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NUTRITION TRANSITION: WORLDWIDE DIET CHANGE

At the start of the new millennium, the pace and complexity of life seem to be increasing exponentially. While the penetration and influence of modern commu- nications, technology, and economic systems (related to what is termed “globalization”) have been a dominant theme since the late twentieth century, there seems to have been a confluence of changes in these factors that have led to a major global concern about the rapid glob- alization of the world economy and its impact on various subpopulations.

Increasing access to Western media and the removal of communication barriers enhanced by the World Wide Web, cable television, mobile telephone systems, and other technology are important. The accelerated intro- duction of Western technology into manufacturing, ba- sic sectors of agriculture, mining, and services is also a key element.

Globalization and China: an example. The types of

changes the developing world is facing can be seen in considering life in China in two different periods. Dur- ing the 1970s food-supply concerns still existed. There was no television, limited bus and other mass trans- portation, and little food trade. Minimal processed food existed, and most rural and urban occupations were very labor-intensive.

By the end of the twentieth century, work and life in China had changed. Small gas-powered tractors were available, modern industrial techniques were multiplying, offices were quite automated, soft drinks and processed foods were consumed everywhere, televisions were found in about 89 percent of households (at least a fifth of whom received Hong Kong and Western advertising and pro- gramming), younger children did not ride bicycles, and mass transit had become heavily used.

Add to such changes similar ones occurring in much of Asia, North Africa, the Middle East, Latin America, and many areas (particularly cities) in sub-Saharan Africa, and it is evident that the shift from a subsistence econ- omy to a modern, industrialized one occurred in a span of ten to twenty years, whereas in Europe and other richer industrialized societies, it took place over many decades or centuries.

To effectively examine the nutrition aspects of these changes, one would need to compare changes in poorer countries in the period from 1980 to 2000 with changes that occurred a half century earlier in the de- veloped world. However, data on diet and activity pat- terns are not available, and there is only minimal data on nutrition-related noncommunicable diseases and on obesity.

The negative elements of the nutrition transition known to be linked with nutrition-related noncommuni- cable diseases are obesity, adverse dietary changes (for ex- ample, shifts in the structure of diet toward a greater role for higher fat and added sugar contents, reduced fruit and

ENCYCLOPEDIA OF FOOD AND CULTURE

vegetable intake, reduced fiber intake, greater energy density, and greater saturated fat intake), and reduced physical activity in work and leisure. The causes of these elements are not as well understood as are the trends in each of them. In fact, there are few studies attempting to examine the causes of such changes, and there are only a few data sets that are equipped to allow such crucial pol- icy analyses to be undertaken.

Obesity Trends

The most commonly measured health outcome due to shifts in the structure of diet is obesity. Increases in over- weight and obese adults in the developing world since the 1970s have occurred much faster than in richer coun- tries. Shifts in body composition among Chinese adults have been examined (Bell et al., 2001) over an eight-year period. Not only did the average BMI (body mass index, which is the common measure for overweight status and measures weight in kilograms divided by height in square meters) level increase, but the shape of the BMI distrib- ution curve changed over the eight-year period of the study so that there was a large proportion of high BMI adults. From 1989 to 1997 the proportion of underweight men and women dropped considerably, and the preva- lence of both overweight and obesity increased greatly, the proportion of overweight or obese men more than doubling and the proportion of overweight or obese women increasing by 50 percent.

China’s changes are not unique. Annual increases in the prevalence of overweight and obese adults in selected poor and middle-income countries can be compared with those in the United States. Elsewhere we present data that illustrate the annualized increases from richer coun- tries with comparable data from poorer countries (Pop- kin, 2002). We also show how quickly overweight status and obesity have emerged in Mexico as a major public- health problem. Compared with the United States and European countries, where annual prevalence increases in overweight and obesity are about 0.25 percent each, rates of change are very high in Latin America. Similar shifts in the prevalence of obesity are found for North Africa and the Middle East and Asia. In each of these countries the annual rate of increase in the prevalence of overweight plus obesity is between 1 and 2.5 (Popkin, 2002).

What is important to note is that increases in the proportion of the adult population who are overweight are far greater in all of these poorer countries than in the United States or most European countries. Only Spain, with its large growth in overweight population in the last decade, is similar, in speed of change, to these countries.

Dietary Changes: Shift in the Overall Structure over Time

The diets of the developing world are shifting rapidly. Good data for most countries on total energy intake are not available, but shifts in the structure of the diet can

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