For the French romantics, melancholy and boredom constituted the « mal du siècle », the malady of the 19th century. In 2012, « mal du siècle » is the expression that first comes to mind when thinking of… obesity. Obesity is a plague that has been spreading in post-industrialized societies and is now reaching developing countries. Within the last 30 years, the average weight of American citizens has gained 10 kilos, and obesity throughout the world has doubled. A tendency that does not say too much good about the future. In 2030,there could be 3,3 billion obese people. 80 % of which would live in the developing world.
But this forecast is balanced by the fact that undernutrition still affects 850 million people today. This number is constantly decreasing, but even if we managed to meet the Millenium Development Goals, there would still be 600 million individuals chronically undernourished in 2015.
It is safe to say that we will keep reducing the number of people affected by lack of food, while the proportion of population suffering from obesity will get higher by the day. And the question raises: will unequalities towards nutrition get even worse? Are we going to live in a world where people are either obese or starving, with only a small and rich minority able to maintain a healthy alimentation? Will malnutrition become the rule, and healthiness the exception?
Why the world grows fat
Obesity has long been the privilege of post-industrialized countries, an extreme characterization of our way of life, based on abundance and consumption. But things are about to change. While it is a known fact that, in the developed world, those who suffer from heaviness are mostly underprivileged, the rule starts to apply at the scale of the world. If we except the cases where obesity is a disease, sometimes congenital, being overweight will soon be the most visible sign of poverty, everywhere on the planet. In some cities of Africa, where development occurs faster than in the countryside, chubbier figures are starting to show : in Burkina Faso, 1/3 of the women living in cities are overweight.
The causes of obesity are environmental, economical and biological. But, in developing countries, they are also the result of a whole process : nutritional transition.
Nutritional transition is said to occur when two different phenomenons converge. For one part, the demographic transition, when there is a shift from high birth rates and high mortality to low birth rates and low mortality. For the other part, the epidemiologic transition, when the population starts suffering less from infectious diseases (associated with malnutrition and poor environmental sanitation), and more from chronic diseases (associated with urban and industrial lifestyles). Nutritional transition thus happens in countries that have long been exposed to undernutrition, poor health and sanitation, even famines and epidemics. And when the standard of living raises, the proportion of fat in the food intake does too, while the organisms are not well-prepared for such a brutal change.
In fact, weight gain may be a sign of the end of undernutrition, but it certainly does not mean that the days of malnutrition are over. The nutritional transition is characterized by the prevalence of aliments heavy in added sugar, saturated fat, and sodium, especially with the importation of food from the developed world. New products flourish and create new dietary habits, but the intake in vitamins, minerals and micronutrients remains far from enough. Which poses serious issues in terms of public health : obesity is an important factor in cardiovascular diseases, diabetes and cancer. It is responsible for 3 million deaths each year. Not the exact synonym of progress…
Two sides of the same coin
On the other hand, undernutrition still hits large parts of the population.
The Food and Agriculture Organization of the United Nations (FAO), in its 2011 report « The State of Food Insecurity in the World », states that in 2008, around 240 million Africans and 560 million Asians were exposed to undernutrition – 850 million in total, which represented 13 % of the world population.
In Africa, after the crisis that provoked a raise in prices of raw materials, the number has increased by 8 % between 2007 and 2008.
In the regions that are most vulnerable to the fluctuations of the food market and very permeable to the importation of (poor quality) food from the developed world, undernutrition and obesity are two sides of the same coin: malnutrition. The difference between the two is whether you have managed to get out of misery or not. Being obese is then a sign that you remained caught in somewhere between misery and normal wealth, somewhere called poverty. To the UN, this lack of proper food is a « hidden hunger ».
But paradoxically, with all its bad effects on public health, contextual obesity is also an omen that nutritional transition is on its way. We can bet that it will continue to spread among underprivileged populations, as they get out of misery and stop experiencing undernutrition. In some parts of the world, not far from now, obesity might become the rule. All things being equal, of course. In developed countries, governments tackle the problem of rampant obesity and populations become more and more aware and concerned about their own health. What if awareness about those issues rose faster in developing countries than it has in the Western world? In other words, the future can and will look brighter in terms of public health if undernutrition and massive obesity in the developing world are treated for what they are : two symptoms of malnutrition, two symbols of poverty. Consuming too much fat is another way to undergo dietary issues – and it will concern the weak and the poor before all.
The fat days will be over
In the movie « Wall-E », mankind has become an army of round and placid human beings, evolving in electric armchairs and doing nothing but eat all day. Is humanity bound to growing old and fat, letting machines accomplish all the work and just laying back to enjoy greasy food and the sweetness of being lazy? It is not likely. Humanity will not grow obese – first and foremost not from lack of activity. It will be a while before we can all just watch the days go by and the hard work get done by itself.
And we will neither become « obese in prosperity », for obesity due to the nutritional transition is meant to disappear just as much as undernutrition. It is the sense of progress. It is true, though, that overweight is likely to affect more and more people in the developing world, as starvation disappears.But it will not last. If the governments, NGOs, international organizations (FAO, WHO, etc.) and the food processing industries take their responsabilities in providing the world with information on their nutrition and better quality food, nutritional transition can happen more smoothly. We can avoid overweight and new chronic diseases on the way to healthy nutrition. And then another question will raise: can undernutrition disappear from our vocabulary? And will obesity stop affecting those who do not bear it in their genes?