Leading article: Wide world

Once, fat was a sign of prosperity. A goodly, portly frame was a measure of success and status to our Victorian forebears. Now the opposite is the case. It is the poor who are fat and the better-off who sport slimmer,healthier physiques.

But we are all getting fatter, the latest statistics show. The rate of increase in average body mass index measurements for British men is second only to that for our fat friends in the United States. No wonder we need wider stretchers in our ambulances.

Yet we are the lucky ones. We can afford the drugs to lower cholesterol and blood pressure, which keep us alive. The causes of this epidemic of worldwide obesity – fatty food, sugary drinks, smoking, and the office-based sedentary lifestyles that come with urbanisation – are now spreading through the world's poorer nations. The women of southern Africa are among the fattest in the world. In all but the very poorest nations traditional staples like rice are being replaced with Western-style fast foods. As a result, a global pandemic of cardiovascular disease looms which could kill tens of millions of people.

But poor countries are not in a position to pay for the drugs their thickening populations will need. Such is the paradox, and peril, of development.