China is not unique, but its importance in the Asian and the global economy is great. Clearly this same transition in diet, activity, and obesity and related health care and other costs is already affecting the middle East and many other South East Asian and Latin American countries.42
Moreover, these changes appear to be penetrating most countries in the developing world.43
In general rates of change, total worsening dietary and physical activity patterns and increased obesity are greater in many developing and transitional countries than in higher-income ones.44
There is no clear way to fully forecast the health care costs of China’s transition toward a lifestyle linked with nutrition-related NCDs. The current trajectory can not measure the role pharmaceuticals might play—both in economic costs and in impact on the overall economy as the available data do not measure pharmaceutical usage.45
Treatment of hypertension and many other treatable NCDs is low now but are expected to increase.46
Nonetheless, the costs of treating diseases such as diabetes are enormous; a more aggressive system of treatment would most certainly increase health care costs. Studies in China do not exist, that allow us to totally understand the exact impact of obesity on productivity, absenteeism, and retirement in that country. Without them, one must rely on studies undertaken in other countries. This leads to a note of caution about some of the results. This brief layout can certainly provide a strong case for public investment to find ways to improve the dietary, activity, and body composition patterns in China and other developing countries. However, it is very clear that from the individual perspective, having a tastier higher-fat and sweetened diet is desirable. Similarly, a reduction in stressful activity in market and home production is desired. The critical issue is finding effective social investments and regulations that will (a) enhance the components of lifestyle that will reduce these problems and (b) provide for a healthier population. Possible solutions in the food system and physical environment are critical factors to consider.
Issues to be addressed from the food sector include (a) learning how to increase the intake levels of fruit, vegetables, and higher fibre products and (b) reducing the intake of caloric sweeteners and fat. We should note that there is great controversy about the need to reduce total fat intake or only reduce the intake of selected types of fats (i.e., transfatty acids, erucic acid, and saturated fats).47
Clearly all agree that the removal of carcinogenic or artherogenic edible oils is important, but the role of total fat is not as clear. Similarly, there is some debate about the role of caloric sweeteners. For instance, an expert committee of the World Health Organization (WHO) has recommended a maximum of 10% of energy from caloric sweeteners—a level above that of caloric sweeteners consumed in diets in high-, low-, and moderate-income countries.48
In contrast, the U.S. Institute of Medicine conducted the same review and concluded that 25% of energy from caloric sweeteners was acceptable.49
Similar shifts in the physical environment to enhance physical activity exist. There is a growing body of knowledge that points to the role of a spread of environmental factors ranging (a) from connectivity of streets to availability of walking options and (b) from street safety to the organisation and layout of buildings and communities. Higher density of, and proximity to, opportunities for physical activity, such as recreation facilities (e.g., private and public facilities, parks, recreation centres, green spaces, and shopping centres) and transportation options (e.g., sidewalks, cycle paths, public transportation, high road connectivity, and lower automobile transportation density) will increase physical activity levels and decrease overweight prevalence. Conversely, constraints to physical activity (e.g., crime and air pollution) will decrease physical activity and increase overweight prevalence.
For each of the desired changes in the food supply and the physical environment, there are clearly a myriad of options, some easy to implement and many quite complex. A few countries are already beginning to take some steps to address these issues.50
There have also been some limited successes in the higher-income countries of the world.51
Few other major attempts are being made to address this problem in the scale needed to decrease or reverse this epidemic. This paper provides some sense of how the epidemic will affect one country (i.e., China) if it does not begin to take radical corrective action.