Obesity is a term referring to excessive body weight rather than just fat accumulation. Any one over Body Mass Index (BMI ) 25 is called over weight whereas any one over 30 is called obese. BMI is calculated by dividing weight by height square. When I look back 60 years ago, fewer people were obese, but now it is increasing at an alarming rate. In this blog, I throw light upon the incidence of obesity in various countries, without going into its management. Some people might argue, although one is over BMI 30, he or she is healthy. Why does medical science not change the goal post, to increase the obesity lower limit to 35?
Research has shown that a lot of diseases are associated with obesity, and recently it has been established that morbidity and mortality of Covid-19 are more in obese people. Medical science has established an optimum range of parameters on vital functions after endless research. For example the serum sodium (Na) level is between 135 and 145 mEq/L, which means the body functions the best in that range, so is the case of BMI. If the range is below 135 or higher than 145, it can cause serious physiological changes in the body. Same is the case with BMI, which cannot be adjusted to accommodate those who do not take regular exercise or eat excessively.
Only 13% of people in the world are classed as obese. Although the rate of obesity is very high in certain Pacific islands, developed western countries take the brunt of the obesity epidemic. The following are the current percentage of obese people in the developed countries;
USA: 37 %
Mexico: 29%
Canada: 29%
UK 27%
Ireland: 25%
Spain : 24%
Germany 22%
France: 21%
Japan: 4%
So as you can see, obesity in America is considerably higher than the world average, and nine times higher than in Japan. Of course, from an American perspective, there is not a lot of obesity in Germany and France, which have less than 2/3rd the obesity rate of the United States. Besides, the more countries eat like Americans, the fatter they are. Obesity in the UK and Canada is relatively high and the trend is that it is getting beyond control. French and Italians are known for their culinary taste, but their obesity rate is much lower than neighbouring UK.
Much has been said about the advantage of a “Mediterranean diet”, and it is true of Italy and Spain. But it can hardly be said in the case of France and Germany. In France higher percentage of Muslims who practise fasting during their festival period lower the overall percentage of obesity rate there. The American way of eating snacks at odd times between meals,over size portions, and drinking sugary drink for thirst are attributed to one of the reasons for obesity. Most people In Italy, France, Germany and Spain normally eat three times a day and drink water or wine during the meal. In addition Americans have a craving for sugary pastry and calorie rich processed food.
Europeans walk more, drive less, play less indoor games and watch less television. Once when I was in Charlotte,North Carolina, US, I was stopped by a policeman in a patrol car, while walking on the pavement.He asked me where I was heading for. I coolly told him that it was only an evening walk. Listening to my accent, the policeman told that Americans do not walk on the street. I heard stories that to post a letter 200 feet away from home, they use their cars! World Health Organization (WHO) reported that 32.4% Americans take insufficient physical activity, whereas in Germany 21% of population take insufficient physical activity. In Europe, most of us mow the lawn ourselves, but in America, even able bodied employ gardeners to do the same.
A number of studies have demonstrated the strong inverse relationship between relative socio-economic status and obesity, particularly among women. The United States has a far higher concentration of wealth than European countries, like Germany, France, Spain and Italy. This means, the percentage of lower class is more in America than in Europe. Fewer American well off people are obese, as they consume low calorie quality food. Moreover lower class Americans consume more fried carbohydrate, junk food and sugar drinks. They cannot afford to go to the gym or attend keep fit training courses. After childhood, poverty stricken Americans do less exercise. The irony is overweight in children, especially in boys is the greatest in Greece despite being a Mediterranean country, next comes Italy. But overweight children are one third less in the US. This means that Americans put on weight after the adolescence.
Asian countries have some of the lowest prevalence of overweight and obesity worldwide .Vietnam (1.7%) and India (1.9%) have the lowest rates of obesity in the world. Malaysia has the highest obesity prevalence at 14 % in the South East Asia region, whilst in Australia the obesity rate is like that of Canada(29%). Most Australians descend from European countries, indicating that obesity has strong genetic predilection and little to do with geographical location. In most asian countries like Japan, obesity is lower than the global average, due to strict discipline, walking to school and using public transport, fasting in certain religions as I mentioned earlier, fewer fast food outlets, predominance of vegans and vegetarians and so on. However, South Asians are more likely to develop central obesity, which is associated with higher risk of developing dyslipidaemia (bad fat),impaired glucose tolerance, type 2 diabetes mellitus and cardiovascular diseases (CVD).
About 15% of the population of the African continent are obese.The latest survey shows Egypt has the highest prevalence of obesity. In Egypt,the obesity rate is 32%, whereas in South Africa and Algeria obesity rates are 28% and 27 % respectively. Childhood obesity in Africa is increasing very fast due to catching up of American style junk food. The rising middle-class in many African countries prefers to buy processed foods, rich in sugars and fats rather than eating traditional food, fruits and vegetables.
Obesity causes heart disease, strokes, type 2 diabetes,hypertension, and certain cancers. As these are related to lifestyle, they can be entirely prevented. Medical cost of obesity in every country is huge, and therefore every government should endeavour to make their citizens aware of the risks of carrying excess weight. Governments can legislate on banning advertisements on sugary food, penalise supermarkets, subsidise healthy nutritious food and gym membership. These measures will help to build a healthier generation and the government can cut back healthcare expenditure in the long run.
Dr.C.J.George FRCS
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