Fighting Obesity in Asia and the Pacific
Two of five adults in the Asia and Pacific region are overweight or obese and the costs associated with these conditions undermine economic growth as well as the achievement of the United Nations 2030 Sustainable Development Goals, particularly on health.
The obesity and overweight “time bomb,” deserves urgent attention in developing countries.
The World Health Organization (WHO) estimates that in 2016, of adults over 18, more than 1.9 billion were overweight and 650 million were obese, which means 39% of adults worldwide were overweight and 13% obese.
That over half the world’s population is overweight or obese is of significant concern. Also alarming is the rate at which obesity grows: worldwide prevalence of obesity nearly tripled between 1975 and 2016. The difficulty in treating excessive weight is reflected in the fact that no country has successfully tackled the problem and reduced obesity rates in recent years.
Further, such statistics are no longer just a challenge of those in developed countries: 62% of overweight people reside in a developing country.
The Asia and Pacific region is home to the largest absolute number of overweight and obese people, about 1 billion—that is, two out of every five adults.
The common storyline is simple: obesity is caused by a chronic positive energy balance, i.e., energy intake in the form of food and beverages consumed exceeds, over a considerable period of time, the energy expenditure (the sum of physical activity, basal metabolism, and adaptive thermogenesis).
Researchers and policymakers, however, have increasingly looked towards proximal socioeconomic explanations for obesity and overweight.
The region has enjoyed impressive economic progress over the past three decades. In most countries, economic success translated into better health outcomes: life expectancy in Asia and the Pacific is among the highest in the world.
However, economic prosperity is also accompanied by a behavioral change which can be linked to increased prevalence of noncommunicable diseases (NCDs).
WHO has identified tobacco use, the harmful use of alcohol, physical inactivity, and unhealthy diets as the main risk factors of NCDs, as they lead to key metabolic/physiological changes (raised blood pressure, overweight/ obesity, raised blood glucose and raised cholesterol).
Further, economic growth has made food cheaper, with the region seeing a massive shift from agriculture to manufacturing and the service sector, which require less physical activity. In addition, rapid urbanization has been associated with more sedentary lifestyles, dining out and longer commuting times. Public health experts have described this shift in eating patterns as the “global nutrition transition.”
Overweight and obesity also increase the risks of NCDs including ischemic heart disease, hypertension, osteoarthritis, sleep apnea, stroke, diabetes and cancer. About 70% of global deaths each year are caused by NCDs (WHO 2017); positive associations between body mass index (BMI) and increased mortality from NCDs have been found. High BMI is an important factor contributing to cardiovascular diseases and coronary heart disease or stroke. The latter killed 7.4 million people in 2012.
The table below shows the prevalence of obesity in the region.
Prevalence of Overweight and Obesity in Asia and the Pacific
|Mean for Asia and the Pacific||34.6||40.9||18.3|
|Mean for Central Asia||42.3||49.3||16.4|
|People's Republic of China||13.2||27.9||111.4|
|Republic of Korea||25.2||32.3||28.2|
|Mean for East Asia||25.1||33.1||31.5|
|Mean for South Asia||23.6||28.9||22.1|
|Lao People's Democratic Republic||19.3||24.6||27.5|
|Mean for Southeast Asia||19.0||26.3||38.6|
|Papua New Guinea||39.1||42.9||9.7|
|Mean for the Pacific||55.6||60.6||9.1|
The implications of obesity and overweight are not limited to health. Significant economic costs are incurred due to increased costs of care and morbidity, as well as lost productivity.
Evidence consistently indicates that health care costs of overweight and obese individuals are higher than those of the general population. One systematic review estimates obesity accounts for 0.7% to 2.8% of a country’s total health expenditure.
In parallel, undernutrition is also becoming more prominent. Surprisingly, the phenomena of both overweight and obese and undernutrition can even be found in the same household under what has become known as an intrahousehold dual burden. Clearly, inequitable health outcomes are no longer contained to differences across countries or income groups within countries, and households may themselves represent a microcosm of the undernutrition and obesity problem.
Yet, the broader goals are clear. The United Nations’ 2015–2030 Sustainable Development Goals include two goals relevant to food and nutrition security and health: (i) end hunger, achieve food security and improved nutrition and promote sustainable agriculture and (ii) ensure healthy lives and promote well-being for all, at all ages. The second goal is particularly prominent because obesity is increasingly problematic for children—and policy interventions must increasingly target younger populations.
This policy brief highlights some of the insights of the book “Wealthy But Unhealthy: Overweight and Obesity in Asia and the Pacific.”
Cost of Obesity in Asia and the Pacific
It is estimated that the direct cost of overweight and obesity in Asia and the Pacific equates to about 0.56% of the combined GDP in this region while the indirect cost is about 0.22%.
It is also estimated that the direct cost of overweight and obesity is heavily affecting the East Asia, Central Asia, and Southeast Asia regions. On the other hand, the indirect cost of overweight and obesity is a heavy burden, particularly for the Pacific and Central Asia regions.
Overall, experts estimate a burden of 12.36% of healthcare expenditure, or 0.78% of GDP. In terms of direct costs, it is estimated that overweight and obesity contribute to about 8.9% of healthcare expenditure. The subregion with the lowest costs in South Asia with 0.56%, while East Asia faces the highest costs with 9.78% of health expenditure. The low direct costs of South Asia are not an indication that overweight and obesity are a minor issue; rather, it is due to the fact that the health systems in these countries only provide a fraction of the health care that would actually be needed.
Millions of overweight and obese people who suffer from related diseases are thus either not treated or undertreated. As the health care systems in the region should improve with economic growth, we expect that the share of non- or undertreated patients will decline. If the prevalence of overweight and obesity remains high or even increases, it will increasingly absorb the health expenditure.
Although the problem of excess body weight has received tremendous public attention in recent years, no country has implemented successful policy interventions to curb the increasing number of overweight and obese individuals in the past 33 years.
This may partly be due to the paucity of data to quantify and document until more recently, or the lack of comprehensive policy approaches.
Overweight and obesity can be tackled from at least two policy angles: improving nutritional intake and increasing physical activity.
These, in turn, are closely associated with cultural, environmental and socioeconomic factors, which make manipulating these angles difficult. Policy makers have chosen to influence food choices through market mechanisms (price changes) and government interventions (regulations against unhealthy foods) and to target behaviors as early as possible (at childhood and in school).
To increase physical activity, policymakers have targeted sports curricula at school and better urban planning, designing cities with well-functioning public transportation as well as sidewalks and green areas.
Costs of these interventions vary substantially. For example, regulations to restrict marketing to children have relatively low costs and possibly a high effectiveness. Food labeling requirements can impose substantial costs on producers; if badly designed, rather than leading to better food choices, labels may confuse the consumer.
Programs to improve school food may impose a substantial burden on schools already operating on tight budgets. Making the urban landscape conducive to physical activity can also be costly.
Another important area of action concerns the health care system. Overweight and obesity are often observed by health care workers, but are typically not well responded to health care professionals tend to be trained in curative health services, not in weight management, and facilities are often ill-equipped to receive obese patients.
In these areas and beyond, more cost-effectiveness research is warranted, especially in developing countries.
Examples of Specific Policies
In the Republic of Korea, concerned ministries (especially the Ministry of Health and Welfare and the Ministry of Education) have introduced many interventions to improve diets and increase physical activity.
For example, the Ministry of Health and Welfare provides budget support to local governments’ obesity programs, develops educational materials and publicizes them, and provides vouchers for management services of physical activity and diets of obese children. The National School Lunch Act, introduced in 1981, has provisions on school dietitians, nutritional requirements, and dietary consultation.
In Thailand, most policies developed in the first decades were initiated by the Thai Ministry of Public Health. Other government authorities, professional communities, and members of civil society have also been active in recent years as the obesity problem has become more evident and the impact of the work of the Thai Health Promotion Foundation has become more prominent.
There are few national policies and activities related to physical activity, save the recent national campaign in 2015 led by the Crown Prince to promote bicycle use, called “Ride for Mom and Dad,” which achieved the world record for the largest number of people riding a bicycle in a public event.
Further, five types of food policies in Thailand have been classified to prevent obesity at the national level: i) school focused policy; ii) labeling, packaging, and restaurant focused policy; iii) marketing policy; iv) pricing policy; and v) nutrition education and national dietary guidelines.
In Indonesia, the Indonesian Ministry of Industry plans in 2018 to introduce regulations for reducing the contents of sugar, salt, and fat in food in response to the growing concern about rising overweight and obesity.
The form of the sugar taxes is still being discussed and there are suggestions to include an excise tax. This will include introducing a sugar levy on soft drinks.
World Health Organization. 2016. Fiscal policies for diet and the prevention of noncommunicable diseases.
World Health Organization. Global Strategy on Diet, Physical Activity and Health.
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The views expressed in these articles are those of the authors and do not necessarily reflect the views of the Asian Development Bank, its management, its Board of Directors, or its members.