The “access and excess” that lies beneath the epidemic of obesity and non-communicable diseases.

Noemi Renzetti

Obesity is not anymore centered in a few high-income countries: it is nowadays a global concern. Urban and rural areas in the poorest countries of sub-Saharan Africa and South Asia, as well as populations in more developed countries like China, Brazil, India and Mexico are nowadays facing an overall shift in their traditionally healthy diet: the nutrition transition. These countries, where poverty, famine and malnutrition were still an issue just thirty years ago, are now experiencing a rapid economic transition, industrialization and globalization process. There are strong evidences to say that the Westernization of the diet and the diffusion of fast and processed food at low prices are one of the main contributors to the high incidence of obesity and other NR-NCD’s (nutrition related non-communicable diseases). Most of these countries, like the almost forgotten Oceania, have always been mostly isolated from the rest of the world and forced to rely on their domestic and territorial resources. The economic development caused the market expansion from a local to an increasingly global base with the consequent introduction of new type of highly processed foods – high in salt, fats and sugars –, previously unknown to the majority of those populations. It has been proved how new flavors and new testes are essential components of eating pleasure and can impact on the amount of food consumed. The use of modern technologies for mass production also caused the prices of the majority of these processed and imported food to fall, thus making them more convenient than healthier and natural products such as fruits, vegetables and cereals. Simultaneously, the economic growth of these countries drew the attention of the Western Fast Food chain. Mc Donald’s opened the first store in South Africa in the 1997, along with the country’s economic boost. Moreover, obesity and NR-NCD’s are nowadays equally and dramatically distributed toward all the strata of the population. The consume of expensive animal products –also rich in saturated fats- is on the rise among the richer people while fast food and junk food products are the main source of energy for poorer people -due to their convenience. An example is the littlest island in the world, Nauru, which was awarded as being also the fattest with a 75% of the native population being obese with an average BMI between 34 and 35. Strictly related to the economic development of the country, the nutrition transition, the GNP per capita and the urbanization, a series of lifestyle changes also occur. The general shift from an intensive to a sedentary work, the changes in the meaning of transportation –the massive use of the car – and the shift in technology leisure, all had a great impact on the development of the obesity epidemic. In addition to all these factors, which should bring to a lower requirement in term of energy introit, people are eating more and choosing the worst possible source of food. Thus, causing the energy imbalance. The Nutrition Transition in the developing countries is having immense implication on the public health not only in terms of premature deaths and the spread of diseases but also in terms of cost for the health care system. Moreover, the majority of these countries still lack a strong health care system able to face the consequences of this dramatic obesity epidemic. There is an urgent need for strong interventions in order to change the transition pattern and prevent it to continue into future generations. Countries like Finland and Norway decreased high levels of NR-NCD among the population with taxation and import controls on risky foods. Their experience showed how government policies could effectively drive the consumers choices, by shifting prices and availability of the foods. However, the reverse is also true: “If we change the way we eat, the system will have to adapt to the consumers new habits and needs” (Knives and Forks, 2011). The introduction of a systemic nutrition and health education is essential to diffuse the correct information that will affect the consumer knowledge and attitude and will allow them to make sensible choices. Personal efforts will than make the rest. Treating obesity with drugs is not the answer and is not even affordable. Prevention, more than intervention, is the only feasible approach. By going back to our traditional diets we could prevent obesity. A clear example is Okinawa, a Japanese island still untouched by the Western Diet, the population of which has been awarded as the healthiest and long living on the hearth. Citing the noted British epidemiologist Geoffrey Rose, the authors say: “Mass disease and mass exposures require mass remedies. Mass remedies require the masses to be part of the solution”.

“Let food be thy medicine.”
(Hippocrates)