JEROME MING / REDUX FOR TIME

URBAN LIFE: Waistlines are expanding even in impoverished Manila

The Economics of Fat
	Bloated are the Poor
	By Lisa Takeuchi Cullen and Bryan Walsh

Posted Monday, November 1, 2004; 20:00 HKT
Baby Cruz stands just 1.55 m tall and weighs 81.6 kg, qualifying for a body mass index of 34, which is well in the dangerously obese range. She snacks on a steady diet of junk food in between her rice-heavy meals. Yet the 56-year-old Manila fish vendor, who says she earns only about $5 a day, is proud of her weight. "At least people will not think I'm not eating three times a day," says Cruz. "They do not think I'm poor, that I'm leading a hand-to-mouth existence. But actually I am."

In the eyes of many Asians, extra weight has long been viewed as a sign of good fortune—proof that you were wealthy enough to eat rich meals and avoid calorie-burning physical labor. But as in the West, extra weight is increasingly turning into a burden, not a blessing, as obesity works its way down the socioeconomic ladder. A recent study in the International Journal of Obesity found that as per-capita income rose in developing countries, the burden of obesity shifted from the relatively well-off to the poor. It is especially prevalent in Asia's rapidly growing cities, where expanded economic opportunities can also mean expanded opportunities to gain weight.

On the surface, the spread of obesity among the poor makes little sense. If they are struggling to buy groceries, how can they pack away enough calories to gain all that weight? The cost of quality food is perhaps the best place to start. Calorically speaking, the best bang for the buck tends to be packed with sugar, fat and refined grains—which means it's not just pleasurable but cheap to stuff yourself with cookies and candy bars. Similarly, poorer shoppers are more likely to end up with unhealthy hot dogs than lean beef, as the sausages are much less pricey. "The stomach is a dumb organ," says J. Larry Brown, director of the Center on Hunger and Poverty in Waltham, Massachusetts. "It doesn't know anything about quality. It knows only when it's full."

Processed foods—which hog ever larger portions of diets—aren't just cheap, tasty and filling. They're also quick to make or pick up, which makes them ideal for the harried poor scraping by in Asia's megacities. A 2003 paper by the Harvard Institute of Economic Research found that a key factor behind the rise of obesity is the dramatic drop in the time people now are required to devote to preparing what they eat, thanks to the wide-scale availability of mass-produced foods and fast food. All that cheap and accessible grub can lead to the kind of constant snacking that has grown increasingly common in the U.S.

It doesn't help that Asian cities, with few parks and open spaces, make it almost impossible for the poor to work out—assuming they have the energy. Cruz says she works up to 18 hours a day, leaving her far too exhausted to exercise. In the countryside, the work itself would have been strenuous enough to burn off all those excess calories, but not in sedentary Manila with its abundance of processed foods.

Saving Asia's urban poor from obesity will require significant government help, not least in providing greater access to green spaces and to markets that sell affordable fresh food. "Cities have a major role to play," says Dr. Catherine Le Galés-Camus of the World Health Organization, who emphasizes that health experts have to work with urban leaders—and not just on the national level. Otherwise, the burden for Asia's poor will only get heavier.

With reporting by Nelly Sindayen/Manila

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