Obesity among the hungry
Ironically, as low- and middle-income countries struggle to reduce hunger, many also face the growing problem of obesity
One in three people in the world are overweight. What used to be a condition associated with high-income countries is now global.
In low- and middle-income countries the number of overweight and obese adults almost quadrupled between 1980 and 2008. Much of this rise occurred in countries where incomes were also rising, such as Egypt and Mexico, but it was also seen in sub-Saharan Africa. Hunger is still rife in this region, but the percentage of overweight adults doubled from 12 per cent in 1980 to 24 per cent in 2008.
Nutrition is a question of quality as much as quantity. Underlying deficiencies in vitamins and minerals can be masked by weight gain, but afflict both the underfed and the overfed. Two of the most common are iron-deficiency anaemia and vitamin A deficiency, which continues to cause widespread blindness in children under five years old.
Obesity in low- and middle-income countries is a result of a series of changes in diet, physical activity, health and nutrition, collectively known as the ‘nutrition transition’. For a start, increasing importation of foods from the industrialised world means that traditional diets featuring grains and vegetables are giving way to meals high in fat and sugar.
Urban areas have higher rates of obesity because cities offer a greater range of food choices, generally at lower prices. And as more and more women work away from home, they may be too busy to shop for, prepare and cook healthy meals at home.
In rural areas increased mechanisation on farms has reduced physical activity. Moreover, many farmers have given up subsistence farming of multiple crops that provide a more balanced diet in favour of cultivating a single, high-yielding cash crop.
In many countries being overweight has reversed its cultural meaning. In Mexico and Brazil being overweight used to be a sign of wealth, but now that the poor have access to a diet high in fat and sugar it often signals poverty. The elite, who have better access to nutrition education, healthy foods and exercise facilities, tend to be slimmer.
But cultural context is important: in South Africa it has been suggested that overweight people may be deterred from losing weight because thinness is associated with HIV/AIDS, a disease with a high degree of social stigma attached to it.