Idea Exchange: Obesity in the US vs. Developing World

A major part of this journey I’m on is an exchange of ideas between friends, family, and all the people I meet who share an interest in nutrition, wellness, and self-improvement. I don’t let a day go by where I can find inspiration in a conversation with someone or an article I read off Twitter or LinkedIn. My friends have really been at the heart of this process, and I feel it’s important for me to acknowledge that here on F4TNYC (you like, that? I’m trying it out..) the way I do when I speak to them in person or online. One of the things I love about my circle is just how diverse they are in opinion, experience both personal and professional, and in background. It’s this aspect that keeps me going back to them for their take on all things nutrition and keeps this exchange going.

That said, I wanted to share this conversation I had with my good friend Gizelle today about obesity in the US versus the developing world. Gizelle is an MPH grad who’s currently working in Cambodia to help implement public health projects in various provinces around the country. She’s got a great eye for issues surrounding public health and how to look at these situations critically in order to take the steps towards intervention and/or prevention. Plus she’s wicked smart!

Without further ado, here’s a snapshot of one conversation that gets me thinking more critically about nutrition. I’d love to hear your thoughts, questions, comments or ANYTHING you want to say about the subject. Like I said, this is all about the exchange. Thanks! 🙂

GIZELLE’S EMAIL

I have given some more thought on the conversation on obesity in America on my flight home to SLC. There are a lot that we can learn from developing nations which helps to explain the eating distortions that we are witnessing.
 
When people think about (East) Asian people the following descriptions usually come to mind: K-Pop, Chinese food, andskinny. Unless you’re a sumo wrestler, Asian aren’t really perceived to be overweight or fat. There’s something in their genes that supposedly gives Asians a higher metabolism that causes them to breakdown anything they put into their bodies with the exception of alcohol (hello, Asian glow). I used to think this was all true until I came home last weekend and people-watched at the LAX airport during my layover from Seoul to SLC. Asians in America are f-a-t. So, no, Asians are not skinny— they have different habits in Asia that give the perception they are skinny. And no just fat in the sense that they need to do some sit ups, but in the sense that Asians in American look unhealthy: they look uncomfortable, were shoving their faces with burgers, and didn’t look like they could run for more than 30 seconds. And while the way someone looks doesn’t dictate whether or not their insides are healthy, it does tell me that there is something going on a deeper level in the way we eat in the United States and our obsession with purchasing unnecessary shit that is discarded as soon something new comes out like iPhones and iPads (this is another conversation for a later time).
 
Sure, I currently live in a country where rates of under nutrition are high, where the country has poor food insecurity, and the diet of the average Cambodian is rice and fish, but based on my travels in the region including China, Philippines, and Singapore, it’s the wealthy who are overweight and unhealthy. Whereas in the United States, it’s the poor who are overweight and unhealthy.
 
We can talk about the built environment, access to good food, safe neighborhoods for people to exercise, educating people to eat better, etc. but I think we need to look at less developed countries to understand the phenomenon of obesity. These environmental and structural factors are important, but there is more to the problem of obesity in the America. 
 
The poor in developing nations aren’t obese but rather the rich. The rich have access to whatever they want: gyms, spas, trainers, tend to be better educated, have maids to cook for them, etc. so the built environment theory, at least in this situation goes out the window and doesn’t address the problem of obesity which is growing in the Philippines and China (there is documented evidence for this). What is causing the rise in obesity of the skinny Asian? Fast food. 
 
Before I came home, I thought I would be eating fresh veggies and fruit. Instead, I’ve been eating out almost everyday, and the food that I used to think was good was really gross. I will be really honest, the best meal I had was at the beer garden and it probably had to do with the fact that the sausage was local. I can now tell if food tastes weird because there are not as much preservatives and chemicals in the food in Cambodia. In the US,  Everything is processed. And, portion size is out of control.
 
In Cambodia, the wealthy are starting to get fat. But so far there are several factors which I think the US can take a cue on if they want to figure out what we’re doing wrong and why diets don’t work:
  • Fast food: The only fast food restaurants in Cambodia is KFC. Pizza Company is a Thai pizza chain, and there are a few burger places. That’s it. No McDonalds, Starbucks, Burger King, Taco Bell. Eating at these franchises is considered a luxury and is expensive. The only people who eat here are fat expats, wealthy Cambodians and Koreans. Most people eat at local food eateries where everything is made of fresh ingredients and nothing is processed or refrigerated. 
  • Processed foods: There is one freezer at the largest grocery store, Lucky, in Phnom Penh. In this freezer, there are shelves of frozen dim sum, fries, and veggies. The only people who own microwaves are expats. Canned foods are really expensive in Cambodia. Everything is prepared fresh. Think about it. In the US there are endless rows of freezers with prepackaged foods. 
  • Portion size: I’ve reduced the amount of coffee I drink since moving almost two years ago. That’s because the portion sizes are smaller. The only place in Phnom Penh that serves large amounts is the new Coffee Bean and Tea Leaf Company and that place is expensive so I don’t go there. I never thought I could reduce the amount of caffeine I could drink but it’s true: if you don’t make large portion sizes an option, you don’t have the chance to overeat, or drink more than you really need to. Otherwise, extra large servings become the norm. 
  • Eating family style: Asians don’t eat one entree for each person. Eating a bonding experience and family style is sharing your food and is a healthier way of not eating an entire plate of pad thai by yourself. I mean, how silly is it going to a Thai restaurant and seeing four people eating four large pad thais? 
  • Not eating out: We don’t know what ingredients are being placed in our food. Sure, you can get your whole wheat pasta, but how much butter is in that sauce? 
Cambodia is not perfect. Diabetes is on the rise, and large of part of this is the rise in the number of prepackaged sugary sweets from China that become luxury status items (“It’s imported from China!”). Sure there are prepackaged “healthy” snacks from Kashi, Odwalla, Back to Nature, etc. in the US but its all processed
 
The key takeaway here is that we can talk about creating access to healthy foods all we want, but if we don’t change our culture of consumption: obsession of always wanting more (bigger car, bigger paycheck, more pad thai, etc), needing to have our own everything (car, food, house, pad thai etc.), eating alone– the risk of obesity won’t go away. Cambodian mothers work harder than any group that I know of and they don’t pick up burgers for their kids because they are too busy to cook. Fast food won’t go away for a long time, but we can change portion size, how we eat out (family style, a few nights a week), increase taxes on fast food and encourage more local production and purchasing of local foods. Healthy food is expensive because as a country we aren’t buying enough of it to bring the prices down.  It’s time to start thinking about the big fat elephant in the room. I’d love to hear your thoughts!
 
MY EMAIL RESPONSE
You made a lot of great points and I’ll most likely need to sit and read through this email again to really think about it more deeply, but here’s what I’ve got off the cuff.
I’m currently reading this book, The Social Networking Diet by Miriam Nelson, who was part of a select team of scientists that actually spent several years researching eating habits in the US for the past fifty years to try and determine what has caused this obesity ‘outbreak’ and why. I’m only a couple of chapters in, but a lot of what you’re saying is in line with what Dr. Nelson argues and what I think a lot of us have said in past conversations. As a society, we overconsume, period. It’s basic math when it comes to weight management. We take in calories (input). We burn it through physical activity (output). 50 years ago, many of the processed foods that we eat now didn’t exist and there was really no such thing as marketing targeting ‘local’ or ‘organic’ goods because, um, most if not all of it already was. So, we know this. We eat way too much. Even worse, we eat way too much of the crap that’s soaked in processed sugars, refined grains, and salt. And even worse than that, we underconsume the natural produce that’s chocked full of vitamins and minerals necessary to maintain a healthy and active system.
Now, I think your point about our need for the new with products and how that’s trickled into our eating habits is an interesting argument. It’s definitely a reflection of the trends that we’ve seen for the past ten years, and more extremely in the past five, as the pace of technological advancement picks up. That said, there’s another aspect to this argument. It was on the tip of my tongue as I typed that last sentence, but let me refrain for a second to backtrack to Dr. Nelson here.
The central argument to Dr. Nelson’s book is the notion that our social networks, specifically physical (but interestingly, I imagine digital will play a role here somewhere along the line if it hasn’t already), has a much deeper impact on how we consume than maybe even we realize. Sure, we know all about how marketing impacts body image and that our environment can direclty affect our eating habits if there are limited resources to healthy foods and produce ie. food deserts. But there’s a whole social angle that Dr. Nelson argues greatly influences how we manage our weight. She referenced several studies, and has a very detailed model and diagram illustrating what she calls the “Socioecological Model” (which I won’t bore you with) that illustrates how our social networks affect our weight. And for women? It’s the worst. She says, “we consume more calories if our dining companions are women” based on research that if one friend was obese, it was likely that there were other friends and family around them that were likely overweight or obese. There’s a culture of “if you do it, I’ll do it too” that helps push the numbers upward, and when you throw in those deadly processed foods, and then a total lack of apathy towards exercise, you get a population thats at least 30% obese. And that’s obese, NOT including the numbers of people that are overweight.
Look I have my doubts about these kinds of studies. I’m always finding a loophole or an exception to the argument. But the reality is that we have 2 major issues that have collided to create one massive problem that is driving the health of our nation downward: a disastrous food system and a societal tendency to consume and have instant gratification with everything. You put those two things together and you’ve got a….recipe for disaster. Yes, horrible pun. But definitely intended.
I can’t help but bring up the economic recession, which was what was on the tip of my tongue earlier. I’m really intrigued to learn how the last 3 years has really affected the way we consume food, especially in light of tighter budgets. But there’s also been a generational shift here as well. We’ve got the millenials shaking things up and challenging the status quo because they’re coming of age in a time when, well, there is no status quo. I read an article recently that labeled the millenials as the cheapest generation in over sixty years because they have no desire to own. Car companies are actually seeing their sales numbers go down in the 18-25 age group because they don’t want to own cars. They don’t drive. They don’t own houses. They barely keep the same lease for more than two years. Just look at our own friends and how often they’ve moved. So, I can’t help but wonder, what does all this mean for this generation and the next as they face a bleak job market, increasing tuition costs, and mounting debt? How does this affect the way they eat, what they eat, and how they feel about food? I don’t know, but I’d be fascinated to find out.
It’s a very very complex issue. I’m now reading about genetics and certain genes play a role in how we metabolize food, our susceptibility to exercise, and how our natural instinct to survive can affect the amount of fat our bodies can store when its consumed (which is why some scientists argue, its harder for some people to lose weight because their bodies store consumed fat much more quickly than its burned). It’s fascinating stuff. But I think your points about looking to developing countries and their eating patterns is 100% correct and vital to understanding our relationship with food. I’ve always said how one of my favorite things about traveling is seeing what people eat, how they relate to their food, and why it seemed that we just kept getting it wrong in the States. We don’t enjoy eating. I honestly believe we don’t. You just said it yourself Gizelle, that everything you’ve eaten has been gross. We’ve all been so desensitized to what actually tastes good because we’re bombarded constantly with crap. I’ve noticed such a change in my own body because I’ve made a strong effort to eat as natural as possible. So the day that I get a hankering for a pastry or something processed that I normally don’t eat, I’ll go ahead and give in and then immediately, I’m reminded, “oh yes, this is why i don’t eat this stuff,” because I feel so sick to my stomach within fifteen minutes. It’s amazing what our bodies can do and how it can let us know what really does us good. People just don’t know how to listen or they start listening way too late in some cases.
I think it’s absolutely fascinating how socioeconomics can flip the nutrition issue when you go from developed to developing. And also when you consider it historically. Just look at all the European portraits and paintings during the Renaissance and Baroque periods and you can see for yourself what kind of body types were admired and revered. It’s difficult to pinpoint just one thing, although I agree the fast foods/processed foods culture is a major culprit. But it’s like I said earlier- there’s 2 parts here. We’ve got a compulsion to say “gimme, gimme, gimme!” once the new and shiny is sitting in front of us, no matter what it is. I think we feed that compulsion much more often than we’re actually feeing ourselves, in the literal sense.
Gosh, I have SO many thoughts on this, but what’s exciting is that I also have so many questions. As much as nutrition and health can be considered scientific, it’s also incredibly social with so many different avenues to explore when you start looking deeper. Thanks for the thought-stimulating conversation. Like I said at the beginning of this, I’m going to have to sit and reread your points and really think more deeply about what impact the developing world might have on our ideas of food….already thinking of another article that I just read….lol Ok, I’M DONE. For now. 🙂
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One thought on “Idea Exchange: Obesity in the US vs. Developing World

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  1. Well, there is just so much food for thought here. I don’t even know where to begin. So, I will begin at the first topic that jumped at me.

    Gizelle, your observations regarding the relationship between socioeconomic status and being overweight in the US and Asia made me think of my observations of Ecuador and Nicaragua. I noticed when I lived there that the people most at risk for being overweight were lower to middle income people living in the cities. Upper-class culture was very much focused on image. Combined with access to conveniences, maid services, safe neighborhoods, gyms, malls, and access to “healthy” food in supermarkets, I observed a tendency for the upper-class in these two countries to not be overweight. Now, these are just observations and generalizations but I think that Latin America tends to follow trends in the US. What are people eating? I saw lots of fried food (often local cuisine but increasingly fast food), not always paired with the fresh fruit and vegetables that grow so abundantly there, lots of soda, and sugar in drinks (in Nicaragua, the fresh fruit juices are often made with lots of sugar).

    Second topic that jumped at me was consumption. I’ve long been an advocate for consuming less and have tried to practice consuming less as often as I can. Right now, that is a challenge for me. With a new job and a new salary, I find myself easily contemplating buying stuff. Ugh, I hate stuff. It creates clutter in all areas of life. It takes up space in my room. It takes up space in calender to go out and buy the crap. It takes up time in my calender to get rid of the crap. I measure success in the number of years that I am able to get out of my stuff. Yet, here I am seriously craving an iPhone. Wanting to expand my wardrobe. Oh, I need a new environmentally friendly water bottle – Klean Kanteen – (NOT – there are like 20 bajillion non-klean kanteens in my home). Maybe, this is a brand loyalty issue. Anyway, the point is, even people that have these issues in the forefront of their mind still need to battle daily to stay true to their core values. How about people who do not have consuming less, eating healthily for body and planet, lowering their negative impact on the planet at the forefront of their minds? I will always believe that people, in the end, want the best for themselves and for the people around them. I think that we get lost. Now to think that we all get lost so often and all at the same time (thanks to the bajillion distractions out there), what does this mean for us? Maribel, Dr. Nelson’s work has implications that we have already discovered. What we do matters. Because you are on this journey and have so graciously invited us to be a part of it, I am now thinking more about how I can make a small change here and there to eventually break through to bigger nutritional and exercise goals. As it has been for you, being healthy as been a goal for me foreva. And you are helping me realize that even defining that for myself is a process.

    K, I’m rambling. Thanks for this 🙂

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