Childhood obesity: Dark side of rising income

The pandemic has had a terrible impact on children, especially their education, among those living in the developing world. But just as it has accelerated trends that already existed such as digitisation, it has exposed the worrying problem of childhood obesity.

A global study conducted by the British government's National Child Measurement Programme this year found the highest increase in childhood obesity during its entire 15-year history. What is especially relevant for Bangladesh is that obesity has traditionally been a marker of excess in rich countries, but in 2018 almost half of all children who fall under the classification of overweight were living in Asia and another quarter in Africa.

Being overweight is measured as those whose body mass index is between 25 and 30, whereas above 30 one is called obese.

The pandemic and the effects of lockdown has only worsened such trends. School closures, restrictions on leaving the house and greater limitations on meeting friends have led to more sedentary lifestyles. All parents will not be surprised by the multiple studies which found children were spending between three to six hours a day more on screens during the height of the pandemic.

Watching the pictures of pandemic life in Bangladesh from afar, a typical picture was that of children in balconies holding the metal rails looking out into the distance. This is a far cry from my childhood memories of Dhaka or village life where children ran around chasing animals or steering moving tyres with sticks.

A 2015 study from the US based Institute for Health Metrics and Evaluation linked to the University of Washington found the proportion of overweight in Bangladesh had doubled in the 33 years -- from 1980 to 2013. Childhood obesity had also increased considerably but at a lower rate than adults and also more slowly than some neighbouring countries such as Pakistan and Bhutan.

"Obesity is an issue affecting people of all ages and incomes, everywhere," said Dr Christopher Murray, director of IHME and a co-founder of the Global Burden of Disease (GBD) study. "In the last three decades, not one country has achieved success in reducing obesity rates, and we expect obesity to rise steadily as incomes rise in low- and middle-income countries in particular, unless urgent steps are taken to address this public health crisis."

This is one of the curious aspects of obesity in countries like Bangladesh that are becoming richer.

Carrying a few extra kgs has historically been a status symbol -- given that for most of history we have lived amid scarcity. A big belly signalled wealth. The opposite is now true in rich countries, where it is the poor that tend to eat cheaper, high calorie food, do less exercise and have higher rates of obesity. Being overweight in a country like Australia or Britain now signals low status.

But these social transformations take time. I have observed newly arrived relatives who have moved to Australia taking pride in being able to afford soft drinks without having to worry about the costs. While some relatives were growing up, such luxuries were bought only as a treat. But the greater wealth that can arise from migrating to the West, at least in time, is often initially spent on enjoying an abundance of high calorie food.

This is compounded by a culture that is regarded as having the sweetest tooth in the world. The syrupy, sweet delights of shondesh, roshogolla or jilapi are no doubt delicious, but they are among the most concentrated sugary desserts in any country. It is also likely that a culture where alcohol does not feature openly tends to prize such desserts for enjoyment.

Migrants from countries like Bangladesh, India and Pakistan have three times the rate of obesity and associated condition such as diabetes and heart disease when they move to the West. This is because they continue to eat fatty, high calorie foods but in greater quantities. Both men and women from such groups are also less likely to exercise.

Unfortunately such trends are no longer limited to those who have moved overseas and are occurring in Bangladesh as the middle class grows. Studies like that of the IHMA also found women had higher rates of obesity compared to comparable countries, which may be related to the greater difficulties they have in freely exercising.

Unfortunately, overweight children are more likely to grow into obese adults. The combination of growing prosperity, the pandemic and cultural preferences mean Bangladesh is especially at risk with regards to obesity, heart disease and diabetes. The World Health Organization estimates the prevalence of diabetes is likely to double in Bangladesh to almost 15 million people by 2045.

This also explains why NGOs previously concerned with malnutrition in the developing world are now having to pivot to combatting obesity. One example is the Swiss based organisation GAIN, which has run a programme called "Nourishing Dreams". A key part of the programme is "Eat Well Live Well" -- "Bhalo Khabo Bhalo Thakbo" (BKBT) campaign. Other notable organisations such as Save the Children and BRAC are also placing the problem of childhood obesity on its high priority list.

The pandemic has affected young people the hardest, hurting their education as well as their emotional and physical development. The problem of childhood obesity is the dark side of the country's successful development and rising income. Tackling it will require challenging some habits at the centre of the culture -- from the love of sweets, sedentary lifestyles and the staple of high calorie diets.

The writer is an Australian based psychiatrist, author of The Exotic Rissole, and founder of website www.bddiaspora.com.