The Effects of Government Policies, Economic Forces, and Globalization on Worldwide Obesity

| April 1, 2015

This column is written by medical students and is dedicated to reviewing the science behind obesity and bariatric surgery.

Column Editor: Daniel B. Jones, MD, MS, FACS
Professor of Surgery, Harvard Medical School, Vice Chair, Beth Israel Deaconess Medical Center, Boston, Massachusetts

This month: The Effects of Government Policies, Economic Forces, and Globalization on Worldwide Obesity

by Jonny Kim, BA
Medical Student, Harvard Medical School, Boston, Massachusetts

Bariatric Times. 2015;12(4):8–10.


Introduction
The negative health effects of obesity are well known, some of which include heart disease, diabetes, obstructive sleep apnea, cancer, and osteoarthritis. While obesity was generally considered a problem of only high-income developed countries, rates of obesity are increasing worldwide in both developed and low- to middle-income developing countries. So much so that the World Health Organization (WHO) predicts public health concerns stemming from overnutrition will outweigh health concerns from undernutrition and infectious diseases.[1]

The increasing prevalence of obesity in the world is partially the result of technological and economic success. The Chicago Council on Global Affairs notes that the world has seen a shift from early death due to communicable diseases and undernutrition to later death stemming from non-communicable, chronic diseases, which are often associated with overnutrition.[2] In fact, most of the world’s population live in countries where more people die from overnutrition-related diseases than undernutrition.[3] Many of the factors that have helped decrease the poor health effects of undernutrition are the same factors that have contributed to the obesity pandemic. This article serves as an overview of the different economic, political, and globalization forces that have influenced the increasing prevalence of obesity.

Increase in Available Calories
Twenty years ago, worldwide morbidity and mortality stemming from undernutrition was of much bigger concern than health problems caused by overnutrition. The world has made much progress in the last 20 years to decrease the burden of undernutrition, but at the cost of increasing morbidity and mortality from overnutrition.[4] Data from the FAOSTAT, or Statistics Division of the Food and Agriculture Organization of the United Nations, is consistent with a steady global increase in available calories per capita.[5] Least developed countries have increased from a national average of 1,968 kcal per capita per day in 1992 to 2,324 kcal per capita per day in 2011.[5] But with this increase in available caloric resources, comes a change in the composition of macronutrients in the everyday diet that has contributed to overnutrition. There appears to be an association with an increased consumption of energy-dense foods, such as vegetable oils, animal products, including dairy and meat, and sugar.[4] This association is supported by the FAO database, which shows a global trend in an increased consumption of animal products and sugars with a concomitant decrease on carbohydrate-rich staples such as cereals and roots.[5]

Food Prices and Income
Increases in food price indices coupled with different demand elasticities among the food groups may have contributed to a shift for meat and processed foods in the global diet.[4] Data from the FAO show that international food price indices across the board have increased substantially since 2003.[5] The indices thats price have increased most significantly are cereals, while meats have only experienced modest increases in price. Studies have shown that demand elasticity for unprocessed foods are highest for fruits, vegetables, and meats, meaning that the price of these goods has a significant effect on demand.[6] Given that the price index for meat has grown at a slower rate compared to cereals and other foods, its high demand elasticity may help explain the higher proportion of caloric intake from meats. Additionally, data from Thomson Reuter’s show that prices for processed foods, such as snack foods and soft drinks, have fallen since 1992, which may help explain why these foods make a larger proportion of a person’s daily caloric intake.[4] Increases in global income may also help explain the shift toward animal products, processed foods, and eating out, a source of food that is commonly associated with an increase in saturated fats and simple sugars. Income elasticities for these products were found to be higher than those for cereals.[7] In other words, an increase in income influences one’s diet to consist of more meat products, processed foods, and calories from eating out.

Technology
Lakdawalla et al[8] hypothesize that obesity can partly be attributed to technological improvements. Because of improvements in technology, the cost of physical activity has increased because modern work is more sedentary compared with historical norms. At the same time, technology has made agricultural production more efficient, lowering the cost of calories. At this time, more data is needed to validate this model.

Globalization
The effects of globalization on overnutrition are not well researched, but many mechanisms have been proposed. Proposals include foreign direct investment (FDI), global food advertising and promotions, urbanization, and transnational food companies. Many of these issues are contentious because globalization has addressed many issues of undernutrition with diversification of food and decreasing the price of calories while increasing the risk of overnutrition.[9] The role of global market integration on the consumption of foods is readily seen in the globalization of agriculture over the past 20 years. The theory of competitive advantage is central to agricultural globalization, leveraging a region’s native resource endowment to produce and specialize in a particular good, thereby maximizing economic efficiency.[9] Global trade rules enacted in the 1994 Uruguay Round of the General Agreement on Tariffs and Trade (GATT) Agreement on Agriculture helped liberalize the global agricultural market. This has resulted in an increased diversity of food trades, foreign direct investments, and the emergence of transnational food companies, all of which have influenced global dietary changes. The increased global consumption of vegetable oils illustrates the effect agricultural globalization has had on diet. Favorable government policies in Brazil, China, and India have resulted in a massive growth in the production and exportation of soybeans.[9,10] This increase in the supply of soybean is considered to be a large contributor to the increased consumption of vegetable oils, with an increase in consumption as much as two-fold over the course of 10 years in China.[9,11] In fact, vegetable oils contributed to the increase in worldwide calorie availability more than any other food group between 1982 and 2000.[12] While the increased availability of vegetable oils has certainly addressed issues of undernutrition in certain parts of the world, it has also contributed to the obesity pandemic as vegetable oil consumption has exceeded the recommended amount in even rural parts of China.[9,13]

Favorable global regulations have also seen an emergence of FDIs, whereby an enterprise in one country has a controlling ownership in a business enterprise in another country.[9] One important result from the increase of FDIs has been an increased exposure of processed foods to the developing world, and thus, another contributing factor to global obesity. United States FDI into foreign food processing increased 500 percent from $9 billion in 1980 to $36 billion in 2000.[14] Transnational food companies, such as McDonalds and Kentucky Fried Chicken (KFC) invested upwards of $5 billion in restaurant chains overseas in 1998.9,15 FDIs have influenced global diet by making processed foods cheaper and more accessible in developing nations.

Conclusion
Obesity is no longer a problem of high-income developed countries. Shifts toward animal products and processed foods in the global diet have contributed to the increasing prevalence of worldwide obesity. These dietary shifts are largely the result of technological improvement, economic growth, and market liberalization. As globalization, economic forces, and policy changes continue to address the issues of undernutrition, public focus on health concerns will shift to the morbidities and mortalities caused by overnutrition. With continued research into the effects these forces can have on global diet, we can begin to understand ways on how to best implement policy changes to curb the rise in obesity.

Acknowledgment: The present work benefited from the input and guidance of Dr. Daniel Jones.

References
1.    World Health Organization Global Health Observatory Data. http://www.who.int/gho/ncd/risk_factors/overweight/en/. Accessed February 15, 2015.
2.    Chicago Council on Global Affairs. Bringing Agriculture to the Table: How Agriculture and Food can Play a Role in Preventing Chronic Disease. Chicago: Chicago Council on Global Affairs; 2011.
3.    World Health Organization, Obesity and Overweight 2015 Fact Sheet. http://www.who.int/mediacentre/factsheets/fs311/en/. Accessed February 15, 2015.
4.    Traill WB, Mazzocchi M, Shankar B, Hallam D.Importance of government policies and other influences in transforming global diets. Nutr Rev. 2014;72(9):591–604. Epub 2014 Aug 8. Review.
5.    Food and Agriculture Organization of the United Nations. FAO Food Price Index. 2014. http://faostat3.fao.org/browse/FB/*/E/. Accessed February 15, 2015.
6.    Regmi A, Gehlhar M. Processed food trade pressured by evolving global supply chains. Amber Waves (publication of the USDA Economic Research Service). 2005;3:12–19.
7.    Grigg D. The changing geography of world food consumption in the second half of the twentieth century. Geogr J. 1999;165:1–11.
8.    Lakdawalla D, Philipson T. The growth of obesity and technological change. Econ Hum Biol. 2009;7(3):283–293. .
9.    Hawkes C. Uneven dietary development: linking the policies and processes of globalization with the nutrition transition, obesity and diet-related chronic diseases. Globalization and Health. 2006;2:4.
10.    FAO. The State of Agricultural Commodity Markets 2004. Rome, FAO; 2004.
11.    Beckman C. Vegetable oils: competition in a global market. Bi-weekly Bulletin. Vol. 18. Ottawa, Agriculture and Agri-Food Canada; 2005. http://www.agr.gc.ca/mad-dam/e/bulletine/v18e/v18n11_e.pdf
12.    FAOSTAT Food Supply Data. FAOSTAT data. 2005.
13.    Ma J. Blame for health crisis placed on poor knowledge; Leading official says more needs to be done to teach public about healthy diets. South China Morning Post. October 13 2004:5.
14.    Bolling C, Somwaru A. US food companies access foreign markets though direct investment. Food Review. 2001;24:23–28.
15.    Harris JM, Kaufman PR, Martinez SW, Price C. The US Food Marketing System, 2002. Washington DC, USDA; 2002.
16.    Thow A, Downs S, Jan S. A systematic review of the effectiveness of food taxes and subsidies to improve diets: understanding the recent evidence. Nutr Rev. 2014;72(9):551–565.
17.    Lifshitz F, Lifshitz JZ. Globesity: the root causes of the obesity epidemic in the USA and now worldwide. Pediatr Endocrinol Rev. 2014;12(1):17–34.
18.    Headey D, Alauddin M, Rao DS. Explaining agricultural productivity growth: an international perspective. Agric Econ. 2010;41:1–14.
19.    Chopra M. Globalization and food: implications for the promotion of “healthy” diets. Global. In: Globalization, Diets and Noncommunicable Diseases. Geneva: World Health Organization; 2002:1–16.
20.    Reardon T, Swinnen JFM. Agrifood sector liberalisation and the rise of supermarkets in former state-controlled economies: a comparative overview. Dev Policy Rev. 2004;22:515–523.
21.    Reardon T, Henson S, Gulati A. Links between supermarkets and food prices, diet diversity and food safety in developing countries. In: Hawkes C, Blouin C, Henson S, et al., eds. Trade, Food, Diet and Health: Perspectives and Policy Options. Chichester, UK: Wiley-Blackwell; 2010:111–130.
22.    Vepa SS. Impact of globalization on the food consumption of urban India. In: Globalization of Food Systems in Developing Countries: Impact on Food Security and Nutrition. Rome: Food and Agriculture Organization of the United Nations; 2004:215–399. FAO Food and Nutrition Paper no. 83.

FUNDING: No funding was provided.

FINANCIAL DISCLOSURES: The author reports no conflicts of interest relevant to the content of this article.

 

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