Obesity Not Just an American Problem Anymore

Two years ago, when Barry Popkin announced that more than a billion people worldwide were overweight—easily outnumbering the 800 million who were malnourished—folks looked up from their Big Macs in shock. Then they went back to eating, pushing the number of overweight people to its current number, an astonishing 1.6 billion. And it's not just Americans, or even Western cultures; obesity has become a global problem. Popkin has a new book that goes a long way toward explaining why that happened. "The World Is Fat" (Avery) pins the blame for the ever-growing obesity crisis on some well-known villains: sugary drinks, couch-potato lifestyles and yes, cheeseburgers. But Popkin also reveals some less obvious culprits: evolutionary biology, for instance, and a host of other forces beyond any individual's control. A professor of global nutrition at the University of North Carolina at Chapel Hill, he spoke with NEWSWEEK's Mary Carmichael. Excerpts:

NEWSWEEK: Your thesis is that we're all getting fat because we're eating more and moving less. That makes sense for individuals: if I sit around eating donuts, I'll gain weight. But you're talking about whole countries--the whole world, really. So what is going on?
Barry Popkin:
The constant thing we've heard in America for the last 20 years is "You fat, gluttonous Americans, you should feel guilty. You're overweight and it's your fault." But all of a sudden, we're seeing the same problems in places where 20 years ago all they worried about was hunger: in Egypt, and among blacks in South Africa, and in China, where a third of adults now are overweight and obese. In Mexico, nobody was overweight 15 years ago; now 71 percent of Mexican women and 66 percent of men are. When you get to this kind of point, you've got to step back and say, "Wait, what is going on?"

What's happened is that from 30 years ago to today, we've had an exponential explosion in what we can think of as the "obesogenic environment." You see food available everywhere. You can't move more than 100 feet without seeing a caloric beverage. In most of the world, it used to be that people mostly drank water, and today they're consuming more and more sweetened beverages. Fruit juice didn't even come into being until the late 1950s, except for what you squeezed at home, and milk—there was some, but people didn't drink so much of it. The average American has not changed the amount of water he consumes in the last 30 years or so. But he's added 22 ounces of caloric beverages to his diet, and that's 300 extra calories per day. Then you match that kind of diet with human biology. We naturally prefer sweet and fatty foods because of what those foods used to mean for survival when we were hunter-gatherers. They had the nutrients we needed, and they let us store more energy for the hungry season.

And now, for most people, there is no hungry season.
Right. But we're still eating the same kinds of foods. From the beginning of humanity, we've always wanted to have tastier food and less work to do. These are innate drives, and we can't change our biology.

It's not just about what we eat. People around the world are less active now, too.
When I started working in China in the '80s, everyone biked to work. Today it's dangerous to bike, so people take mass transit or cars or motorcycles, and kids under 12 are banned from biking because it's not safe. They don't walk, either.

How important a factor is globalization? Your title, a play on Thomas Friedman's book on the global economy, "The World Is Flat," suggests it's a big factor, that we created the obesity crisis in America, then exported it.
Well, let's take an example. Up until three years ago, there was no snacking in China. Now it's exploding. Why? Because all of a sudden, there are Chinese equivalents of Wal-Mart. A lot of people used to live in a subsistence world, a more primitive world, and they couldn't afford things like modern vegetable oil. But now we have supermarkets everywhere, and everybody sees the same TV we see and wants the same things we want.

Wasn't it once the case that people in developing nations tended to get fat only when they moved to cities?
It certainly was the case in the early phases. But now in China and Mexico, people in the rural areas are as fat or fatter than they are in the urban areas. That's because all of a sudden food is cheap in rural areas, and farmers and fishermen who used to have very labor-intensive jobs are cutting out activity in favor of technology, like tractors. That means they end up burning 1,000 fewer calories in a day, and it's very hard to just suddenly cut 1,000 calories out of their diet.

Meanwhile, malnutrition rates have been going down steadily since 1990. How is that connected with obesity going up? Is it the same forces at work, or different ones?
The programs that have been developed around the world to deal with hunger have ignored obesity. We need to change them to focus on things that benefit the malnourished while not exacerbating obesity, and that's not something the hunger-aid community has not been willing to deal with.

So, the big question: What do we do about this? How should we be rethinking policies to combat obesity around the world?
In this country, at least, the first thing we can do is what we're starting in New York right now, which is a beverage tax. Beverages are the only thing that we truly can pick up and say, "These have super-negatives." Juice, soft drinks, fruit drinks, energy drinks, all caloric beverages except skim milk—all of these have [little] value except calories. So I'd start by taxing them. It's a lot harder with fatty foods. They may have some important nutritional value. Besides, it's not fat we really care about, it's calories. So I would prefer not to do a "fat tax," but to have an added-sugar tax, as well as a tax on fried foods and certain junk foods that are really energy-dense.

Wouldn't you also want to make healthy foods cheaper? How do you do that?
That's a critical step. ... Beans and fruits and vegetables and other components of a diet that would be really healthy—we have essentially ignored those crops, and instead we have made certain foods, staples like grains and animal foods, dirt-cheap by creating a whole system around them, with big agribusinesses and government funding and lobbyists. And we've replicated that system around the world. If it were up to me, we would cut out half of the subsidies we currently put into the grain sector. We subsidize food when we have more than enough surplus, and the subsidies are not helping the farmers, they're helping the agribusinesses.

Some people are going to respond to all this by saying it should be a matter of individual responsibility that diet and weight are a matter of choice and the government shouldn't meddle.
That's OK if those people want to pay for the extra health-care costs that come with obesity. But right now this is affecting everyone in America, because we all pay those costs. It's the same issue we had with seatbelts. People who didn't use them were only hurting themselves, physically, but in the process, they were raising insurance costs for everyone. Now we are at a point where people can't even walk and they need scooters to get around, where we have to build special beds and chairs in hospitals, where we're taking toes and feet off people that have diabetes. If the government is going to pay for all of this, that affects everyone, and we need to do something about it. But America is a society that prefers to break things and then pay to fix them.