the
diet in developing countries in 2005, compared
with 12 percent in developed countries.
During the same period, calorie consumption per
capita also rose in the least developed countries
(those with per capita incomes below $500 per year).
The gain from 2,000 calories in 1970 to 2,200 in
2000, however, was much smaller than in developing
countries, and least developed countries remain
far behind the rest of the world in overall nutrition.
The calorie contribution of vegetable oils grew
the most (28 percent), followed by sugar and eggs
(15 percent) and meat and milk (7 percent). In
absolute terms, however, consumption of these foods
remains well below the level in other countries.
Moreover, consumption of nutritionally beneficial
foods, such as pulses, vegetables, and fruits,
has declined in least developed countries. The
decline was sharpest for vegetables (32 percent),
followed by fruit (9 percent) and pulses (5 percent).
Even with the modest increase in overall calorie
consumption in these countries, the shift in diet
toward fats and sugar and away from their traditional
diet of vegetables and pulses seems to be clear.
Urbanization and Globalization Also Influence Diet
Change
Increasing urbanization has been gaining attention
for its contribution to shifts in diets. Unlike
rural agricultural households, urban residents
do not rely solely on home-grown or locally grown
foods and therefore have access to a wider selection
of foods. In developing countries, the rate of
urbanization was two to three times higher than
the population growth rate during the last three
decades.
Although detailed data for each country are not
available, examining diet composition across countries
shows that, in countries with the same income level,
those with a higher share of urban population tended
to have diets with more fat, both vegetable and
animal. For example, the urbanization rate is 67
percent in Mexico versus 92 percent in Uruguay,
and daily per capita consumption of fat in Mexico
was half that of Uruguay, despite similar per capita
income levels ($6,172, and $6,248 in 2005). Similarly,
fat consumption in Jordan was more than four times
that of Namibia. Although their per capita income
was almost the same ($2,086 in Jordan and $2,083
in Namibia in 2005), the 82-percent urbanization
rate in Jordan was much higher than that of Namibia’s
35 percent. Other factors, such as cultural and
dietary habits, might also contribute to differences.
All urban environments are not the same; the openness
of an economy, access to mass media, particularly
television, and marketing systems can also significantly
influence consumers’ choices. Regardless
of consumer food choices, however, an urban lifestyle
usually means a decline in physical activity and
higher participation of women in the workforce.
The latter often translates into less time for
preparing food, which often leads to increased
consumption of processed foods.
ERS statistical analysis confirms this relationship.
Analysts used cross-country data for 136 countries
to estimate the impact of such factors as per capita
income, urbanization rate, share of households
with TVs, and a country’s development level
on daily consumption of calories and fat. The results
showed positive and statistically significant relationships
between each of three variables (per capita income,
urbanization rate, and share of households with
TVs) and calorie and fat consumption.
Global Integration and More Trade Increase Availability
of Processed Foods
In addition to income growth and urbanization,
the expansion of international trade through world
economic integration has influenced global diets.
Trade agreements of the last three decades, in
addition to expanding global trade, have been a
catalyst for increased investment in transportation
and communication systems. The average ocean freight
and port charges for U.S. import and export cargo
decreased 60 percent between 1970 and 1990. Technologies,
such as refrigeration, allowed trade in perishable
products, including cut flowers and live shellfish.
The decline in global trade barriers was followed
by liberalization in global financing, which altered
the food systems of most countries by expanding
the role of supermarkets in food marketing.
Food imports have become an important component
of food supplies in both developed and developing
countries because national food self-sufficiency
has declined in many countries during the last
few decades. Trade in grains, vegetable oils, and
meat increased three to five times during the past
three decades. Developing countries also became
more dependent on imports of staple commodities,
such as grains, and vegetable oils. Rising consumption
of wheat, in the processed form of bread and pasta,
has replaced traditional grains such as millet
and sorghum, as well as root crops.
Import growth was not limited to staple foods;
imports of a variety of commodities, including
semi-processed and processed foods, have also grown.
Between 1970 and 2005, global trade volume of highly
processed foods (the FAO definition includes food
items such as canned meat, breakfast cereals, pastries,
and wine) increased more than four times. Import
growth for this category of food was highest in
developing countries—growing more than fivefold
between 1970 and 2005.
Growth of Supermarkets Increases Food Variety
The evolution of the global food system and the
increase in the number of supermarkets have promoted
convenience shopping and wider food varieties in
developing countries. With their large scale of
operations, supermarkets are often able to offer
lower prices than traditional retail stores. Lower
prices have boosted the market shares and profits
of supermarkets, which have fueled their expansion.
The high growth in market share of supermarkets
in Latin America highlights the extent of the change:
from a 10- to 20-percent market share in the 1980s
to 50-60 percent in the 1990s, and now rapidly
approaching the U.S. share of about 70-80 percent.
The experience of East and South Asia also shows
a similar pattern. In Sub-Saharan Africa, with
the exception of South Africa, the supermarket
share in the retail food market is much smaller,
but expansion is underway due to growing investment
by South African companies.
The growing role of supermarkets has both positive
and negative implications for consumers. On the
positive side, supermarkets are introducing better
quality, greater variety, higher standards, and
lower prices to the food systems of developing
countries. On the negative side, increased access
to low-cost, high-calorie, convenience foods for
urban consumers with limited physical activity
fuels obesity problems.
Both Obesity and
Undernutrition Are Problems
in Developing Countries
The global increase in calorie consumption has
included excess food consumption by some segments
of the population in many countries. In developing
countries, consumption of high-calorie foods, such
as fats and sugar, has risen, and the income elasticity
(percentage change in consumption for each 1-percent
change in income) for these products remains positive.
Because incomes are projected to rise for almost
all developing countries, the role and contribution
of these commodities in the diets of these countries
is expected to increase. At the same time, the
problems of undernutrition and food insecurity
still exist. An estimated 800 million to 1 billion
people are food insecure, and, according to FAO
and ERS researchers, the number of food insecure
people has remained relatively steady during the
last decade. The International Food Policy Research
Institute estimated that there are about 1 billion
overweight and obese people worldwide. Although
this problem is more prevalent in Western countries,
it is increasing rapidly in developing countries,
as well.
In many developing countries, the growing trend
of overweight populations is most prevalent among
the higher income groups. In contrast, in higher
income countries, this problem is more prevalent
among lower income groups. ERS estimates that in
2007, consumption by those in the upper 20 percent
income group in low-income Asian, Latin American
and the Caribbean, and North African countries
equaled roughly 2,800 calories per person per day.
This level is in the upper range of the requirement
for a moderately active adult. In fact, consumption
for the highest income quintile in North Africa
was estimated at nearly 3,300 calories per day.
Among individual countries, food consumption in
the highest income quintile was 2,800 calories
or higher in 23 of the 70 study countries. Therefore,
although an estimated 982 million people in these
70 countries were food insecure, an estimated 370
million, or 12 percent of the population, consumed
at least 2,800 calories per day in 2007.
The situation with overweight populations in developing
countries could worsen because of the increasing
number of overweight children. For example, according
to a study by the World Health Organization (WHO),
8-9 percent of children under age 5 in Egypt and
Algeria were overweight, which is close to the
10 percent estimated for the United States. According
to FAO, in six case study countries (China, Egypt,
India, Mexico, the Philippines, and South Africa),
the increase in food consumption over the past
20 years led to a reduction in the number of underweight
children and adults. In China, Egypt, Mexico, and
the Philippines, there were more overweight adults
than underweight adults in 1999.
Rising Rates of Obesity-Related Diseases Bring
New Challenges
to Developing Economies
The main concern of the developing countries continues
to be how to curb food insecurity, hunger, and
associated diseases. More recently, however, obesity-related
diseases such as diabetes and hypertension have
become more widespread. For example, the WHO reports
that, in China, hypertension increased 12 percent
(or the equivalent of 160 million people) between
1991 and 2002. Similarly, an estimated 25-50 percent
of the population in countries like Mexico, Thailand,
and Tunisia suffer from diabetes. The WHO assessment
indicates that overweight and obesity represent
a rapidly growing threat to health in an increasing
number of developed and developing countries. It
also indicates that, in some countries, overweight
and obesity are now replacing the more traditional
public health concerns of undernutrition and infectious
diseases.
The direct cost of obesity is the increased risk
of chronic diseases such as diabetes, cardiovascular
disease, gallbladder disease, and cancer. If current
trends continue, health costs for the developing
economies could be substantial. In most developing
countries, people are a major resource, and public
health is a key to economic progress. Research
in developed countries shows that obesity reduces
productivity. Moreover, health costs associated
with the growing rate of obesity and its related
diseases could overwhelm the health care systems
of developing countries already overburdened with
the costs of combating communicable diseases and
the effects of malnutrition among lower income
populations. According to the latest World Bank
data, average health expenditures per capita in
developing countries are less than 10 percent of
expenditures in developed countries and less than
1 percent in the least developed countries.
Policy Options
In contrast to undernutrition and hunger, issues
and problems related to overweight and obesity
are a fairly new phenomenon for developing countries.
As a result, data in this area are limited, but
health statistics indicate a growing trend in diet-related
diseases. For example, WHO estimates that the top
10 countries in the number of cases of diabetes
are India, China, the United States, Indonesia,
Japan, Pakistan, Russia, Brazil, Italy, and Bangladesh.
The health and economic costs associated with these
diseases are well known. The new challenge for
developing countries is to identify effective policies
that could prevent repeating the obesity experience
of Western countries.
Nutritional education is probably the key in terms
of reaching out to consumers. Because dietary habits
are formed at a young age, nutritional education
of children can play a vital role in influencing
dietary habits. Advertising, particularly
on television, directed to children profoundly
affects their perceptions. A survey of six Asian
countries—India, Indonesia, Malaysia, Pakistan,
the Philippines, and South Korea—showed that
most children in these countries watch television
2-4 hours per day on weekdays, and more on weekends
and during school vacations. Each hour typically
contains 20 minutes of advertising. The survey
also revealed that, with the exception of parents
in South Korea, more than 50 percent of parents
in the study countries said that their children
influenced family food purchases. U.S. research
shows a significant correlation between television
viewing and obesity among children. For this reason,
countries like Sweden, Australia, Canada, and the
United Kingdom have taken steps to curb the impact
of advertising on children.
Other policy interventions can promote healthy
eating. The Scandinavian countries reduced coronary
heart disease between 1976 and the 1980s by providing
subsidies for the purchase of healthy food items,
such as fish. During the 1990s, Singapore reduced
child obesity through a combination of changes
in school diets and increased fitness and physical
activity programming. Its Trim and Fit program,
started in 1992 and managed by the Ministries of
Health and Education, is credited as one of the
most successful
programs in the world in terms of
sustained obesity management (see box, “Singapore’s
Efforts To Control Obesity”). The program
includes teacher and student education, changes
in school lunches, assessment of students, and
increased physical activities during school time.
Defining Obesity
For adults, overweight and obesity ranges
are determined by using weight and height
to calculate the “body mass index” (BMI).
BMI is used because, for most people, it
correlates with their amount of body fat.
An adult who has a BMI between 25 and 29.9
is considered overweight, and an adult who
has a BMI of 30 or higher is considered obese.
More detailed information is
available at:
Defining
Overweight and Obesity (U.S. Centers for Disease Control and Prevention) and
Obesity
and Overweight (World Health Organization) |
Singapore’s Efforts To Combat
Obesity |
Recognizing a rise in
obesity rates as well as Type 2 diabetes
among children, the Singapore Government
introduced the Trim and Fit (TAF) program
in 1992. The program was
targeted toward schoolchildren from primary
school to pre-university levels. The
program’s goal was for the students to
achieve a healthier lifestyle through improved
nutrition and regular exercise.
Through this program, all students participated
in fun runs and aerobic workouts. Overweight
students engaged in 1½ hours of physical
activity per week, in addition to their regularly
scheduled physical education classes, until
they lost a required amount of weight. This
activity could be in the form of playing games
or a particular sport. The schools provided
parents with information on the program as
well as ideas for activities and improved nutrition
at home. The Government also provided guidelines
to the schools as to the types of food and
drinks they should sell. Additionally, water
coolers were installed in all schools to encourage
students to drink more water.
Since TAF was implemented in 1992, the share
of students who passed the Government’s
national physical fitness test jumped from
less than 60 percent in 1992 to more than 80
percent in 2002. The share of overweight students
fell from 14 percent in 1992 to 9.5
percent in 2005.
After receiving criticism for targeting overweight
children and thereby stigmatizing them, the
Singapore Government ended the TAF program
in 2007. It was replaced by the Holistic
Health Framework (HHF), which targets all
schoolchildren and has a broader focus
than TAF. In addition to improving physical
fitness, it aims to improve mental and
social health through a general healthy
lifestyle. |
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