Obesity Goes Global

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ht-year-old Hannah McGoey lives in an upstairs apartment on a busy thoroughfare in London. She has no yard to play in, and her school holds physical-education classes just two days a week. Her busy parents tried to be careful about nutrition, giving up their Friday fish and chips, for example. But over the years, Hannah only became plumper. By the time she turned 6, children's sizes no longer fit her. "I would have to buy jeans for 12- and 14-year-olds," her mother Julia remembers, "and then cut a foot and a half off the leg."

But things began to change when a school nurse told the McGoeys about a program called MEND (mind, exercise, nutrition, diet), started by Paul Sacher, a dietitian at London's Great Ormond Street Hospital for Children. Hannah enrolled last September, and by the time the program ended 10 weeks later, she had shed nearly 5 lbs. and grown more than an inch. That wasn't all. Once a shy, clingy child, Hannah, who is now 4 ft. 11 in. tall and weighs 84 lbs., brims with confidence and loves physical activity. "I didn't swim much before," she says. "Now I go swimming once a week."

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Hannah McGoey, unfortunately, is a rare exception to what is rapidly becoming a global epidemic of childhood obesity. More and more countries around the world — even some that have been struggling to prevent starvation — are now wrestling with the dangers of excessive nutrition. The U.S. continues to lead the way, with as many as 37% of its children and adolescents carrying around too much fat. But other countries are rapidly catching up. According to statistics presented recently at the European Congress on Obesity in Helsinki, Finland, more than 20% of European youngsters between the ages of 5 and 17 are either overweight or obese. Children in North Africa and the Middle East aren't far behind. Across Asia too, childhood obesity is on the rise, and the trend has been documented even in urbanized areas of sub-Saharan Africa.

"These figures should set alarm bells ringing in ministries of health across the developed and developing world," says Tim Lobstein, co-editor of a forthcoming report to the World Health Organization on childhood obesity. And with good reason: people who are obese as children have a high risk of becoming obese adults — meaning they will have a much higher risk than their slender counterparts of contracting a broad range of debilitating diseases, including heart disease, hypertension, diabetes and cancer. The surge of obesity among children, in short, presages a global explosion of illnesses that will drain economies, create enormous suffering and cause millions of premature deaths. "This is a true health-care crisis," says Robert Lustig, a pediatric endocrinologist at the University of California, San Francisco, far bigger than severe acute respiratory syndrome (SARS) and ultimately, he thinks, even bigger than AIDS.

According to Hungarian pediatrician Dr. Denes Molnar, fully 9% of obese children and adolescents already suffer from a premorbid condition known as metabolic syndrome. Among the most worrisome symptoms are changes in blood chemistry that can trigger future health problems. A substantial fraction of chubby kids, for example, have elevated levels of LDL cholesterol, putting them at risk for atherosclerosis. Many also have elevated blood-sugar levels, a precursor of Type 2 diabetes. Around the world, the prevalence of Type 2 diabetes, formerly known as adult-onset diabetes, is soaring in the under-18 crowd. As a result, complications like nerve and eye damage, which typically take years to develop, are suddenly popping up among people in their 20s.

Why do children become obese? One important factor is insulin, which enables the body to store extra calories as fat. Physical exercise helps control insulin levels, while certain foods elicit its massive release. For example, ingesting fat alone doesn't prompt a big surge in insulin, but fat combined with starches and sugar does. A child who sits in front of the TV for hours on end, eating potato chips and doughnuts, is an ideal fat-storage machine.

Genetics can make a difference as well. Those who are most susceptible to gaining weight on high-fat, carbohydrate-rich diets are those who are primed to produce high levels of circulating insulin in the first place. Among them are the inhabitants of the South Pacific island of Nauru, who — thanks to a surfeit of cheap, calorie-dense foods, along with a shift away from jobs requiring physical activity — have the unwelcome distinction of being some of the fattest, most diabetes-prone people on the planet.

Alas, the Nauruan experience, while extreme, is not unique. Asia, for instance, lags behind the U.S. and Europe in its obesity statistics, but Thailand, Malaysia, Japan and the Philippines have all reported troubling increases in recent years. In China, where a one-child-per-family policy has created millions of spoiled and overnourished children (feeding a phenomenon known as little-emperor syndrome), the rise in childhood obesity is particularly alarming. Up to 10% of China's 290 million children are believed to be overweight or obese, and that percentage is expected to have doubled a decade from now.