Tip­ping the scales


Southeast Asia Globe - - Feature - BY JANELLE RETKA

The stom­achs of South­east Asia have be­come en­larged in re­cent years. Un­for­tu­nately, the con­se­quence is not well-nour­ished pop­u­la­tions but an in­creased like­li­hood of non-com­mu­ni­ca­ble dis­eases from di­a­betes to heart dis­ease, which are of­ten fa­tal.

“It's re­ally spread­ing. It's not just an ur­ban wealthy prob­lem. Now it's a prob­lem for ev­ery­one,” Jes­sica Blanken­ship, Unicef's East Asia and Pa­cific nu­tri­tion spe­cial­ist, says of dra­matic weight gain across the re­gion. Pre­vi­ously thought to be quite lean, South­east Asia has been trans­formed by one of the world's most rapid in­creases in over-nu­tri­tion in re­cent years. Mov­ing for­ward, “the com­po­nents are in place to in­crease obe­sity in the re­gion”, ac­cord­ing to Blanken­ship.

Seden­tary lifestyles, in­creased screen time, more women mov­ing into the workplace – thus de­plet­ing the promi­nence of healthy, home-cooked meals – and grow­ing con­sump­tion of pro­cessed goods as in­ter­na­tional food chains en­ter the lo­cal mar­ket are all con­tribut­ing fac­tors to in­creas­ing obe­sity rates. Both ru­ral and ur­ban pop­u­la­tions are see­ing the im­pact of traditional grains, fruits and veg­eta­bles be­ing pushed off the kitchen ta­ble to make way for con­ve­nient, high-su­gar, high-calo­rie pro­cessed foods. The re­sults are stag­ger­ing.

Ac­cord­ing to World Health Or­gan­i­sa­tion (WHO) sta­tis­tics, at the turn of the cen­tury 7% of Malaysia's adult pop­u­la­tion and 3.7% of Thai­land's were con­sid­ered obese; those rates have since more than dou­bled in each coun­try, with 15.6% of Malaysia's adults clas­si­fied as obese as of 2016. At the same time, the in­ci­dence of over­weight and

obese chil­dren across South­east Asia has in­creased by 150%, re­sult­ing in a to­tal of 4.2 mil­lion over­weight or obese kids un­der the age of five in the re­gion.

Across the pop­u­la­tion as a whole, WHO es­ti­mated that by 2016, 8.5 mil­lion South­east Asians were dy­ing each year from non-com­mu­ni­ca­ble dis­eases such as heart dis­ease and di­a­betes. An un­healthy diet and lack of phys­i­cal ac­tiv­ity are lead­ing causes, along­side tobacco use and al­co­hol abuse.

Ex­perts say the uptick in the over­weight pop­u­la­tion is likely to con­tinue as South­east Asia makes its way through a ‘nu­tri­tion tran­si­tion' that is pro­pelled by ur­ban and eco- nomic devel­op­ment and moves its pop­u­la­tion away from traditional home-cook­ing. “It's pretty clear. We've had a rise [in obe­sity], and un­less there's a ma­jor in­ter­ven­tion, there's no rea­son why it would change,” Blanken­ship says.

The re­gion's malnutrition is­sue, how­ever, does stand out from oth­ers glob­ally due to its ‘dou­ble burden' of un­der­nu­tri­tion and ex­cess weight that could ag­gra­vate the prob­lem, ex­perts say.

“There is a com­plex in­ter­play be­tween early un­der­nu­tri­tion (in moth­ers be­fore and dur­ing preg­nancy, and in early child­hood) and later over-nu­tri­tion that ex­ac­er­bates the risk of non-com­mu­ni­ca­ble dis­eases (NCDs), the preva­lence of which is ris­ing rapidly in low- and mid­dle-in­come coun­tries,” write nu­tri­tion spe­cial­ists Pat­ta­nee Winicha­goon and Bar­rie Mar­getts in a re­port on the dou­ble burden pub­lished last year by the In­ter­na­tional Agency for Re­search on Can­cer.

The ex­act link be­tween un­der­nu­tri­tion and obe­sity

Obe­sity is re­ally spread­ing. It’s not just an ur­ban wealthy prob­lem. Now it’s a prob­lem for ev­ery­one

later in life has yet to be de­ter­mined, but as new fac­tors come into play, such as low-qual­ity foods en­ter­ing the mar­ket, a likely cause has be­come clear.

“What we think is hap­pen­ing is that the process of be­ing un­der­nour­ished at a very young age… causes phys­i­o­log­i­cal and meta­bolic changes in the child, and it leaves them at higher risk of obe­sity later on in adult­hood and also for NCDs,” says Blanken­ship.

In­done­sia, Malaysia, the Philip­pines and Viet­nam are all con­sid­ered to have “public health con­cerns” caused by both un­der­nu­tri­tion and ex­cess weight, ac­cord­ing to Unicef. In In­done­sia, 12% of chil­dren un­der five years of age – 2.89 mil­lion of them – are over­weight.

In coun­tries such as Cam­bo­dia, ex­cess weight and obe­sity have not yet be­come prom­i­nent, with only 3.9% of the adult pop­u­la­tion con­sid­ered obese in 2016. Nu­tri­tion ex­perts say the ground­work has been laid for the fu­ture, though.

“[In Cam­bo­dia], one in four chil­dren un­der [the age of ] five is un­der­weight, one in ten is wasted and one in three is stunted, ir­re­versibly da­m­ag­ing their long-term cog­ni­tive and phys­i­cal devel­op­ment, and con­tribut­ing to low wages and lost pro­duc­tiv­ity as adults,” ac­cord­ing to the 2017 Global Nu­tri­tion Re­port, which com­piles data from global or­gan­i­sa­tions in­clud­ing the WHO.

Foods with poor nu­tri­ent lev­els are be­ing suc­cess­fully mar­keted to young Cam­bo­dian chil­dren and their moth­ers, says Alissa Pries, a tech­ni­cal ad­vi­sor for Helen Keller In­ter­na­tional's As­sess­ment and Re­search on Child Feed­ing (Arch) Project, which stud­ies in­fant feed­ing habits in Ph­nom Penh and other de­vel­op­ing cities.

Walking into an in­fant and baby sup­ply store in Cam­bo­dia's cap­i­tal city, this be­comes es­pe­cially ev­i­dent. Along­side nap­pies, wet wipes and baby sham­poo sit Choco-Pie treats, Kin­der eggs and potato chips with a smil­ing potato-man car­toon on their pack­ag­ing. Baby ce­real boxes list nu­tri­tional in­for­ma­tion in In­done­sian – an un­com­mon lan­guage in this nearby coun­try, mak­ing it a chal­lenge for moth­ers to know what they are buying for their grow­ing chil­dren.

Gov­ern­ments are well aware of obe­sity, but I think that there’s usu­ally less fo­cus on chil­dren. There’s a lot of progress that needs to be made

“The taste pref­er­ences that chil­dren de­velop start from a very young age,” says Pries. “If kids are be­ing ex­posed to and eat­ing things that are high in su­gar or high in salt, that can re­ally steer the di­rec­tion of their diet later into child­hood and even into ado­les­cence and adult­hood.”

The Arch Project in Ph­nom Penh shows that where in­fant food prod­ucts are mar­keted, moth­ers are bit­ing. Among 222 moth­ers sur­veyed, 55% had fed their chil­dren aged un­der 23 months com­mer­cial pack­aged foods, such as those found in the in­fant store, the day prior to speak­ing with re­searchers; roughly 80% had done so in the week prior. Sim­i­larly high rates were recorded in other de­vel­op­ing cities sur­veyed glob- ally, ac­cord­ing to Pries, mak­ing it a likely is­sue through­out South­east Asia.

“For this young age group, they have very tiny stom­achs, so what­ever goes in needs to be very nu­tri­ent dense, packed full of good things,” Pries said. “If you're con­sum­ing a lot of things that are low in mi­cronu­tri­ents, vi­ta­mins and min­er­als but high in en­ergy [and] calo­ries, it could po­ten­tially dis­place con­sump­tion of other nu­tri­tious foods, so it could con­trib­ute not only to higher rates of over­weight and obe­sity, but also un­der­nu­tri­tion… So, for this age group there's sort of a dual con­cern.”

Ac­cord­ing to Blanken­ship, gov­ern­ments through­out the re­gion are mak­ing ef­forts to ed­u­cate their pop­u­la­tions on nu­tri­tious eat­ing and reg­u­late the mar­ket­ing of food. How­ever, she says that much of this is fo­cused on adult diet al­ter­ations, which of­ten end up be­ing tem­po­rary changes.

The re­al­ity begs for at­ten­tion to be shifted to in­fants and young chil­dren who can build healthy habits from the start, she says, pointing to a lack of school cafe­te­ria reg­u­la­tions in the re­gion – with the ex­cep­tion of the Philip­pines. Fruits, veg­eta­bles, an­i­mal prod­ucts and items low in salt and su­gar should be pro­moted in these set­tings to create healthy habits for the long-term.

“Gov­ern­ments are well aware of obe­sity and NCD re­duc­tion, [but] I think that there's usu­ally less fo­cus on chil­dren,” Blanken­ship says. “There's a lot of progress that needs to be made.”

South­east Asia suf­fers from a ‘dou­ble burden' of un­der­nu­tri­tion and ex­cess weightA group in a shop­ping mall in Bangkok. In­creased screen time and seden­tary lifestyles are key con­trib­u­tors to ris­ing obe­sity lev­els

Ex­perts say that the growth of the re­gion's over­weight pop­u­la­tion is likely to con­tinue

The ar­rival of in­ter­na­tional food chains has in­creased con­sump­tion of pro­cessed goods, which has con­tributed to the re­gion's grow­ing obe­sity prob­lem

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