Fighting the flab

Rising prosperity has brought with it the challenge of childhood obesity, but China has set ambitious goals to address the problem

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September 25 – October 1, 2017
in Sydney

Childhood obesity is one of the fastest-growing health concerns in China.

With more than 15 million kids over 7 years of age classified as obese, the country now has the highest childhood obesity rates in the world. And the government is taking steps to slow the rate of incidence.

Late last year, the State Council, China’s cabinet, announced the introduction of its Healthy China 2030 initiative. It aims to improve health and tackle obesity by promoting healthy lifestyles.

“China has recognized the problem, especially among children and adolescents,” said Mu Li, professor of International Public Health at the University of Sydney.

One of the leaders in the public health field, she has been a visiting fellow at Peking University Health Science Center and the Institute of Food, Nutrition and Health, Swiss Federal Institute of Technology (ETH) in Zurich, Switzerland.

The issue of obesity is “not just for the government to solve but one in which society as a whole has a responsibility”, Li told China Daily Asia Weekly.

The Healthy China 2030 program is central to the government’s agenda for health and development and a strategy that is being closely watched by many foreign countries, according to the World Health Organization (WHO).

According to the WHO, China’s investment in health reaps huge dividends not only for its domestic population but also for the rest of the world.

It is an issue that has not escaped the attention of President Xi Jinping, who has put health at the center of the country’s entire policymaking machinery.

“Health has now become a key component in all areas of government and government policy,” Li said.

By promoting healthier lifestyles through health and nutrition education campaigns and programs to improve physical fitness, the government hopes to lift the overall health of the nation and tackle obesity, said a spokesperson for the WHO in Beijing.

The government has set some ambitious goals in its program. It hopes by 2025 that more than 500 million people will be exercising regularly and the smoking rate among people over 15 years of age will be held at 20 percent. China still has one of the highest rates of smoking in the world.

At last year’s National Health Conference — which the WHO said was the most important national meeting on health in 20 years — the government showed great political will and determination to tackle not only obesity but the overall health of its people.

At the conference, Xi said health is a prerequisite for people’s all-round development and a precondition for economic and social development.

He said that if the problems in the health sector are not effectively addressed, people’s health may be seriously undermined, potentially compromising economic development and social stability.

According to the WHO, following the National Health Conference, China’s leaders ensured that health became an “explicit national political priority” with the approval of the Healthy China 2030 Planning Outline by the CPC Central Committee and the State Council.

“This is the first medium- to long-term strategic plan in the health sector developed at the national level since the founding of China in 1949,” the WHO said.

Through greater technological advances and improvements to the health insurance system, China also hopes to ensure that health equity can be basically achieved by 2030.

“Huge steps have already been taken here. Over the last decade, China embarked on the biggest health system reform the world has seen, aiming to extend health services beyond the country’s prosperous urban centers,” the WHO said.

“At the start of the century, less than one-third of China’s population had access to health insurance. Now nearly 100 percent do. In essence, China has given its huge population a safety net that protects people from being impoverished by the costs of healthcare. This makes a tremendous contribution to a fair and prosperous society,” it added.

According to the WHO, China’s investment in health reaps huge dividends not only for its domestic population but also for the rest of the world.

Students play in a pool during a summer camp for overweight children in Zhengzhou city, Central China’s Henan province, on July 12. Credit: Zhang Tao / ImagineChina

The country’s contribution to global health security attracted international attention during the Ebola outbreak in West Africa, supplying well-trained and self-sufficient medical teams.

More recently, China has been supporting the Emergency Medical Team (EMT) initiative, the WHO’s website said.

Shanghai East Hospital was classified in the first batch of EMTs under the WHO Classification List. The Shanghai team is now registered by the WHO for emergency deployment when the next regional or global outbreak strikes.

“Building on these achievements and its domestic successes, China has a key opportunity to ensure that the huge progress it makes in developing a Healthy China at home can deliver great benefits across the world when exported elsewhere,” the WHO said.

Childhood obesity will challenge the government and society.

Less than a generation ago, it would have been hard to find an overweight child in China. But with the country’s rapid economic development and associated lifestyle changes, there has been a substantial increase in the prevalence of obesity, and with it, related noncommunicable diseases (NCDs) such as type 2 diabetes, cardiovascular disease and cancer.

Matthias Helble, senior economist with the Tokyo-based Asian Development Bank Institute (ADBI), told China Daily Asia Weekly: “Obesity is a complex problem. Economic prosperity has given many Chinese the means to eat better and more. However, it has increased the risk of overeating.

“Urbanization has led to a change in lifestyle with more sedentary jobs, and less time for cooking and more meals outside.”

Helble said childhood obesity, especially among boys, has increased rapidly in recent years and will become a “time bomb” for the future, as obese kids have a very high chance of remaining obese for their entire lives.

The ADBI estimates the direct costs to the Chinese health system at around $17.9 billion or 3.4 percent of healthcare expenditure.

“We estimate that the costs due to premature mortality and disability are even higher at $32.7 billion,” Helble said.

“In total, we estimate that obesity costs China 0.53 percent of GDP every year. That’s a heavy burden.”

The problem of childhood obesity was highlighted last year with the release of a 29-year study — carried out between 1985 and 2014 — of nearly 28,000 children and adolescents, by the department of education in East China’s Shandong province.

Published in the European Journal of Preventive Cardiology, the study found that 17 percent of boys and 9 percent of girls were obese in 2014, compared to less than 1 percent of children and adolescents in 1985.

Dr Zhang Ying-xiu, leader of the investigative team at the Shandong Center for Disease Control and Prevention, at the Shandong University Institute of Preventive Medicine, said the increases in overweight and obesity coincide with increasing incomes in rural households.

“We expect this trend to continue in the coming decades in Shandong province and other regions of China,” he said in the study.

“China has experienced rapid socioeconomic and nutritional changes in the past 30 years. In China today, people eat more and are less physically active than they were in the past.”

He said the traditional Chinese diet has shifted toward one that is high in fat and calories, and low in fiber.

A traditional Chinese diet is characterized by plant-based protein, low cholesterol and some dietary fat. But the food composition of the diet of many Chinese families has changed into one that has high fat and animal protein.

The University of Sydney’s Li agreed, noting that the increase in urban living has exposed children to an “unhealthy food environment”.

“Parents have become too busy to prepare food at home and, coupled with a higher family income, children eat preprepared food or eat out more often, and have pocket money to buy their own snacks,” she said.

“They live in much more confined spaces and have limited opportunities to walk to and from school or play outside. Such factors have influenced both their energy intake and output.”

Nutritionists say that a non-active child who drinks a 2-liter bottle of fizzy drink a day would need to walk 46 kilometers just to burn the calories off.

Relaxation of food restrictions, the rise in family disposable income and the availability and abundant supply of a range of foods in many regions of China are also contributors to the obesity epidemic now sweeping the country.

A traditional Chinese diet is characterized by plant-based protein, low cholesterol and some dietary fat. But the food composition of the diet of many Chinese families has changed into one that has high fat and animal protein.

Li said a study by the China Health and Nutrition Survey, of children aged 7-17 years, has demonstrated a steady decline between 1991 and 2009 in daily carbohydrate intake (from 382.5 to 254.1 grams) and in the proportion of energy from carbohydrates (from 66.7 percent to 56.8 percent).

In contrast, she said, daily fat intake has steadily increased from 54.8 to 66 grams, and the proportion of energy from fat from 21.5 percent to 30 percent.

But Li is optimistic, and noted that if any country can solve the problem of obesity, China “will do it”.

Fast ways to grow fat Western-influenced changes in diet have led to increased Chinese obesity, but consumers are starting to demand healthier options

September 25 – October 1, 2017
in Sydney

To get some idea of how the obesity rate in China has risen, you only have to look at the growth of the fast-food industry.

For years now, research has shown a direct correlation between obesity and fast food.

When the first KFC outlet opened in Beijing in 1987 — 30 years ago — obesity, especially among children and adolescents, was hardly a factor in the nation’s health. Today, it has become an epidemic.

“It opened the floodgates not only to Western fast food but the development of the domestic fast-food industry as well,” said Mu Li, professor of International Public Health at the University of Sydney.

She said the fast-food industry in China has seen enormous growth in the last 20 years, in line with the country’s changing economic fortunes.

China is one of the most urbanized countries in the world: Millions have become affluent, and with that affluence has come changes in lifestyle, including eating habits.

“Fast food, especially Western fast food, has played a big part in the changing dietary habits of the Chinese,” Li told China Daily Asia Weekly.

Increased sugar levels, fatty and processed foods have all contributed to the rise in obesity, especially among children. The problem has been exacerbated by the shift from traditional eating habits to more modern — including Westernized — patterns, featuring high energy density, high fat and low fiber diets.

According to Bloomberg, fast-food giants McDonald’s and Yum, the parent company of KFC and Pizza Hut, had a combined 38 percent share of China’s fast-food market in 2015.

Interestingly, both in the past year have separated their China businesses from the US-headquartered operations.

Yum China Holdings became a licensee of Yum Brands on the Chinese mainland, trading separately on the New York Stock Exchange since November 2016. The spinoff plan was announced back in October 2015.

A customer eats at a KFC outlet in Shanghai. Western fast food is a major cause of obesity in China. Credit: AFP

Meanwhile, in a $2 billion deal completed on July 31 this year, McDonald’s sold a controlling 52 percent stake in its Chinese mainland and Hong Kong operations to State-backed conglomerate CITIC and CITIC Capital Holdings. US private equity firm Carlyle Group holds a 28 percent stake, while McDonald’s has kept 20 percent.

KFC is still the dominant player in China with some 4,600 outlets, compared with 2,100 in 2010.

In its annual review of China’s fast food industry, IBISWorld, a global market research firm, estimated there are 2.3 million fast-food outlets in China and that they will generate $150.9 billion in revenue this year, up 9.6 percent from 2016.

In August, McDonald’s said it would add 2,000 stores in China — increasing the number to 4,500 by end-2022 — as part of its strategic partnership with CITIC and Carlyle.

“China will soon become our largest market outside of the United States,” Steve Easterbrook, McDonald’s chief executive, told Reuters in August.

The fast-food chain said it would aim to open more restaurants in lower tier Chinese cities, boost delivery capacity and introduce a “digitalized and personalized” dining experience to more Chinese customers.

Modern Chinese-style fast-food restaurants have also emerged and developed rapidly, learning from the Western chains, especially in management techniques.

Studies have shown a correlation between fast food and obesity. The majority of these studies have been conducted in Western countries, but China is fast catching up with its own research.

One study published last year, in the International Journal of Environmental Research and Public Health, said the “rapid expansion of China’s fast-food industry will likely have many public health consequences, while some have already become alarming as indicated by increasing obesity”.

The study, A Review of the Growth of the Fast Food Industry in China and its Potential Impact on Obesity, added that the change in diet will also lead to an increase in diseases such as cardiovascular disease and diabetes.

“Compared to the traditional Chinese diet (predominantly vegetables and grains, featuring plant-based protein, and high in fiber but low in cholesterol and fat), fast food often consists of more meats and very limited vegetables, and is high in energy density, fat, protein and sodium, and prefers deep frying to boiling,” the study said.

Domestic Chinese-style fast food outlets have expanded as well, largely influenced by Western-style chains such as KFC and McDonald’s.

Summer Chen, food service analyst at Mintel, said leading fast-food brands in China like KFC are trying to change people’s association of high calorie fast food with “obesity” to “energy boost” so that it appears healthier.

One of the biggest domestic fast-food chains is Malan Noodle, founded in 1995. The company operates well over 400 outlets in China, offering Chinese-style sets.

Despite the growing rate of obesity, China is taking steps to slow it down, especially with regard to what children and adolescents eat.

Research by global market intelligence firm Mintel shows that after decades of rapid economic development and social change, people are changing priorities to adapt to China’s “new normal”.

“Parents are continuing to put their focus on investing in their futures, in their kids, health and longevity,” according to Mintel.

The research shows that 70 percent of consumers prefer buying drinks specially designed for children, and that well over a third of parents would like to see more ready-made meals designed for kids.

Mintel’s study shows that nearly half of consumers would like to see more vegetables in ready meals, and one-fourth would like to see more vegetarian ready-meal options.

It said the number of vegetarian ready meals is also rising, with 45 percent of consumers agreeing that “juice with plant protein or vegetables is healthier than pure juice”.

Summer Chen, food service analyst at Mintel, said leading fast-food brands in China like KFC are trying to change people’s association of high calorie fast food with “obesity” to “energy boost” so that it appears healthier.

“To make the ‘energy boost’ concept relevant, they are nowadays targeting more at students and young working people (with campaigns featuring energy breakfast sets with coffee, and working lunch meal sets) instead of kids.

“Their food offerings are also going healthier,” Chen told China Daily Asia Weekly.

“McDonald’s China has launched a campaign announcing that the brand will use less salt, better oil, and more vegetables and grains in their meals.” Meanwhile, she said KFC had opened its first store with a health concept serving fresh juices, salads, and panini sandwiches with grilled, not fried, chicken.

“Some of them have even launched sports/exercise-related marketing campaigns (such as McDonald’s McHappy Run) featuring families with kids, as an attempt to fit the brand image into a healthy lifestyle that everyone desires,” Chen said.

The trend toward healthier food is entwined with food-safety concerns, which remain a source of worry for Chinese consumers.

According to global consultancy McKinsey & Company, consumers in China are now starting to turn away from fried fast food to a healthier eating lifestyle.

A McKinsey survey showed that 51 percent of consumers in China said they ate Western fast food in 2015, down from 67 percent in 2012. “They have since shifted to healthier, more environmentally friendly brands,” it said.

The survey, between September and November 2015, included 10,000 respondents from 44 cities.

In all, 38 percent of Chinese consumers reported food branded as ‘organic’ and ‘green’ was one of the top ways they identify the safety of food products, despite the fact that no credible organic certification exists yet.

“Some companies developing credible food certification standards have shown promise,” the survey said.

The trend toward healthier food is entwined with food-safety concerns, which remain a source of worry for Chinese consumers. The government in 2015 began implementing a sweeping food-safety policy.

For many years, big Western brands including KFC benefited because Chinese saw them as cleaner, safer alternatives to local options.

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