January 15, 2013
SHUTTERSTOCKIn developing countries, wealthy women are gaining weight, while the poorest women remain underweight and dangerously malnourished, a new study has found led by U of T clinical fellow Dr. Fahad Razak.
The rich in developing nations are riding their new gravy trains to increasing obesity, accounting for almost all of the average weight gains recorded in the world’s poorer countries.
The impoverished, meanwhile, remain at dangerously low and malnourished weights, a new University of Toronto study indicates.
“You get almost this pulling apart of the population, with heavy people becoming much heavier,” says Dr. Fahad Razak, a clinical fellow at the University of Toronto and lead study author.
“People on the other end, people who are really underweight, are gaining very little weight. . . . They are missing the economic gains being made by their countries; they’re being left behind.”
The study, also conducted by researchers at Harvard University, was published Tuesday by the journal PLOS Medicine.
It looked at some 730,000 women in 37 developing countries between the years 1991 and 2008. The countries ranged from those in destitute, sub-Saharan regions of Africa to economically rising nations like Egypt and Turkey.
These countries have a combined population of 2.4 billion people, but the paper’s results can be extrapolated to all the earth’s developing nations, home to more than half the planet’s population, Razak says.
“We’re seeing this really clear divergence. If you just looked at the average weight over 20 years . . . the average weight (in each country) has gone up,” he says.
“But that average is being driven by the fact that people at the high end of weight are gaining a lot of weight.”
Overweight people in poorer countries are gaining weight at 2.5 times the rate of their malnourished countrymen, the study shows. And those underweight people are not moving up to average body mass indexes as their national economies grow.
The increasingly rotund social segments, meanwhile, dovetail almost exactly with portions of the population who are gaining wealth in poor nations, says Razak, who is also an internist at St. Michael’s Hospital.
“The people at the very low end of the population — 10, 20, 30 per cent of the population in some places — are gaining almost no weight over time,” he says.
In Bangladesh, for example, some 30 per cent of the population remained severely underweight over a decade of the study, while the country’s average weight rose substantially.
“A rising tide does not lift all boats,” Razak says.
Jean-Philippe Chaput, an obesity expert at the University of Ottawa, praised the study but said more work was needed to prove the link between wealth and weight.
“We need to go beyond (weight gain) and look at who is gaining the weight,” says Chaput, aCanadian Institutes of Health Research scientist.
The study’s strict reliance on women could also skew its findings since males and females gain weight differently, Chaput says.
But Razak says the growing wealth inequities and fears of a shrinking middle class in Western nations are being reflected in weight gain disparities in their developing counterparts.
“This really parallels what you’re seeing (in the West) — that kind of income inequality story is being paralleled (in the developing counties) in a weight inequality,” he says.
“And all (the same) things are driving it — income, employment, education, all of this stuff — is driving it.”
As with the shrinking middle class in developed countries, people of average weight are becoming more and more rare in emerging nations, Razak adds.
“I think there’s a very nice parallel there,” he says.
But weight shifts in the Third World stand in stark contrast to a trend in the West, which more and more sees obesity as a problem of poverty.
Here, the ready availability of cheap, fast foods is pushing obesity levels higher among lower income populations, while the better off have greater access to healthier but more expensive fare.
In much of the developing world, however, there are widespread genetic and metabolic intolerances to calorie-rich diets. And so obesity-related ailments like heart disease and type 2 diabetes are greater dangers to people culturally used to subsistence-level eating.
This means countries with emerging economies are increasingly facing a pair of pressing health issues, with problems related to malnutrition persisting as the incidents of obesity-related ailments soar.
And in this diet-driven duality, it’s the poor and malnourished who are likely to suffer most as health-care resources are divvied up, Razak says.
He says media reports on health issues in poorer countries are already focusing on obesity, with little mention of the large and intractable crisis of malnutrition.
“They (media health stories) talk almost exclusively about obesity and weight gain as being the critical problem of the day,” Razak says.
“But that is because they are ignoring . . . this large segment of the population that is not obese — they are severely underweight.”
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