The growing U.S. obesity problem travels abroad

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Giovanni Colacione, 47, is one of about six million people with obesity in Italy — a country known for its healthy, olive-oil-based, vegetable-heavy Mediterranean diet.
Italy’s incidence of obesity is indeed relatively low, at 10 percent, compared with the United States, whose rate of 38 percent is the world’s highest. But its rate of childhood obesity is worrisomely high, more than 30 percent and growing. And 45 percent of Italy’s population is overweight, which, some experts warn, could signal an impending rise of adult obesity, as well.
For now, though, Colacione struggles with feelings of isolation. “In the cities, within the buildings, behind the walls, there are people like me, folks you’ll never see in the streets,” he told Rome-based photographer Silvia Landi, who has traveled the globe documenting the lives of those struggling with obesity and its various health effects. As part of her research, she spent three years in the town of Monte Terminillo with Colacione, whose fluctuating weight has been as high as 660 lbs.
“Some people have decided to live in a safety shell that make them feel at ease,” he told Landi, “because the outside is hostile and rejecting [of] them. And when you’re obese, people around you are the most important thing.” 
Worldwide, there are now more than 700 million obese people, and 108 million of them are children, according to a recent study published in the New England Journal of Medicine. The research also found that the prevalence of obesity has doubled in 73 countries since 1980, contributing to four million premature deaths.
And for the first time in human history, according to a 2016 study published by the Lancet medical journal, there are more obese people than underweight people in the world.
To illustrate the growing “globesity crisis,” Landi has attempted to illustrate the fallout in three countries: Italy, South Africa and Mexico, all in distinctly different positions regarding weight gain. Italy has its high childhood obesity rate (35 percent), South Africa struggles with a high adult-female obesity rate (42 percent), and Mexico has one of the highest overall obesity rates in the world — nearly 30 percent, putting it just behind the U.S., Saudi Arabia, and Egypt, although it has at times been in the top spot.
Many point to obesity as a problem that the U.S. is exporting, through the growing presence of its processed-food and soda companies into nations where diets have traditionally consisted of healthy whole foods. Sales of packaged and processed foods, according to market research firm Euromonitor, grew 25 percent globally between 2011 and 2016, while sales of soda and ultraprocessed foods grew 48 percent in Latin America (compared with 2.3 percent in North America) between 2000 and 2013, according to the World Health Organization. Recent news reports have, just for starters, examined the relationship between Nestlé and obesity in Brazil, and between KFC and the rising obesity epidemic in Ghana
“In general, the change in physical activity cannot account for the increase of prevalence of obesity,” Dr. Ashkan Afshin, assistant professor at the Institute for Health Metrics and Evaluation at the University of Washington, told Yahoo News. “It’s excessive calorie intake … and that the intake of unhealthy food has increased.” Afshin was lead author of the June 2017 study published in the New England Journal of Medicine that found more than 10 percent of the world’s population to be obese.
While the purpose of that study was not to parse the reasons behind the rise, the authors did note that “changes in the food environment and food systems are probably major drivers. Increased availability, accessibility and affordability of energy-dense foods, along with intense marketing of such foods, could explain excess energy intake and weight gain among different populations.” 
Afshin also warned that looking strictly at rates of obesity (defined as a body mass index of 30 or higher), rather than rates of people who are overweight (defined as a BMI between 25 and 29), misses the bigger picture.
“If we just focus on the number of obese people, we are ignoring the overweight people, and a large number of the studies show adverse health effects start when people become overweight,” he said. “On a global level, there are 1.5 billion who are overweight but not obese. That can develop into obesity, and even if it doesn’t, they are at risk of health problems, cardiovascular disease, diabetes, and many cancers.” 
Surpassing Italy’s near-half rate of overweight people is the rate of 58 percent in South Africa, and 69 percent in Mexico.
“Some would say Mexico’s traditional foods are the cause, but that’s not the case,” said Fabio da Silva Gomes, regional adviser on nutrition at the Pan American Health Organization (PAHO), a part of the World Health Organization. “If you look at the evidence, what you really see increasing is not an epidemic of traditional soups or beans. No. What is happening is the increase of ultraprocessed products and sugary drinks.” 
Seeking to expand beyond their saturated markets in the northern hemisphere, da Silva Gomes said that the processed-food and drink corporations have been “aggressively targeting countries where most of the diets and most of the food systems are still comprised of real food — foods that are grown, prepared and shared by human beings and not by machines and industrial process. That’s why they’re being more aggressive in Latin America and the Caribbean, where no more than 35 percent of what people [traditionally] eat are in the form of ultraprocessed products — industrial formulations of flour, salts, sugar and cosmetics, which try to mimic real food but have very little food as ingredients.” 
To get the remainder of the population on board, he said, companies rely on aggressive marketing strategies, and the fact that sugar drinks are cheap to produce and can be manufactured pretty much anywhere. “They resist any sort of regulations on price, marketing, school restrictions, in order for them to expand their markets and the presence in people’s lives,” da Silva Gomes added, noting that Mexico’s soda tax, of one peso (about five U.S. cents) per liter, appears to be having a positive effect. 
“You can measure it by the sales of sugary drinks … month by month. Overall there has been a sustained 10 percent reduction on sales since it was implemented in 2014.”
While in Mexico and also in South Africa, Landi spent time with some of her subjects at doctor appointments. One was Ricardo Martin, 36, who met with a bariatric surgeon, Dr. John Scott Turner, in Cape Town.
“I met Ricardo on the day of his appointment with Dr. Turner. It was an important day for him because on that specific day he received the doctor’s approval for the operation, and Ricardo was very happy about it,” Landi explained. “He is young, and obesity caused him many physical problems; his knee problems prevent him from walking out of pain and his leg bones are bending due to weight. Ricardo told me he felt feel very uncomfortable with his condition, and that surgical operation was the only chance to change his life.” 
South Africa also has a sugar tax, just instituted this year, as do countries including India, Thailand, Britain and Saudi Arabia.
“Speaking to people I photographed, especially in South Africa, I have understood that they often did not realize they have a problem,” Landi said. “I interviewed people who believed that eating fried food every day was not a problem for their health, people who have realized they have severe obesity problems only after having had a respiratory crisis, and others convinced that drinking sugary soft drinks with fruit flavor was just the same as eating fresh fruit. And I’ve seen parents of a of 1-year-old child fill his baby bottle with Coke.”
Da Silva Gomes says it’s these types of critical health moments that can help drive change. “As Mexico got to epidemic levels of obesity and diabetes, mainly driven by the expansion of sugary drinks and sugary products, it’s helped society to realize they needed to take a very strong step in reversing that,” he said, “and I think that’s where advocacy works.”

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