Obesity in the developing world

It’s 9 o’clock at night. Jenny walks into the supermarket, and heads straight to the frozen foods aisle. She grabs 8 frozen pizzas. There are only Hawaiian ones left, which James hates, and Harley will pick all the pineapple off them, but they’ll just have to deal with it tonight. She hesitates at the produce section — at the half-day-old wilting lettuce, the reject fruits left lonely in their baskets. But she only hesitates for a second, because otherwise she will miss the next bus (as she has before), and they are already so hungry (which they always are), and she only has an hour to help them with their homework.

This situation, while anecdotal, is one that many people face every day. Time is a luxury to the poor, and junk food is a cheap, convenient solution. Obesity therefore, is a major problem for those who simply cannot afford to eat healthy. In developed countries, the prevalence of obesity is found predominantly among people from a lower socioeconomic status (SES) compared to a higher SES (1).

In contrast, developing nations exhibit an inverse relationship between SES and obesity. Obesity in a developing country mainly plagues those who come from a more affluent society, unlike that of developed countries (2). Furthermore, this trend is consistent in low income countries as those with a better income or education (higher SES) display higher rates of obesity compared to those from a lower SES (3).

Why are the rich more susceptible to obesity compared to the poor in low income countries?

· Scarcity of food which drives low/moderate food intake among the poor

· Manual work for the poor requires a higher energy expenditure

· The rich in developing countries have access to surplus/excess food and desk bound jobs (4).

· In some low-income countries, a larger body displays a positive status signal (e.g. morocco and Senegal) (5).

In contrast, middle income countries

· Food shortage is no longer a problem (6).

· Access to healthy foods is what separates those who are/are not affluent

· Low calorie foods (e.g whole grain cereals, fruits and vegetables) is expensive for the poor

· In rural South Africa, healthier diets (wholemeal bread, brown rice, fat free milk) cost between 10 and 60% more per month (6).

Healthier diets cost ~US$1.22 (69%) more
Extra cost totalled up to ~US$140/month (30% increase)

· Technological advancement and urbanization leads to less manual labour and less energy expenditure

· Poor people consume a more energy dense diet (7).

The rise in obesity among urban dwellers in low income countries, is most likely due to a sedentary lifestyle brought upon a variety of factors, resulting in a decreased energy expenditure (8). Furthermore, the lower levels of education and poor health awareness have increased the susceptibility of the poor to obesity (9).

Therefore, the rich in low income countries can afford and demand surplus food resulting in obesity, while the rich in high income countries can afford to diet and exercise to prevent obesity. On the other hand, the poor in low-income countries experience food scarcity which prevents obesity, while the poor living in the higher income countries are exposed to energy dense foods (10).

The situation expressed here is a dreadful one and with global obesity rates climbing, it is crucial that we deliver a solution to this problem. Not only do developing countries deal with the incidence of infectious diseases, they also deal with the prevalence of obesity which brings forth a variety of health risks such as cardiovascular disease and diabetes. We suggest that more educational awareness be provided on a nationwide level covering issues such as proper eating and obesity related illnesses.

You can also play your part, spread the tag #obesitymatters

  1. Sobal J, Stunkard AJ. Socioeconomic status and obesity: a review of the literature. Psychological bulletin. 1989;105(2):260.

2. Wang Y, Beydoun MA. The obesity epidemic in the United States — gender, age, socioeconomic, racial/ethnic, and geographic characteristics: a systematic review and meta-regression analysis. Epidemiologic reviews. 2007;29(1):6–28.

3. McLaren L. Socioeconomic status and obesity. Epidemiologic reviews. 2007;29(1):29–48.

4. Who J, Consultation FE. Diet, nutrition and the prevention of chronic diseases. World Health Organ Tech Rep Ser. 2003;916(i-viii).

5. Fernald LC. In: Perception of body weight: a critical factor in understanding obesity in middle-income countries. 2009 Mary Ann Liebert, Inc. 140 Huguenot Street, 3rd Floor New Rochelle, NY 10801 USA.

6. Temple NJ, Steyn NP, Fourie J, De Villiers A. Price and availability of healthy food: A study in rural South Africa. Nutrition. 2011;27(1):55–58.

7. Drewnowski A, Specter S. Poverty and obesity: the role of energy density and energy costs. The American journal of clinical nutrition. 2004;79(1):6–16.

8. Ziraba AK, Fotso JC, Ochako R. Overweight and obesity in urban Africa: A problem of the rich or the poor? BMC public health. 2009;9(1):465.

9. Nyaruhucha C, Achen J, Msuya J, Shayo N, Kulwa K. Prevalence and awareness of obesity among people of different age groups in educational institutions in Morogoro, Tanzania. East African medical journal. 2003;80(2):68–72.

10. Block JP, Scribner RA, DeSalvo KB. Fast food, race/ethnicity, and income: a geographic analysis. American journal of preventive medicine. 2004;27(3):211–217.

Image featured: World Health Organization, Thomson Foundation Reuters news. 5 facts you didn't know about obesity in developing countries