Fighting the flab
2017-09-25, KARL WILSON 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).
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. 
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. 
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”.

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