ILLUSTRATION FOR TIME BY THOMAS FLUHARTY

How We Grew So Big
	Diet and lack of exercise are immediate causes—but the problem began in the Paleolithic era
	By Michael D. Lemonick and Bryan Walsh

Posted Monday, November 1, 2004; 20:00 HKT
There are many ways to measure Asia's remarkable economic progress over the past half-century, but you can't get more basic than this: starvation, for most of the region, has become a thing of the past. In 1943, India's Bengal famine killed more than 4 million people, and as recently as the early 1960s, tens of millions of Chinese died in the man-made famines of the Great Leap Forward. Just 25 years ago, the United Nations estimated that up to 40% of Asians were chronically undernourished. That number now stands at 16%. While people in countries such as North Korea, Cambodia and Bangladesh still struggle with malnutrition, hundreds of millions of other Asians who grew up amid scarcity now live in relative abundance. Barring catastrophe, most of their children will never know the pinch of real hunger.

And that's leading to a whole new problem. Asia's economic transformation has left many of its inhabitants with more food on their plate than they can healthily handle. The explosive growth of urbanization has dramatically cut rates of physical activity and introduced fat-laden foods of convenience to a new generation of Asians once accustomed to lean diets. The result has been a sharp upswing in obesity, a condition virtually unheard of in Asia a quarter of a century ago. In India, home to half of all undernourished people in the world, 55% of women between 20 and 69 years old are overweight, according to a recent study. A survey released last month by China's Ministry of Health found that the number of obese Chinese had doubled to 60 million between 1992 and 2002, while some 200 million are at least overweight; among children, the obesity rate has reached 8.1%. Altogether, the International Obesity Task Force, a global NGO that studies the spread of the epidemic, estimates that 1.7 billion people—one out of every five worldwide—are overweight or obese. "It's gone very quickly from that period when famine was receding," says Professor Barry Popkin, a nutrition expert at the University of North Carolina. "All of a sudden, instead of having a normal-weight body for a decade or two or three, you move from undernutrition to overnutrition in years."

Unlike the corpulent United States, it can be difficult to tell the extent of Asia's weight problem just by visiting your local fast-food franchise. Relatively few Asians have cracked the ranks of the obese; even technically overweight Asians, with their naturally small frames, can look slim compared with the average Westerner. But those seemingly svelte appearances can be deceiving. Doctors define overweight and obesity by a rough-and-ready measurement called the body mass index (BMI). For Westerners, a BMI above 25 is considered overweight, while one above 30 is obese. Yet studies have shown that Asians can suffer the ill effects of obesity at a much lower BMI; a World Health Organization (WHO) study has suggested that the threshold for Asians could be a BMI of 23 for overweight, and 26 for obesity. "In all likelihood, this means we have probably underestimated the effects of excess weight in a country like China," says Dr. Catherine Le Galés-Camus, a noncommunicable-diseases expert at the WHO.

It's not clear why Asians seem to show such a marked vulnerability to the effects of gaining weight. Some scientists theorize that children who are undernourished in the womb, which was not uncommon throughout much of Asia until recently, might develop unusually high levels of abdominal fat in adulthood if they're exposed to above-normal calorie levels. This puts them at greater risk for obesity-related illnesses like heart disease, cancer, hypertension and diabetes. India and China already have 32.7 million and 22.6 million diabetes sufferers, respectively; by 2030, the WHO forecasts, Asia could have as many as 190 million cases, with India and China having over 100 million between them. Asia's overburdened health-care systems will be struggling to cope. China, where 160 million people suffer from hypertension, is already feeling the strain, says Popkin: "You wait another decade and it's going to be very scary what it does to their health system."

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