The nation has seized a much better future, but that future includes living with and tackling obesity

Growing up in the late 1950s in the countryside in southern England, I recall a time when food was scarce as the country continued to recover from World War II. For most of the time between 1939 and 1945, German submarines had surrounded Britain, sinking many of the ships bringing US food across the Atlantic. As Britain did not grow enough food to feed itself, the government imposed rationing, which continued until the 1950s. As a child I became used to eating, and enjoying, salads that my mother made from wildflowers and leaves, and she cooked nettles. When I was young we often saw folk whose clothes hung from their thin bodies. In England in the 1960s and 1970s fat people were rare, and everyone noticed them.

It was not until 1983, when I went to the US to attend business school at Dartmouth College in New Hampshire, that I started to see a lot of people who were much fatter than I was. The first time I saw a person who was fat enough to have difficulty in walking was in Washington, in 1984, when I was working as an intern at the World Bank. Returning to London in 1985 after two years in the US, everyone seemed skinny and small. I had become used to larger bodies in the US.

But that was then. Since 1985 the average British physique has altered dramatically, from thin and often undernourished then, to overweight today. Over-nutrition has become a much bigger problem in Britain than not having enough to eat. In 2010 the annual survey of the British National Health Service showed that 26 percent of British adults, and 16 percent of children aged between 2 and 15, were fat enough to cause serious problems to their health, a condition described as obesity. A wide range of medical research conducted since the 1990s has established a direct relationship between obesity and ill-heath. Diabetes, high blood pressure leading to heart failure and some cancers such as cancer of the bladder and of the kidney are all more likely in people who are seriously overweight.

This dramatic change of circumstances in British health has had a large impact on local health services. In June in eastern Yorkshire, northern England, a 35-year-old woman weighing 127 kilograms with a blood clot in her leg had to wait 11 hours before she could be taken to hospital for an operation because none of the outsize ambulances specially designed to carry obese patients were immediately available. This was despite the local health authority last year buying special equipment designed to carry people weighing up to 250 kg, at a cost of more than 1 billion pounds ($1.57 billion, 1.28 billion euros), with each wheelchair costing 140,000 pounds, each stretcher 13,000 pounds and each ambulance 108,000 pounds.

Britain now has the third-largest number of obese people in the world, measured as a proportion of the national population. The associated costs, already very large, are growing. Tony Leeds, a British obesity expert, calculates that the direct annual cost of obesity to the National Health Service by 2015 will be 6.5 billion pounds, with an additional 27 billion pounds of wider, indirect costs, such as lack of productivity. In the US, with about two-thirds of its population overweight or obese, the estimated obesity costs amount to $300 billion each year, taking loss of productivity and total disability into account together with the direct medical costs of being dangerously overweight.

But the overweight problem is not limited to developed countries. The World Health Organization estimates that 12 percent of the global population, or about 500 million people, is obese. This number, in absolute terms, is growing fastest in China, not only because it has the world's largest population, but also because its fat problem has grown to huge proportions. The number of obese Chinese, almost nil in 1980, was estimated to be 18 million in 2005, growing to 100 million in 2009. Today the number must be much larger than 100 million.

Last year an investigation by researchers at the Chinese Academy of Sciences working with experts from the University of North Carolina examined the particular causes of the explosion in Chinese obesity. One factor is cultural. Sports and exercise, which promote good health, are not perceived in China today as improving one's lifestyle. Instead, the emphasis is on education and getting ahead in one's career by working long hours in an office, probably in front of a computer, which requires virtually no physical effort.

Another factor is the spread of television into every Chinese home, affecting particularly young people and involving constant exposure to hard-hitting advertisements for high-energy protein, fatty foods, and alcohol. A survey in 2010 showed that 22 percent of Chinese parents believed that their children were underweight, even when they were not. Overweight Chinese boys are often thought to be "strong and healthy". Another survey showed, as you might expect, that better education reduced the likelihood of obesity in China, but only among women. With men it was the opposite: better-educated men were more likely to be overweight. Perhaps this is because for Chinese, fatness indicates prosperity, and no Chinese man wants to look thin.

A study carried out between 1989 and 1996, when some Chinese families were beginning to acquire their first car, compared the impact on excess weight of having a car against not having one. The study established a clear correlation between being overweight and having a family car in which to drive to work or go shopping. Particularly dangerous in China is the prevalence of obesity among young people. For example, in Xi'an, capital of Shaanxi province, 20 percent of adolescents were overweight in 2010.

But after so many years with not enough to eat, much of China has still to become rich enough to enjoy its moment of being fat. Now firmly established, the trend of Chinese obesity will be hard to reverse. China seems certain to suffer the same healthcare cost increase that is now being experienced in Britain and the US. With a diabetic population proportion that approaches that of the US, China already has more diabetics than any other country. A heavy additional burden is set to fall on the country's healthcare system, although the impact of more prematurely retired people on the old age pension system may be offset to some extent by the fact that obese people tend not to live as long as healthy people, and therefore may not require their pensions to be paid for as many years.

China's move, within two decades, from a predominantly under-nourished population to a partially overweight one is a symptom of its recent history - a mad rush to escape an immediate past scarred by turbulence, in order to seize a better future. China has seized a much better future, but that future does not come problem-free and without costs. Now China has to address the new set of problems that comes with being richer. Widespread obesity is one of them.

The author is a visiting professor at Guanghua School of Management, Peking University. The views do not necessarily reflect those of China Daily.

(China Daily 07/27/2012 page9)