OBESITY, MALNUTRITION AND EATING DISORDERS IN CHINA

OVERWEIGHT CHINESE

right Throughout China, but especially in cities such as Beijing, Shanghai and Tianjin, obesity is growing problem. The Chinese state media reports have said more than 300 million of the country's 1.3 billion people are overweight, 120 million of them obese. While not as severe a problem as in the United States, where estimates place more than 60 percent of adults as overweight or obese, experts say China increasingly faces a population coping with heart disease, diabetes and other weight-related illnesses.

Though most Chinese think a chubby child is a healthy child, society can be less tolerant of overweight adults, who complain of not being able to find jobs. "I want to give people a good impression when I go for interviews," said Zheng Xiaojie, a 22-year-old university student from far-western Xinjiang, who has lost over 5 kilograms in seven weeks. "People feel more comfortable about thinner people." [Source: Sui-Lee Wee and Sabrina Mao, Reuters, August 27, 2011]

In the old days, being fat was a desirable trait. It signified wealth while being thin was equated with poverty. Back then many people only were able to eat meat a few times a month; many didn’t get enough to eat period. These days being obese is viewed in an unfavorable light. Overweight people are increasingly becoming common sights in China. Overweight children are bullied in school. Some have parents who are embarrassed to be seen in public with them, Fat adults are the butt of jokes and thinly-disguised whispers on the streets. As is true with short people in China, they are routinely denied places in schools and passed over for jobs and promotions that go to thin people.

Health experts say that the speed with which China is putting on weight is alarming. Ding Zongyi, a professor at the Chinese Medical Doctor Association, who has been studying obesity in China for the past 30 years, said the obesity rate has jumped 158 per cent since 1996 to 2006 and is set to rise further. Even the most conservative assumptions have the rate of change in overweight and obesity in China doubling over the next two decades, Barry Popkin, professor of nutrition at the University of North Carolina, wrote in the July/August 2008 issue of the journal Health Affairs.About 12 per cent of children aged 7-18 years old in China are overweight or obese, Popkin said. [Op Cit, Wee and Mao, Reuters]

Obesity in China

Obesity — adult prevalence rate: 6.2 percent (2016). In the 2000–2002 period, China had one of the highest per capita caloric intakes in Asia, second only to South Korea and higher than countries such as Japan, Malaysia, and Indonesia. According to some estimates, a third of China's population — some 429 million — are overweight or obese, prime candidates for heart disease and diabetes. It is growing fatter faster than any developing nation except Mexico, with grave implications for the work force and economic growth in the world's second biggest economy. [Source: CIA World Factbook, 2022; Library of Congress, August 2006; Sui-Lee Wee and Sabrina Mao, Reuters, August 27, 2011]

Obesity is a relatively recent problem in China. A 2009 report by the Chinese Association for Student Nutrition and Health said the number of overweight young people aged between seven and 17 had tripled between 1982 and 2002, a trend that had accelerated in recent years. About 35 percent of adults in Beijing are overweight, compared to 22.5 percent nationwide, and 17 percent are obese, and the rate has been increasing at a rate of 10 percent a year. Obesity is defined as being 20 percent above the accepted body weight. Currently 10 percent of children are obese and their numbers increasing by 8 percent every year.

Obesity is most acute in China's biggest urban cities such as Beijing and Shanghai, where people enjoy higher incomes, eat richer foods and lead more sedentary lifestyles. "Urban China got richer. It's just gone out and bought itself more food and bought itself cars and couches to sit on while watching TV,"Paul French, co-author 'Fat China: How Expanding Waistlines are Changing a Nation,' told Reuters. Mu Ge, the sales manager at Bodyworks, said the most glaring difference between China and other countries "is that the rich people in China are all extremely fat ... (whereas) in other countries, the wealthy are all very thin and beautiful." "In the U.K., only the poor people will eat junk food, and will therefore be fat," Mu said. "In China, it's the opposite. The more money you have, the fatter you are. It's almost as if it's proof that living standards have improved."

Reasons for High Rates Obesity in China

Many blame the problem on Western foods and a more sedentary lifestyle that has occurred as people have switched from farming and bicycles to cars and office jobs. Higher incomes have meant more people are eating rich, high-caloric diets In 1990 the average Chinese ate 51 grams of fat per day — the equivalent amount of fat found in one KFC chicken pt pie and biscuit. Now they eat considerably more than that. Experts also blame poor city planning — the dearth of green space and parks in Chinese cities — and general attitudes toward exercise and leisure. Bicycling, a key way for many Chinese to remain lean, is out of fashion. [Source: Lily Kuo, Los Angeles Times, October 31, 2010]

Paul French, co-author 'Fat China: How Expanding Waistlines are Changing a Nation,' told Reuters."In America and Europe, they had to go through the whole process of inventing supermarkets and processed food.It took stages in the West. The Chinese didn't have to invent the Mars bar. It was given McDonald's, KFC, Tesco and Wal-Mart." Popkin said that more fried food, consumption of food from animal sources, sugared drinks and too few vegetables have contributed to China's expanding girth.Although the prevalence of fast food is a major culprit, extra-high amounts of salt, sugar and oil in Chinese cooking is another factor contributing to the sharp rise in obesity.

Some blame the rising consumption of dairy products in a country where milk, cheese and butter have traditionally not been consumed, Harvard anthropologist James Watson told Reuters, “I’m personally convinced that this has much more to do with the obesity and health problems that are emerging than the usual scapegoat fast food...There’s a big change in terms of taste when people want ice cream throughout their lives.” The ongoing growth of China's economy — and a quest for the good life — is bound to continue influencing how the population responds to calls for healthy eating and fitness, said French. "The idea of going and mucking around in your garden, that's like being a peasant," French said. "Why would you ride a bicycle when you can drive a car.”

Obesity-Related Health and Economic Problems

While China's obesity rate is still half that in the United States, the U.K. and Australia, it has led to a worrying rise in chronic non-communicable diseases such as cancer, strokes, heart disease and diabetes.In a growing number of developed nations, obesity is fast replacing tobacco as the most important preventable cause of chronic non-communicable diseases, health experts warned. [Source: Sui-Lee Wee and Sabrina Mao, Reuters, August 27, 2011]

In China, the economic costs of obesity are enormous, Popkin said. An increasingly obese population poses economic problems in terms of treatment costs, paid sick leave, loss of productivity, disability and premature death.The indirect effect of obesity and obesity-related dietary and physical activity patterns was 3.58 per cent of GDP in 2000 and was projected to reach 8.73 per cent in 2025, Popkin wrote."These estimates do not account for much of the recent rapid increase in the use of and spending for pharmaceutical products, which would make the total costs even higher," he wrote. [Source: Sui-Lee Wee and Sabrina Mao, Reuters, August 27, 2011]

In Beijing, the city critics have called China's fattest, the municipal government last year announced a campaign called "Healthy Beijinger: A 10-year Plan to Improve People's Health."The campaign is aimed at overall health but one of its specific goals is reducing the amount of fat Chinese adults eat each day. Officials hope to reduce the number of overweight children in high school and primary schools from 17 percent to 15 percent by 2018. The initiative has included sending informational nutrition pamphlets as well as 600,000 tape measures to schools with instructions from the Beijing Municipal Commission of Education that students should measure their parents' as well as their own waistlines and endeavor to lose weight over the Chinese New Year holiday. For employees of state-owned companies, communist-style group exercise, or "radio calisthenics," were brought back in August and will become mandatory sometime in 2011. The Beijing Federation of Trade Unions has hired 5,000 instructors to teach employees how to maximize the eight-minute exercise routine. Study published in

Chinese Fat Camps, Beijing’s Fattest Man and Cashing In On China’s Obesity Problem

Diet fads and weight loss centers are on the rise. In recent years Chinese have become obsessed with slimming down and losing weight. Ads for appetite suppressants and slimming potions are everywhere. An A.C. Nielsen survey in 2004 found that two thirds of urban Chinese interviewed were concerned about losing weight, 80 percent exercised regularly and three quarters said that health was one of their main concerns. One weight loss center that opened in 1993 now over 1,000 locations across the country. Weight reduction methods include acupuncture and eating copious amounts of cucumbers. Today there in an increasing demand for liposuction and bands placed around the stomach that restrict food intake and give a person a feeling of fullness.

Drugs, treatment and access to good doctors are expensive and beyond the reach of average Chinese. The government is spending $125 billion to revamp the health system to cover all Chinese citizens by 2020, but the plan is not expected to cover common diseases associated with weight. Chen Chunming, who leads research teams at the Chinese Center for Disease Control and Prevention, an agency of the Ministry of Health, told the Los Angeles Times government officials have initiated efforts to address the health risks. "The government understands that if the situation is not controlled it can get serious," Chen said. "We've already started to pay attention to the issue of obesity and overweight so we're not pessimistic about the future." [Source: Lily Kuo, Los Angeles Times, October 31, 2010]

On the grounds of the Bodyworks weight loss campus in Beijing, 30 tubby men and women sweat profusely, gasping for air as they pound the treadmills in an exercise room....At the Bodyworks campus, they range in age from 7 to 55 and come from across China. Each pays 30,000 yuan ($5,673) for the six-week program. For that, they get balanced meals and exercise for six hours each day. The regimen includes weight training, running, yoga and football. "For the first two to three weeks, it was especially hard. I cried on the phone to my parents and told my father, 'I can't make it,'" said Zhang Fang, a 28-year-old employee with China Unicom from northern Shanxi province. "My mother said: 'If you don't continue, you're finished. You need your health.'" When Zhang joined the camp, she weighed 150 kilograms (300 pounds), had high blood pressure and had trouble breathing when she walked. She's lost 50 kilograms in one year."Now I'm a fat person, but at least I'm not a super-sized fat person," Zhang said. Dressed in an oversized t-shirt that did little to conceal his rotund belly, Liu Chi has lost more than 10 kilograms since he first entered Bodyworks six weeks earlier nd now weighs in at about 90 kilograms.To Liu, his progress represents a new lease on life -- one he hopes will include a girlfriend and fewer taunts."I had an inferiority complex," said the cherub-faced 20-year-old student from Hebei province. "People will look at me on the streets and ask me: 'How heavy are you?'" [Source: Sui-Lee Wee and Sabrina Mao, Reuters, August 27, 2011]

A popular reality intervention television show called "Tian Weighs 462 Pounds, Beijing's Fattest Man," featured a man named Tian Ning who lost 242 pounds in six months. He lived at the Kelikexin International Weight Loss Club, where his meals were monitored and a machine jiggled his abdomen area for an hour for exercise each day. For extra exercise, Tian went for walks by himself. "When I get down to [220 pounds], I'll be ready to go home," tain said nea the end of his struggle. "I can live a normal life." Tian said he hopes his weight loss will change his life. His plans include a job in computer programming and a happy marriage. Among his biggest challenges are controlling himself in a city where inexpensive, unhealthy food abounds and exercise is not part of the daily lifestyle. [Source: Lily Kuo, Los Angeles Times, October 31, 2010]

Malnutrition in China

While obesity is becoming a problem in the cities malnutrition is still a problem in the countryside. A survey in 2005 found that 9 percent of children under 9 in the rural areas were underweight, with the figure increasing to 14.4 percent in poverty stricken areas. In the mid 2000s, 24 million Chinese suffered from malnutrition. As many as a third of the children in Guizhou and a fourth of the children Guangxi were underdeveloped physically at that time.

About 13 percent of the total population in China was undernourished according a report issued by the World Bank in 2000. This problem was most prevalent away from coastal areas. People living in inland areas are more likely to be poor and to have a diet lacking in adequate nutrition. About 17 percent of children under age five are underweight. [Source: Junior Worldmark Encyclopedia of Foods and Recipes of the World, Gale Group, Inc., 2002]

Most Chinese don’t get enough minerals, a condition that experts blame on a preference for refined foods. Iron deficiency is a problem. One in five Chinese suffer from anemia. Many also have calcium deficiencies. The average Chinese takes in 391 milligrams of calcium a day, 40 percent below the recommended level. About 40 percent of Chinese children below seven have a zinc deficiency.

Eating Disorders in China

Eating disorders were nearly unheard of in China in the 1980s but now they are not really common but they do occur. Jessica Meyers wrote in the Los Angeles Times:In a country where “Have you eaten?” is a common greeting, experts struggle to understand the life-threatening ailment and determine how a stretched mental health system can ensure adequate care. “People think if someone is skinny, it means that she is very successful,” said Ning Yaxian, who at 14 started suffering from a self-starvation syndrome commonly known as anorexia. She would make up for it by compulsive binge eating and guilt-induced purging, often associated with bulimia. It gave her a sense of control. [Source: Jessica Meyers, Los Angeles Times, August 29, 2016]

Yaxian’s parents, both doctors in the vibrant southern city of Shenzhen, couldn’t figure out what was wrong. Her grades dropped. She left school. “The eating disorder patient in China is much more common than people think,” said Yaxian, now 17 and about to repeat her senior year of high school. “It’s very dangerous but no one is stopping them.”

The Shanghai Mental Health Center has witnessed its greatest uptick in the earky 2010s. The outpatient clinic last year received nearly 1,000 eating disorder-related visits. Officials have yet to conduct a widespread investigation, which means the disorders’ true impact remains unknown. A 2013 study among female college students in the central Chinese city of Wuhan, considered one of the best estimates of national rates, found levels comparable to Western countries.

Japan started to document eating disorders in the 1960s, the first Asian country to do so. By the 1990s, cases were popping up in South Korea, Singapore and Hong Kong. Patients didn’t always link their behavior to a fear of getting fat, but started to when knowledge of the disease spread.

Reasons for Eating Disorders in China

Jessica Meyers wrote in the Los Angeles Times: Doctors can’t pinpoint what exactly causes eating disorders. They disagree how much Hollywood and Western influences dictate these behaviors, as opposed to broader effects of industrialization and shifting expectations for women. Changes in what is considered an ideal body type, “some of which are coming from the West, are influencing where China is now,” said Kathleen Pike, executive director of the Global Mental Health Program at Columbia University. “But China has its own set of dynamics occurring that results in increasing risk.” [Source: Jessica Meyers, Los Angeles Times, August 29, 2016]

“Whereas images of robust, working-class women once signaled achievement, narrow chins and concave waists now do. Diets and plastic surgery are popular; so are laxatives and thinness competitions. This spring, scores of women posted photos on Chinese social media to prove their waists did not protrude from behind a vertical 8.3 x 11.7 inch piece of paper. People’s Daily, the Communist Party’s flagship paper, called it a “fitness challenge.” Add to this the intense pressure that only children, the legacy of China’s one-child policy, often feel to achieve.

“He Yi recognized the sounds that followed meals in her college dorm, a retching and gagging from the bathroom stall next door. She wasn’t the only one who was regularly purging. “I lost weight as a way to obliterate my frustrations,” said the 27-year-old native of Hunan. “What I was looking for was some sense of wholeness.”

China has a tangled history with body shape. For centuries, the country prioritized delicate features and bone-crushing foot binding. But the Tang Dynasty favored larger body types. One of its most revered beauties, Yang Guifei, had stomach rolls. And few focused on body image in the early 1960s, when Chinese leader Mao Tse-tung’s failed attempt to industrialize the country led to widespread starvation. Older generations equate eating with well-being.

“Society’s pursuit of a certain body type or facial feature style is harming the youth a lot,” said Zhang Darong, a medical professor at Peking University and one of the country’s foremost experts on eating disorders. “It’s not necessarily a determining factor, but it’s definitely a contributing factor.” She also links the spread of the disease to “the culture of personal success.” When she started focusing on the issue in the 1980s, foreign experts would question whether eating disorders even existed in China, Zhang said. “They believed it was a Western condition, that Chinese are so thin to begin with.”

Treatment for Eating Disorders in China

Jessica Meyers wrote in the Los Angeles Times: A mother stood in front of the packed room and described how doctors labeled her daughter’s eating disorder a digestive ailment. A teenager said she was on her fourth stay at the hospital and hoped to stop vomiting after every dinner. A woman begged for help with a child whose bones showed through her skin. The support session at a Peking University hospital, one of only a handful with services dedicated to eating disorders. [Source: Jessica Meyers, Los Angeles Times, August 29, 2016]

Treatment options have not kept pace with the disorder, often misdiagnosed and shrouded in stigma. “Are there enough treatment centers? Of course not,” said Li Xueni, director of the Eating Disorder Center’s inpatient unit at Peking University Sixth Hospital, which opened the country’s only closed ward for eating disorders five years ago. “Often after visiting, doctors come to the conclusion that they don’t have the necessary resources to establish another facility at their hospital.” The new unit, on a locked floor colored in pale blue, treated about 250 patients last year. That’s 10 times the number the entire psychiatric ward assisted just over a decade ago.

Officials have poured resources into tackling the more visible epidemic of excessive weight gain. But Chinese society still largely views the opposite problem as a personal weakness, something to handle quietly if it is addressed at all. When He Yi, the girl from Hunan, finally told her mother, she took it as a public indictment of her parenting. He Yi now runs an online eating-disorder information group with about 12,000 subscribers, and just went to the U.S. to study clinical social work. “When you tell people you have disabilities, you get understanding,” she said. “But say ‘eating disorder’ and they say, ‘What?’”

Zhang, the professor at Peking University, assists at a new, upscale private hospital in northwest Beijing, near the shady repose of the Fragrant Hills imperial garden. Massage chairs, a fitness center and coffee bar give the aura of a luxury hotel. Beijing Yining Hospital caters to a clientele willing to pay for quality mental-health services — not least of them eating disorders.

Image Sources: 1) Landsberger Posters; 2) Beifan. com; 3) Cgstock ; 4) Bucklin archives; 5) Asia Obscura

Text Sources: New York Times, Washington Post, Los Angeles Times, Times of London, National Geographic, The New Yorker, Time, Newsweek, Reuters, AP, Lonely Planet Guides, Compton’s Encyclopedia and various books and other publications.

Last updated September 2022