Weighing the Risk of Obesity in Low- and Middle-Income Countries

The international news cycle is saturated with stories of countries experiencing food and nutrition crises that have put them at risk of famine. Yemen, South Sudan, and Nigeria are just several places that have captured the attention of the global community. Hunger-related crises like these rightfully demand our consideration because they pose a significant threat to public health, economic productivity, and political stability. Yet, there is another global crisis that warrants our attention for these exact reasons: the rising prevalence of overweight and obesity in low- and middle-income countries.

The numbers are staggering: the amount of overweight people is more than twice that of undernourished people globally. Almost 2 billion adults are overweight, and a third of those are obese. Additionally, 41 million children under five years of age were overweight or obese in 2016. Global obesity has almost tripled since 1975, and the numbers keep climbing. Yet compared to undernutrition, the international community is collectively failing to address the issue. To date, no country has reversed its obesity epidemic, and development objectives fall short in measuring and mitigating this growing public health crisis. Failing to assign the same weight to obesity as the global community does to undernutrition curbs our collective health, financial well-being, and stability in wealthy, middle-income, and poor nations alike.

The numbers are staggering: the amount of overweight people is more than twice that of undernourished people globally.

While obesity has traditionally afflicted high-income countries, low- and middle-income countries now experience accelerating rates of the epidemic. One-quarter of all overweight children live in Africa, and almost half live in Asia. Egypt has the highest prevalence of obesity in Africa, at nearly 40 percent of the population. Since the 1990s, levels of obesity have tripled in Mali, Malawi, Zambia, and Tanzania, while doubling in Kenya, Rwanda, and Uganda. Most of these are target countries of the U.S. government’s global hunger and food security initiative, which lays out a vision of “a world free from hunger, malnutrition, and extreme poverty” where “people consume balanced and nutritious diets.” Yet, since Feed the Future’s primary nutrition emphasis is on undernutrition, not overnutrition, the growing threat of obesity is not prioritized. While components of the U.S. development framework—such as the U.S. Global Food Security Strategy and the U.S. Agency for International Development’s Global Health Initiative—acknowledge the rise of overweight and obesity, a pragmatic response to the issue has been incomplete.

The epidemic’s root causes are complex and multisectoral, but there is broad concurrence that two main drivers account for growing rates of overweight and obesity. First, there has been a significant shift in dietary patterns in the past three decades, largely driven by income growth, accelerating rates of urbanization, and a growing modern food retail sector. Due to improved financial and geographical access to foodstuffs, populations are consuming more animal-sourced and ultra-processed foods high in fat, sugar, oils, and refined grains, while moving away from staple cereals, whole grains, and pulses. Second, adults in urban areas are transitioning from physically active agricultural and domestic labor to more sedentary duties, expending less energy on daily work, chores, and transportation.

The combination of these phenomena is commonly referred to as the “nutrition transition,” which experts attribute to demographic and economic changes. The transition is occurring more rapidly in urban areas than in rural ones, though rural communities often experience these shifts to some degree. In urban Ghana, Kenya, and Senegal, obesity is double the levels found in rural areas. Socioeconomically, obesity does not discriminate; it is rising among affluent and poor families alike.

Growing waistlines pose additional threats to low- and middle-income countries already burdened by high levels of undernutrition and infectious diseases such as malaria and water-borne illnesses. It is common for undernutrition, food insecurity, and obesity to coexist within the same communities and, in some cases, within the same households. This triple burden of malnutrition undermines the health and economic well-being of families across the globe, especially in conjunction with conflict- or climate-related disasters. The combination and the consequences of undernutrition, food insecurity, and obesity will not diminish unless lawmakers and private-sector leaders make concentrated efforts to reform our food system to support healthier diets for all. Until concrete actions are taken, overweight and obesity will continue to pose a significant short- and long-term danger to public health.

Failing to assign the same weight to obesity as the global community does to undernutrition curbs our collective health, financial well-being, and stability in wealthy, middle-income, and poor nations alike.

Research shows that overweight and obesity can weaken cognitive and motor functions over the course of a lifetime, reducing a person’s ability to reach his or her greatest potential. The epidemics are linked with impaired mental and physical development, and they are significant risk factors for noncommunicable diseases such as cardiovascular disease, hypertension, diabetes, musculoskeletal disorders, and some cancers. Persons who are overweight or obese often fall into the lowest quartile of global cognition, intelligence, logical memory, and verbal fluency.

Obesity’s comorbidities, in turn, have serious implications for productivity and earnings potential and are linked with higher mortality rates. Disability Adjusted Life Years (DALYs), which measure years of productivity adjusted for the burden of disability, reflect obesity’s increasing toll on low- and middle- income countries. Of the total DALYs lost to obesity worldwide, 71 percent stem from premature death and 29 percent from disability. This is a serious cause for concern in countries that seek to improve economic productivity but whose citizens are unable to make their full potential economic contributions.

Women are disproportionately affected by obesity: the prevalence of the disease is higher among women than men in most countries. Obese women also experience higher risks of associated disease, increased health care costs, and lower life expectancy than obese men. It also undermines women’s upward social, economic, and political mobility. The burden of obesity among women—both the disease’s risk and its outcomes—can be transferred to children at the time of conception and may persist through adulthood. Children born to obese mothers or who develop obesity early in life often have lower attention spans, reduced executive functions, and diminished mathematics and reading achievement. As a result, young generations with high levels of overweight and obesity may also be predisposed to lower productivity. Overall, this negative effect on earnings potential aggregates to significant economic loss and reinforces the intergenerational transmission of poverty.

It is common for undernutrition, food insecurity, and obesity to coexist within the same communities and, in some cases, within the same households.

Obesity is exorbitantly expensive. It costs the global economy U.S. $2 trillion each year by one estimate, equivalent to 2.8 percent of global gross domestic product (GDP). That makes it the third most expensive human-caused social burden, behind only smoking and armed violence, war, and terrorism. In Mexico, obesity is the costliest social burden, pricing in at 2.5 percent of GDP. Morocco, South Africa, and Brazil lose similar shares of their national economies to obesity’s rising costs. In Indonesia, the indirect costs of overweight and obesity were estimated at $28 billion in 2016.

The health and economic costs of obesity are too great for policymakers and the development community to treat the disease as a second-tier nutrition problem. Most of the world’s population lives in places where overweight and obesity kill more people than undernutrition. If obesity continues to increase at its current rate, half the world’s adult population may be overweight or obese by 2030. Without decisive action, the obesity crisis in low- and middle-income countries will worsen. As much of the world continues to urbanize and resources grow increasingly scarce amid shifts in consumption, human geography, and climatic conditions, it is important for development leaders in the public and private spheres alike to address the root causes of this problem.

While widespread action to combat obesity has been rare, there have been bright spots of leadership in addressing the crisis. The Milan Urban Food Policy Pact is one of these moments. Signed in 2015 by over 160 cities, the pact calls for the development of equitable, sustainable food systems and urban policies that address all forms of malnutrition. The World Bank is formally launching the Human Capital Index at this year’s October meetings in a bid to incentivize countries to spend more on chronically underfunded health and social problems like obesity. The Index will hold countries accountable based on their commitment to these areas.

Meanwhile, independent and private-sector groups, like the Global Panel on Agriculture and Food Systems for Nutrition (GLOPAN) and the McKinsey Global Institute (MGI) conduct necessary research that informs and encourages action on this issue. Such varied initiatives are indicative of the global community’s potential to address the overweight and obesity challenge.

Governments and the private sector should take seriously multiple approaches in fostering food systems that support diversified and healthy diets. Lawmakers should consider agriculture and trade policies that support the availability and affordability of a nutritious, culturally sensitive food system embedded in local markets. Private-sector actors must also take greater responsibility for their power to influence local and global food systems through academic research, transparent business strategies that value public health, and smart marketing practices.

It is not enough for agriculture and food supply chain policies to be nutrition sensitive; they must be nutrition driven. A narrow focus on hunger and undernutrition, without addressing the mounting prevalence of overweight and obesity worldwide, jeopardizes the health, livelihoods, and welfare of billions of people. Increased advocacy and investments by the public and private sector in policies, research, and programs that address the overweight and obesity crisis, in addition to undernutrition and food insecurity, will only continue to pay off in the long run.

Reid Hamel is a senior fellow of the Global Food Security Project at the Center for Strategic and International Studies (CSIS) in Washington, D.C. Elizabeth Black is a research intern with the CSIS Global Food Security Project.

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