Trends in the Global Rise of the Prevalence of Obesity ... Silva.docx · Web viewTrends in the Global Rise of the Prevalence of Obesity from the 1980’s- Present between Developed

2015 Cambridge Business & Economics Conference ISBN : 9780974211428

Trends in the Global Rise of the Prevalence of Obesity from the 1980’s- Present between

Developed and Developing Countries

Marylud Silva, University of Texas at Dallas

July 1-2, 2015Cambridge, UK 1


Abstract

Purpose: Understanding and analyzing the trends associated with the economic effects due to

the global rise in the prevalence of Obesity since the 1980’s between developed and developing

countries.

Design/methodology/approach:The data was collected from over fifteen different peer-

reviewed academic articles and the World Bank.

Findings: The findings showed that between rates of obesity, between 1980-present seem to be

increasing in both developed and developing countries. The greatest increase in the rate of

overweight and obesity was between 1992 and 2002, but has slowed in the last decade, more so

in developing countries. There were limitations of current accurate global obesity rates, most of

the data came from self reported height and weight that can sometime be over reported by males

and underreported by females. In the past 33 years no country has successfully reduce obesity.

Originality/Value/Contribution: This current study is original in that it discusses the

correlation between the tactics used by the Tobacco industry in the United States, to avoid profit

loss, exclusively from 1954 to present, and the strategies such as Leanwashing, used by the big

businesses in the Food industry, in order to promote inactivity as the primary determinant of

obesity, primarily in the western world, but not limited to the United States Europe or Asia.

Terms: obesity, medical costs, overweight, food industry, leanwashing, lobbying, diet theorist,

tobacco industry, BMI, nutrition



Introduction

According to the World Health Organization, WHO, since the 1980’s global prevalence

obesity had nearly doubled. In 2008, when examining the adult population of 20 years and older,

WHO found that more than 1.4 billion adults (accounts for 35% of adults) were overweight; and

of these over 200 million men and nearly 300 million women(accounts for 11% of adults) were

obese. Although obesity is preventable, overweight and obesity are leading risks for global

deaths, which accounts for the deaths of 3.4 million adults each year. WHO found 65% of the

world’s population lives in allhigh-income and most mid- and low-income countries where

obesity kills more people than underweight.

Generally overweight and obesity are defined as abnormal or excessive fat accumulation

that may impair health. The body mass index (BMI) is used worldwide to classify overweight

and obesity in adults. It is measured by a person's weight in kilograms divided by the square of

his height in meters (kg/m2). Generally a BMI greater than or equal to 25 is classified as

overweight and a BMI greater than or equal to 30 is classified as obesity.

Although there are countless factors in research that cause obesity and overweight the

three fundamental factors include poor nutrition, lack of physical activity (a combination of these

two leads to an energy imbalance between calories consumed and calories expended) and genetic

predisposition. Technological and economical advances have led to a global an increased intake

of energy-dense foods that are high in fat; and an increase in physical inactivity due to the

increasingly sedentary nature of many forms of work, changing modes of transportation, and

increasing urbanization. WHO finds that changes in dietary and physical activity behavior and

patterns are often the result of environmental and societal changes associated with development



and lack of supportive policies in sectors such as health, agriculture, transport, urban planning,

environment, food processing, distribution, marketing and education.In research to date at least

four major categories ofeconomic impacts have been linked with the obesity epidemic including:

direct medical costs, productivity costs, transportation costs, and human capital costs.

Supersized America

Among the high-income, mid- and low-income countries covered in this paper will draw

much focus on the obesity crisis in the United States. As of 2010, WHO’s Global InfoBase,

reports the prevalence of obesity amongst American males as 80.5% listing the United States as

the 7th highest out of 192 countries; and American women are listed as having a prevalence of

obesity of 76.7% listing the United States as the 14th highest out of the 192 countries. While

factors such as, preferences, lifestyle, culture, ethnicity and income level are closely related to

the choice of certain products and eating habits many developing countries are looking to the

western world and tend to adopt similar eating habits as their own food culture changes. (Insert

research about diets). Economic and technological developments, since World War II, introduced

an industrialized American diet, and have led to greater availability and variety of food along

with the availability of information and access to packaged food, which has resulted into greater

obesity rates. The data shown in the maps below were collected through CDC’s Behavioral Risk

Factor Surveillance System (BRFSS). Each year, state health departments use standard

procedures to collect data through a series of telephone interviews with U.S. adults and include

self-reported height and weight data ((Mokdad, 1999).In 2011, BRFSS had methodological

changes to estimate the prevalence of self-reported obesity so the estimates below should not be

compared to the most recent prevalence estimates calculated after 2013.



The data above shows how obesity has gradually increased year after year in the United

States, as explained by the CDC among the states participating in the BRFSS, by 1990, ten

stateshad a prevalence of obesity less than 10% and no state had prevalence equal to or greater

than 15%. By 2000, no state had a prevalence of obesity less than 10%, while twenty three states

had prevalence between 20–24%, and no state had prevalence equal to or greater than 25%.

Finally in 2010, no state had a prevalence of obesity less than 20%. Thirty-six states had a

prevalence equal to or greater than 25%; and twelve of these had a prevalence equal to or greater

than 30%(Mokdad, 1999). The most recent data obtained from BRFSS, shows that by 2013 no

state had a prevalence of obesity less than 20%; seven states and the District of Columbia has a

prevalence of obesity between 20% and <25%; twenty three states had a prevalence of obesity

between 25% and <30%; eighteen states had a prevalence of obesity between 30% and <35%;

two states hadprevalence of obesitygreater or equal to 35%.



Non-discriminatory Disease

The rates of obesity have been increasing in both developing and developed countries; no

country has successfully reduced obesity in 33 years, according to data from an analysis

including 188 countries. In 2010, it was estimated 3.4 million deaths and 4% of years of life lost

were as a result of overweight and obesity; causing concern about the health risks associatedwith

rising obesity led member states of WHO to introduce a voluntary target to stop the rise in

obesity by 2025(Ng, 2014) and monitor change in the prevalence of obesity among the world.

Almost 30% (2.1 billion people) of the global populations are now classified as being overweight

or obese; between 1992 and 2002 the rate of increase of obesity was the greatest, but in the past

decade has slowed down, more so in developing nations(Ng, 2014). More than 50% of obese

individuals (671 million) in the world live in ten countries: US, China, India, Russia, Brazil,

Mexico, Egypt, Germany, Pakistan, and Indonesia (listed in order of number of obese

individuals).



The analysis estimated prevalence of obesity in adults exceeded 50% among developing

countries in for men Tonga and women in Kuwait, Kiribati, the Federated States of Micronesia,

Libya, Qatar, Tonga, and Samoa. In developed countries, more men than women were

overweight and obese, however, in developing countries, overweight and obesity was more

prevalent in women than in men, the highest prevalence of obesity in women, 42.0%, was

recorded insub-Saharan Africa in 2013. Central America and Latin Americaconsisted of 14

countries with prevalence in women of greater than 20%. The lowest rates of obesity in were

found in, China and India, which also accounted for 15% of obese individuals worldwide, in

2013. In China, 3.8% of men and5.0% of women were obese, comparedwith 3.7% of men and

4.2% ofwomen in India.In developed countries, the United States reported in 2013 with a high

prevalence of obesity; roughly a third of men (31.6%) and women (33.9%) were obese; and

accounted for 13% of obese people worldwide in 2013(Ng, 2014).



There was a distinct noted geographic pattern in high rates of child and adolescent

obesity in many countries in the Middle East and north Africa, in particular girls, and in several

Pacific Island and Caribbean nations among both sexes. Looking at countries individually, the

prevalence of obesity in children and adolescents ranged from as high as more than 30% for girls

in Kiribati and the Federated States of Micronesia to less than 2% in Bangladesh, Brunei,

Burundi, Cambodia, Eritrea, Ethiopia, Laos, Nepal, North Korea, Tanzania, and Togo (Ng,

2014). The rates of obesity amongst boys, within Western Europe, ranged from 13.9% in Israel

to 4.1% in the Netherlands. The highest prevalence of child and adolescent obesity was found

among Latin America, for boys it varied from11.9% in Chile and 10.5% Mexico, and for girls it

varied in 18.1% in Uruguay and 12.4% in Costa Rica.

Economic Analysis



Among low- and middle-income countries, cardiovascular diseases are among the leading

causes of death. Currently the CDC finds 9.3% of the US population suffers from diabetes and

increase of 1.5% from 2007 (Nandi, 2014). The growing problem of obesity can be reviewed in

different phases. From the 1970s to present, Phase 1 of obesity began when the average weight is

steadily increasing among children from all socioeconomic levels, racial and ethnic groups, and

regions of the country(McDowell, 1997).Phase 2 of obesity is began by the emergenceof serious

weight-related problems (Ludwig, 2007), such as diabetes and cardiovascular disease (Gaziano,

2010). Phase 3 of obesity, when the medical complications of obesity lead to life-threatening

disease; the last phase will take a few more years to acknowledge due to

misdiagnoses(Ruhm,2007).

Advances in agricultural technology have led to declines in the relative price of food and

is one primary explanation for the observed growth of body weight over the past quarterand

higher exercise (or calorie expenditure) prices (Drichoutis, 2012). Analyses of price increases

during the period of 1985-2000 for food in different categories shows that cost of sweets, fats,

and caloric beverages fell substantially in relation to fresh vegetables and fruits; while the retail

price of fresh fruit and vegetables increased 120 percent and the price of fats and oils increased



by 38 percent (Hojjat, 2015). Developments in agriculture and food technology have made added

sugars and vegetable oils readily accessible at remarkable low costs.

Using Engel’s Law, when the relative price of a good or service rises, the quantity

demanded falls (Budd, 2004). Although Americans have the lowest cost food supply in the

world, Table 2, shows that the typical American (33% obesity rate) spends about 7% of their

income for Food; compares to the average Indonesian (4.8% obesity rate) who devotes about

43% of their spending on food (Hojjat, 2015). Generally, healthier diets cost more; the average

American diet consists of almost 40 percent daily energy from added sugars and added fats

which are relatively inexpensive (Frazoa, Allshouse, 2003).In the United States, the gains in life

expectancy since 1970 have also been much more modest than in most other OECD countries.

While life expectancy in the United States used to be one year above the OECD average in 1970,

it is now more than one year below the average (OECD, 2014). Diet quality is influenced by

socioeconomic position and may well be limited by financial access to nutrient-dense foods.

Obesity is the second leading preventable cause of death in the United States and is associated

with multiple chronic conditions, such as high blood pressure, high cholesterol, heart disease,

and stroke, Type 2 diabetes. The direct medical costs related to obesity are secondary to

preventive, diagnostic and treatment services; while indirect can be measured with a higher

disability insurance premium, and labor market productivity (Hojjat, 2015). In 2007, 7.8% of the

U.S. population suffered from diabetes and had average total medical expenditures of about

$10,478 per year; it is estimated diabetes was responsible for approximately $2,044. Compared

to the general population, average medical expenditures for all adults 35 and older was

approximately half the amount at, $5,185 (Meyerhoefer, 2007). Due to the multiple chronic

conditions that result from overweight and obesity, employers have acknowledged the economic



consequences on resulting as the loss of productivity and high medical expenses; which, in 2013,

were estimated to be $170 billion in the United States.

“Thank You for Not Smoking” –The Food Industry

The food industry, unlike the tobacco industry is very diverse and fragmented; this paper

will focus on three businesses, “packaged food (companies such as Kraft, General Foods,

General Mills, Kellogg’s, Unilever, Nestle, Danone), beverages (companies such as Coca-Cola,

PepsiCo), and fast food (companies such as McDonald’s, Burger King, Yum! Brands)” (Karnani,

2014). As the prevalence of obesity has been on the rise, the food industries’ actions to respond

the concerns about their products causing harm are significantly similar to the tobacco industry

in 1957, which marked the first time the U.S. Public Health Service took a position on smoking

and health, after the first U.S. Surgeon General Leroy E. Burney found clear scientific evidence

establishing a relationship between smoking and lung cancer.

For decades the tobacco companies had been exempt from the standards of responsibility

and accountability that apply to all other American corporations.In 1958, a survey found that

only 44 percent of Americans believed smoking caused cancer, while 78 percent believed so by

1968. In 1994, six tobacco company CEOs declare, under oath, that nicotine is not addictive.One

executive insisted that cigarettes were no more addictive than coffee, tea or Twinkies.

Representative Henry Waxman, a Democrat from California, replied, "The difference between

cigarettes and Twinkies is death."This hearing would bring about government intervention with

policy and systems changes, such as higher tobacco excise taxes, smoke-free indoor air laws, and

access to cessation treatments, to significantly reduce death and disease from tobacco.



As the data shows in 1963 yearly per capita consumption of cigarettes in the U.S. reaches

its peak, at 4,336 cigarettes per person per year, cigarette consumption would begin a true

downward trend in 1964. “Public health experts have drawn parallels between how the tobacco

industry responded to health concerns due to smoking, and how the food industry is responding

to concerns about obesity (Holford, 2014).”

Leanwashing



While it is reported by numerous amounts of research that a poor diet is a much greater

determinant of obesity than lack of exercise, several food and beverage companies consistently

overemphasize the lack of obesity. “The term leanwashing is used to describe the public relations

and marketing activities of a firm that deceptively promote the perception that the firm is helping

to solve the obesity problem and that deflect attention from the fact that it is directly contributing

to the obesity crisis”(Karnani, 2014).This paper highlights an indirect effect of food marketing

by the food industries on obesity; through the substantial promotional and PR messages that are

released in as a response to public concern in their involvement in the rise of obesity.

Leanwashing strategy can be identified in public statements, lobbying, philanthropy and

sponsorship of sports teams and events.

From 1980-2000 the number of people (self-reported) who perform regular exercise

increased from 47% to 57% and from 1993 to 2009 the number of gym memberships doubled

from 23M to 45M. Regardless of the evidence showing the primary determinants of obesity is

nutrition, rather than inactivity, the public has held their lay theories, about the cause of obesity,

over scientific evidence. The American Beverage Association (ABA) has spent an average



around $1 million annually from 2003-20013 between, 2009-2012; the food industries spent

$175 million on lobbying activities. When taxes on sugar were being proposed around 2009 and

2010 the ABA reported and expense of $18.9 million and $9.9 million on lobbying activities.

Public statements by companies tend to argue that lack of exercise or an increase of a sedentary

lifestyle is the primary cause of obesity, consumer have been listening because since the 1980’s

surveys suggest that levels of physical activity may be improving at the same time that

overweight and obesity rates are increasing (US Burden of Disease Collaborators, 2013).Table 4

below compares the television and/or radio use among males and females at different education

levels, it is provided in the paper to show the potential reach of the lay theories being reinforced

through the food industry.

Table 3 represents empirical results from six separate studies to determine the relative

importance of over nutrition versus lack of exercise as the causes of obesity in lay theories;

results suggest that only about half the population is diet theorists, or people who believed over

nutrition was a primary cause of obesity more so then inactivity. There was a significant

correlation noted with the participants actual BMI and the results in Table 3. “Diet theorists were

the least overweight, while exercise theorist we the most overweight, and belief that genes were

the primary cause had no relationship observed with any of the studies” (Karnani, 2014).



Source, table 4: (Michaud, 2007)

Technological advances are not just increased sedentary lifestyles but avoid visiting

experts for accurate information regarding all problems, including their health; national data

suggest that 64% of Americans are trying to lose weight and that 48% are following a weight

loss strategy; and they are turning to the Internet forinformation about health and weight loss.

Currently, 82% ofAmericans use the Internet, according to national data, 42.83% of Internetusers

access the Web for weight lossand physical activity information (Modave, 2014). The

government, universities, and the medical communities has used the internet as a platform to

provide readily available information to the public, however the table below shows the results of

the accuracy of weight loss information on the internet, in 2012 (Modave, 2014). Although

medical, universities and government sites ranked highest, along with blogs, they did not top the

search engine results and less likely to be read before other inaccurate websites. An assumption

can be made that a growing number of individuals are taking an initiative to providing health



information to help raise awareness of obesity by providing accurate tips, and aside from the

high number of unsubstantiated claims they more like to be read than a medical, universities or

government site.

Concluding Comments

The data collected reflects that although the increase of the prevalence of obesity slowed

down in the past decade no country has successfully reduced obesity in the past three decades;

with rates of obesity growing so rapidly among children there is an alarming need for

government intervention to educate and providing the public with readily available information

on the primary determinant of obesity to reduce and prevent future obesity rates and obesity

related diseases and deaths. Although government intervention is needed to pass policy changed

among the food industries actions, it will be a costly, time consuming battle on both sides while

the obesity rate continues to climb.

This papers main recommendation as a catalyst for change comes from the Healthy Cities

and Communities Movement, which focuses on change among spreading awareness in cities,

because “often they are the incubators of social and political change; they take global thinking



and act locally” (Bezold, 2014). They Healthy Cities and Communities Movement believe cities

are generators of economic opportunity and sources of innovation and creativity, (from anti-

tobacco laws to sustainability, from taking action on fast foods to participatory budgeting) and

their concentration and population density enable them to be generally more environmentally

sustainable on a per capita basis and to provide services efficiently; cities have been more

effective to lead the way, more so than any provincial/state or national government.

Technological advances have aided the rise of prevalence of obesity; but can also be used to

form a strong sustainable movement to empower cities to help fight obesity everywhere and

make information and resources readily available among communities on proper nutrition. Cities

and communities must push through local laws to have their children learn in school systems

how to maintain healthy lives and how determine a healthy diet for a lifetime, the solution to

decreasing the obesity rate in the United States lies in the children education; which can only be

changed by educating adults.



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