Epidemic Obesity
in China
Chwan-Li (Leslie) Shen, PhD
Associate Professor
Pathology, School of Medicine
May 20, 2009
 China
is now the fattest
country in the world, second
only to the US.
China’s National Nutrition and
Health Survey of 2002
 Compared
to 1992 survey, body weights
and heights of preschool children in urban
and rural areas have significantly
improved, the prevalence of malnutrition
(underweight and stunting) has been
significantly reduced.
China’s National Nutrition and
Health Survey of 2002 (continued)
 However,
micronutrient deficiencies,
including calcium, zinc, vitamin A, vitamins
B1 and B2, are still common in preschool
and school children.
 Between
1992 and 2002, more than
60 million people became obese.
 In
o
o
2007,
215 million people were overweight;
68.44 million people were obese.
(Li et al. 2007 Obes Surg)
What is of greater concern
still, is the vast and fastgrowing number of
Chinese children and
youth that are obese.
 One
out of five Chinese children over
the age of 7 is overweight, and
nearly 10 percent are obese.
 Although
the rate of obesity is lower
in China than in America or Europe,
the overall number is huge (China
has 1.3 billion population).
 By
2020, more obese people in China
than in US.
Body mass index (BMI)
Gao et al. 2007. J Public Health
Overweight prevalence
distribution
Gao et al. 2007 J Public Health
Obesity-associated complications
 Glucose intolerance, diabetes
 Coronary artery disease
 Hypertension
 Hyperlipidemia
 Metabolic syndrome
 Depression
Obesity-associated complications
(continued)
 Reduced lifespan
 Respiratory system
complications
(obesity-hypoventilation syndrome
and sleep apnea syndrome)
 Joint degeneration
 Cancers (breast, rectal, prostate)
 Hepatic steatosis (fatty liver)
Related to both genetic and specific
environmental factors.
Why is it so devastating
that obesity rates have
increased 30-fold in 15
years in China?
How did a country that
struggled with starvation
just half a century ago
now find itself dealing
with an obesity epidemic?
Causes of Obesity
Culture
Excess body fat represents
health and prosperity… a
consequence of chronic
malnutrition that caused
millions of deaths in the past
two centuries.
China's one-child policy
 Food
is a common reward…
when started early, can be hard
to unwind when a child becomes
an adolescent.
 Money from generous parents.
Economic growth
 Nutritional
quality was often poor in
the past.
 China’s first nutrition and health
survey (2002) revealed dramatic
improvement in nutritional quality
with modernization and economic
growth.
 Obesity occurs due to:
o massive decrease in daily activity
and caloric expenditure,
o increase in food intake.
Changing dietary intake
 Intake
of energy from animal sources
increased from 8 to 25% from 1982
to 2002.
 Average intake of dietary fat
increased from 25 to 35% of energy
(>30% recommended).
 Expansion of the processed food and
soft drink sector.
Introducing high-fat fast food
-- KFC, McDonald’s …
 Sign
of affluence: you have some
extra money to splurge.
 Calorie count ignored.
 Instead of sharing food, which is the
Chinese norm, when a child eats at a
fast food restaurant, the pressure is
to finish all the food, even if full.
Changing portion size
 In
an agrarian economy, with a
limited food supply, the Chinese
people historically ate small portions
and worked off those calories in the
fields.
 Calorie intake and portion sizes
increase, while the society shifts to
more sedentary lifestyles ---- perfect
storm for the obesity crisis.
Changing lifestyle
 More
sedentary lifestyles …
television, computer, and
automobile.
 Night life.
 Less time for exercise due to
academic stress.
 Hormone imbalance.
Relationship between energy intake and energy expenditure
in the emergence of obesity over the last century.
(Levine 2007, Chinese Medical Journal)
How can obesity be halted
in China?
Strategic planning to
halt obesity in China
(Levine 2007
Chinese Medical Journal)
Organization
Need:
a
system for resource sharing,
 universally recognized evaluation
tools,
 to define the standard for
“success”,
 to allow obesity interventions
(personal or population) to be
evaluated and compared in a
common scientific-language.
Organization (continued)
Need partners for change:
 food industry
 clothing manufacturers
 pharmaceutical industry
 media industry
 furniture companies
 health insurers
 architects
Define models of success
 Not
only invoke personal
action but also populationwide environmental reengineering to directly
promote daily physical
activity and healthy eating.
 Economically
viable.
Define models of success
(continued)
 Cost-effective
for the
government in the long-term.
 Positive economic balance –
Obesity was created by
wealth, and a successful
obesity solution should not
destroy this wealth.
Implementation
 Obesity
 Need
can be reversed.
strong leadership
focused on the health of
people.
Psychological treatment
 In
Asia, people often hold a prejudice
against overweight/obesity.
 Intense pressure on
overweight/obese individuals (more
serious among children).
 Psychological interventions to
release pressure leading to weight
loss.
Involvement of family
 Encourage
proper balanced meals at
home.
 Encourage exercise.
 Discourage TV and video games.
 Dietary intervention.
 Health education.
School-based intervention
 Current
strategies:
 improving
level of knowledge,
 increasing physical activity,
 dietary intervention in overweight children
and adolescents.

None of the trials demonstrated convincing
evidence of the efficacy of any single
intervention for the prevention of overweight
and obesity in children and adolescents.
School-based intervention
(continued)
Future direction:
 facilitate
health and nutrition
educational components
incorporated into school curriculum;
 promote
modification of the school
and community environments to
improve and support healthy lifestyle
behavioral patterns.
Agro-food industry growth
 China
is the largest food
producer and consumer in the
world.
 Roles of government and agrofood industry in addressing
childhood obesity.
Alternative and
complementary treatment
 Herbal
medicine
 Dietary supplements
 Acupuncture: flexible point selection
and various methods without toxic
and side effects
Still need more studies to confirm.
Bariatric Surgery
Europe and USA: BMI  40 kg/m2 or
BMI  35 kg/m2 with related
comorbidities.
 In China: BMI  37 kg/m2 or BMI  32
kg/m2 with related comorbidities.
 Surgery for obesity is now in its
primary stages in China.
 Success should be determined by
weight change and by the
improvement of obesity-associated
complications.
 In
Bariatric Surgery (continued)
 Appropriate
training and supervision
of the multidisciplinary team to assure
good outcomes.
 Medical
diagnosis and management of
complications specific to bariatric surgery
 Dietary instruction
 Exercise training
 Nursing care
 Psychological support
The prevention and
treatment of obesity
in China remain to be
open problems.
Thank you.