Epidemic Obesity in China Chwan-Li (Leslie) Shen, PhD Associate Professor Pathology, School of Medicine May 20, 2009
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Epidemic Obesity in China
Chwan-Li (Leslie) Shen, PhD Associate Professor Pathology, School of Medicine May 20, 2009
China is now the fattest country in the world, second only to the US.
China’s National Nutrition and Health Survey of 2002
Compared to 1992 survey, body weights and heights of preschool children in urban and rural areas have significantly improved, the prevalence of malnutrition (underweight and stunting) has been significantly reduced.
China’s National Nutrition and Health Survey of 2002 (continued)
However, micronutrient deficiencies, including calcium, zinc, vitamin A, vitamins B1 and B2, are still common in preschool and school children.
Between 1992 and 2002, more than 60 million people became obese.
In 2007,
o o
215 million people were overweight; 68.44 million people were obese.
(Li et al. 2007 Obes Surg)
What is of greater concern still, is the vast and fast growing number of Chinese children and youth that are obese.
One out of five Chinese children over the age of 7 is overweight, and nearly 10 percent are obese.
Although the rate of obesity is lower in China than in America or Europe, the overall number is huge (China has 1.3 billion population).
By 2020, more obese people in China than in US.
Body mass index (BMI)
Gao et al. 2007. J Public Health
Overweight prevalence distribution
Gao et al. 2007 J Public Health
Obesity-associated complications
Glucose intolerance, diabetes Coronary artery disease Hypertension Hyperlipidemia Metabolic syndrome Depression
Obesity-associated complications (continued)
Reduced lifespan Respiratory system complications (obesity-hypoventilation syndrome and sleep apnea syndrome) Joint degeneration Cancers (breast, rectal, prostate) Hepatic steatosis (fatty liver) Related to both genetic and specific environmental factors.
Why is it so devastating that obesity rates have increased 30-fold in 15 years in China?
How did a country that struggled with starvation just half a century ago now find itself dealing with an obesity epidemic?
Causes of Obesity
Culture Excess body fat represents health and prosperity… a consequence of chronic malnutrition that caused millions of deaths in the past two centuries.
China's one-child policy
Food is a common reward… when started early, can be hard to unwind when a child becomes an adolescent.
Money from generous parents.
Economic growth
Nutritional quality was often poor in the past.
China’s first nutrition and health survey (2002) revealed dramatic improvement in nutritional quality with modernization and economic growth.
Obesity occurs due to:
o
massive decrease in daily activity and caloric expenditure,
o
increase in food intake.
Changing dietary intake
Intake of energy from animal sources increased from 8 to 25% from 1982 to 2002.
Average intake of dietary fat increased from 25 to 35% of energy (>30% recommended).
Expansion of the processed food and soft drink sector.
Introducing high-fat fast food -- KFC, McDonald’s …
Sign of affluence: you have some extra money to splurge. Calorie count ignored.
Instead of sharing food, which is the Chinese norm, when a child eats at a fast food restaurant, the pressure is to finish all the food, even if full.
Changing portion size
In an agrarian economy, with a limited food supply, the Chinese people historically ate small portions and worked off those calories in the fields. Calorie intake and portion sizes increase, while the society shifts to more sedentary lifestyles ---- perfect storm for the obesity crisis.
Changing lifestyle
More sedentary lifestyles … television, computer, and automobile.
Night life.
Less time for exercise due to academic stress.
Hormone imbalance.
Relationship between energy intake and energy expenditure in the emergence of obesity over the last century.
(Levine 2007, Chinese Medical Journal)
How can obesity be halted in China?
Strategic planning to halt obesity in China
(Levine 2007 Chinese Medical Journal)
Organization Need:
a system for resource sharing,
universally recognized evaluation tools,
to define the standard for “success”,
to allow obesity interventions (personal or population) to be evaluated and compared in a common scientific-language.
Organization (continued) Need partners for change:
food industry
clothing manufacturers
pharmaceutical industry
media industry
furniture companies
health insurers
architects
Define models of success
Not only invoke personal action but also population wide environmental re engineering to directly promote daily physical activity and healthy eating.
Economically viable.
Define models of success (continued)
Cost-effective for the government in the long-term.
Positive economic balance – Obesity was created by wealth, and a successful obesity solution should not destroy this wealth .
Implementation
Obesity can be reversed.
Need strong leadership focused on the health of people.
Psychological treatment
In Asia, people often hold a prejudice against overweight/obesity.
Intense pressure on overweight/obese individuals (more serious among children).
Psychological interventions to release pressure leading to weight loss.
Involvement of family
Encourage proper balanced meals at home.
Encourage exercise.
Discourage TV and video games.
Dietary intervention.
Health education.
School-based intervention
Current strategies:
improving level of knowledge,
increasing physical activity,
dietary intervention in overweight children and adolescents.
None of the trials demonstrated convincing evidence of the efficacy of any single intervention for the prevention of overweight and obesity in children and adolescents.
School-based intervention (continued) Future direction:
facilitate health and nutrition educational components incorporated into school curriculum;
promote modification of the school and community environments to improve and support healthy lifestyle behavioral patterns.
Agro-food industry growth
China is the largest food producer and consumer in the world.
Roles of government and agro food industry in addressing childhood obesity.
Alternative and complementary treatment
Herbal medicine
Dietary supplements
Acupuncture: flexible point selection and various methods without toxic and side effects
Still need more studies to confirm.
Bariatric Surgery
In Europe and USA: BMI BMI
35 kg/m comorbidities.
2
40 kg/m 2 or with related In China: BMI kg/m 2
37 kg/m 2 or BMI
with related comorbidities.
32 Surgery for obesity is now in its primary stages in China. Success should be determined by weight change and by the improvement of obesity-associated complications.
Bariatric Surgery (continued)
Appropriate training and supervision of the multidisciplinary team to assure good outcomes.
Medical diagnosis and management of complications specific to bariatric surgery
Dietary instruction
Exercise training
Nursing care
Psychological support
The prevention and treatment of obesity in China remain to be open problems.