No Simple Answers for a Global Epidemic

by JHI Staff on July 8, 2012

As a frequent overseas traveler, I’m vulnerable, just like everyone else, to random twists of airline-related fate (despite my frequent flyer status). This past week bad luck struck in the form of a last-minute cancellation of the second leg of my flight to India, where I was scheduled to participate in a New Delhi conference on undernutrition and obesity.

That might raise the question as to why a conference would try to simultaneously address what seem like two very different problems, other than the superficial connection to food. Hunger is an issue we associate with developing nations; widespread obesity is a problem that has become widely seen as an American one. But while it’s true that the U.S. has been a real leader in expanding waistlines, with about two-thirds of the population overweight, the rest of the world is catching up fast. And that includes less-industrialized countries, many of which still have serious undernutrition problems.

In India, for example, a government study estimated that nearly a third of the population—that’s more than 350 million people—are living on less than one dollar a day, and half of the children younger than age five are chronically malnourished. Yet more than a fifth of Indians living in urban areas are overweight. In the parlance of the international development community, this leaves India and many other countries with “a double burden” of undernutrition and “overnutrition.”

It’s fashionable to pin the rise of obesity in less-industrialized countries on an invasion of U.S. fast-food restaurants, as did a recent Businessweek article that zeroed in on Kuwait, which is second only to the U.S. in the percentage of the population that’s overweight. If only it were that simple. Most of us know people who are overweight but who don’t eat much fast food, and people who eat fast food but aren’t overweight. Studies make clear the failure of “fast-food-itis”  to serve as a good explanation of the overseas incursion of obesity, an especially striking example being a recent study of adolescents in Saudi Arabia, which like many Gulf states has a serious and growing obesity problem. The study found that obesity there is inversely correlated with consumption of sugared beverages and other sweet foods.

Certainly the popularity of fast food is a contributing factor to the rise in obesity, but the real issue to come to grips with is not that these restaurants exist, but rather that so many people find the food there—and other rich, fatty and sugary foods from many other sources—so appealing and rewarding that they can’t help overindulging in it, while neglecting healthier foods and physical activity. That’s a complex, multi-factorial problem tied to education, culture, social influences, economics, marketing, and food accessibility, as well as to human neurology, genetics and metabolics. Besides, if fast-food restaurants did actually account for a big piece of the puzzle, what are we supposed to do about it? Ban them? Even New York City, one of the most regulation-happy cities in the world, is having trouble just banning supersized sodas.

The complexity of the problem suggests the solution is likely to be complex as well. That’s what the conference in New Delhi was all about—getting past simplistic solutions. The conference brought together representatives from a number of different sectors to try to map out actionable schemes for addressing under- and overnutrition. That included industry, academic science, the government, non-profits, and, of course, health care, which was where I was supposed to come in, and why I was so disappointed to have to miss the conference.

The effects of the growing obesity epidemic have had an enormous impact on the health care challenges facing the populations of many of the countries in which Johns Hopkins Medicine is collaborating. Throughout the world, and particularly in developing countries, the disease burden is switching with alarming speed from infectious diseases like malaria and tuberculosis to the non-communicable diseases that are associated with obesity: cardiovascular disease, cancer, and especially diabetes.

We can treat these diseases, but we need to do more than that. In particular, we in health care need to find ways to help overweight people achieve and maintain healthy weights. Even better, we ought to be playing a role in helping people—and especially children—avoid becoming overweight in the first place. One good way to start is to do a better job of understanding the scope of the problem, and the way it manifests in the local population.

Thus, for example, we collaborated with the University of Trinidad and Tobago, the University of the West Indies, several Trinidad and Tobago government agencies, and others to create a diabetes outreach program that included a comprehensive survey of diabetes patients and the care they receive. The survey, released earlier this year, has provided an extremely detailed and useful picture of how the disease affects the region, and may well shed light on its effect on other developing areas around the world. Given the close ties between obesity and diabetes, we think this outreach effort will contribute to our understanding of the damage done by excess weight, and might allow making new connections between diabetes, obesity, access to treatment, and health-related behaviors such as diet and exercise.

But as the Delhi conference emphasized, health care can’t solve the obesity problem alone, nor can any other one segment of society. It has to be a real global, society-wide effort. We at Johns Hopkins are eager to work with our partners around the world to continue to further health care’s contribution to that cause.

Now if only we can get the airlines to cooperate.


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