Older people in China remember the Great Famine of 1958-61, when 15 million to 45 million people died of hunger and related causes.
Today, nearly every street corner in Beijing and many other cities seems to boast a McDonald's. There are KFC outlets in almost every Chinese city, 3,700 in all. Meanwhile, newly minted members of the Chinese middle class have rushed to buy cars, leaving bicycles that were once a major source of exercise rusting on the street. Pizza Hut is considered a fancy date-night restaurant, T.G.I. Friday's has several branches in Beijing, and cans of Coca-Cola are sold at every corner stand.
With fast food and rising affluence, a country only a generation removed from hunger is getting fat. How fat? According to the World Health Organization, the percentage of adults who are overweight and obese rose from rose from 25 percent in 2002 to 38.5 percent in 2010 in a population of 1.37 billion. Urban dwellers account for much of this. WHO projects that 50 to 57 percent of the Chinese population will be too heavy by 2015. (By comparison, 69 percent of Americans age 20 and older are overweight or obese.)
There's a standing joke, notes Lyn Wren, a physician with International SOS Beijing Clinic, that "Chinese waistlines are growing faster than the GDP."
Given how impoverished the country was not long ago and how impoverished parts of it still are, "having a problem where people are eating too much — it can seem a little churlish to complain about that," says Paul French, the Shanghai-based author of "Fat China: How Expanding Waistlines are Changing a Nation." French and co-author Matthew Crabbe found that even as recently as five years ago, obesity wasn't recognized as a problem by health professionals in China.
The Chinese Health Ministry has said it encourages healthful eating programs in schools and the construction of more playgrounds to promote exercise. And the Chinese Center for Disease Control and Prevention makes vague references to "health promotion" and providing "scientific guidance for healthy diets," but nationwide campaigns about eating healthfully and exercising are not evident.
In fact, pushing the population to lose weight, exercise and cut back on unhealthful foods seems to strike a discordant note to some inside the government, French says. "When I talked to government officials, their argument was: Right now we're trying to tell them to do and not do a lot of things," such as not spitting on the street, not dropping trash everywhere and not driving "like complete idiots."
"They know they can only tell people to do some things . . . before they get fed up."
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Although the era of famine is long past, many grandparents and parents still push their children to eat a lot.
Setsuko Hosoda, a family doctor at Beijing United Family Hospital, says the parents and grandparents she sees are "always worried that their child is not eating enough." A 2012 Penn State study of 176 Chinese children ages 6 to 18 found that 72 percent of mothers of overweight children thought their children were normal or underweight.
Sissi Zhong, a 26-year-old Beijing secretary, recalls that her grandparents got angry if she left food on her plate when she was a child. "They said, 'Do you know, in my time of food shortages, people didn't have food, so how can you waste your food?' " Zhong says. So she cleaned her plate even if she was very full.
When her father came home from business trips with boxes of a Chinese soft drink called Jianlibao, she started to put on weight. Drinking four and five cans a day made her weight jump to 143 pounds by the time she was 18. At 5-foot-3, that would put her barely into the "overweight" category by U.S. standards, but she was miserable, getting kicked off her school's dance team for being too fat and being teased by boys who liked her skinnier pals. Today, Zhong says she spends many hours at the gym to stay slim.
Obesity has tended to be an issue that grows along with affluence. Prosperity means bigger paychecks, which can mean more meat, fast foods and bigger meals. Meanwhile, long hours at desk or factory jobs instead of agricultural ones mean less physical activity. The obesity problem is primarily an urban one in a population that is rapidly urbanizing.
China also has particular problems, French says, that can promote obesity. A survey he did found that recent scares about contaminated milk, fruit and vegetables have made consumers feel more safe buying and eating packaged foods. "It's perceived to be less tainted," he says. "If it's packaged and done by Nestle, they're thinking and hoping that there is not going to be poison" in the food. Yet, the fat and sugar content of many packaged foods is often much higher than that of fresh food.
Contradictory impulses are apparent here, much as in the United States. Chinese editions of Vogue display models who are bone-thin. When popular singer A-Mei suddenly seemed to gain weight, online commentators wondered what had happened, until she gave an interview attributing her extra pounds to a love of high-calorie green teas made with tapioca balls, coconut jelly and sugar.
At the same time, China seems oddly fascinated by obesity. Two years ago, a shopping mall in the city of Shenyang held an obesity competition to celebrate International Women's Day. Contestants stood onstage in frilly white wedding dresses.
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Chinese are turning to surgical solutions for weight loss. Huiqi Yang, a general surgeon at Beijing United Family Hospital, has just started offering an operation in which an adjustable band is surgically tied around the stomach to constrict it, leading patients to eat less. Chinese doctors have been doing such bariatric surgeries for 15 years, but Yang says there is growing interest. She said she performed about 100 gastric-band surgeries in recent years at her previous hospital, in the city of Tianjin.
Meanwhile, as obesity, rises so do the ills associated with it.
A recent World Bank report said diabetes, heart disease and hypertension are among several noncommunicable diseases threatening China and other countries. The International Diabetes Federation estimates that there are 92.3 million diabetics in China. No other country has as many diabetics — not surprising, given that China is the most populous country in the world — and even China's outgoing president, Hu Jintao, is rumored to have diabetes.
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Debra Bruno is a writer based in China.