From stressed-out executives toiling away in concrete jungles to the inhabitants of palm-fringed Pacific atolls, millions across Asia are being stalked by a silent killer -- obesity.
A steady rise in living standards over the past two decades has lifted millions out of poverty in Asia but also brought with it a new problem. Throughout the region, people are getting fatter.
YUSHA
At a meeting in Geneva last weekend, World Health Organization (WHO) experts adopted new policies aimed at tackling what was once seen as primarily an American problem.
Today, it has gone global and many Asian governments are only now starting to grasp the full impact it is having on their health services and societies.
Dr Gauden Galea, an adviser on chronic diseases with the WHO's regional headquarters in Manila, said the gradual way in which obesity has developed in societies was the reason nothing had been done before.
"Obesity and all that it brings has no immediate impact like bird flu or SARS," Galea said. "It creeps up slowly on society. Chubby children were said to be healthy children."
"As a society becomes more affluent, people's life styles change with that growth in affluence. They tend to adopt more sedentary life styles, get bogged down with work, life becomes more stressful and fast-foods and processed foods become the norm," he said.
"We have seen these changes in the developed world over the past 50 years. Today we are seeing it in a decade in parts of Asia," Galea said.
The WHO says more than one billion adults worldwide are overweight and at least 300 million of these are considered obese.
In urban centers, bikes are giving way to cars, western-oriented fast food chains have proliferated, processed foods have taken over from more traditional meals as more and more people pursue sedentary life styles.
Associated with obesity has been a dramatic rise in heart disease and diabetes, especially in the Asia-Pacific region.
According to WHO data 120 million people worldwide have insulin resistant Type 2 diabetes, of which 30 million are in the Asia-Pacific. By 2010 that figure is expected to be a staggering 130 million out of 216 million worldwide.
Galea said one of the biggest concerns is the rapid spread among Asian children of Type 2 diabetes, what was once known as "adult-onset diabetes."
"This rarely affected children in the past. As children grow overweight they become subject to diabetes, which is so closely linked with obesity that the combination has sometimes been called diabesity," he said.
Galea said between 2000 and 2010 diabetes in Asia is expected to increase by 57 percent.
"That is a frightening statistic. If that were HIV there would be an uproar. But diabetes is not stigmatized like HIV and it grows largely unnoticed while it does profound damage to health and development in the region, causing large numbers of heart attacks, heart disease, blindness, renal failure and others."
One of the biggest problems facing governments is the staggering cost of treating diseases related to obesity.
A study by the US-based Center for Disease Control and Prevention found that obese Americans cost the country about US$75 billion in weight-related medical bills last year.
In Australia a national study has just started on the health burden and costs of diabetes and obesity. Diabetes and associated illnesses cost Australia more than A$3 billion (US$2 billion) annually.
And it is not just in the more developed countries of the region that it is a problem. The London-based International Obesity Taskforce has declared Pacific islanders, especially women, to be the fattest people in the world.
It said 55 percent of Tongan women, 74 percent percent of Samoan women and 77 percent of men and women living in Nauru are obese.
Obesity is defined as a condition in which there is an excess of body fat and is measured by what is known as the body mass index (BMI).
BMI is calculated by dividing bodyweight in kilograms by height in meters squared. For example, a man who is 1.7m tall and weighs 65kg would have a BMI of 22.5. Someone with a BMI of 27 is at risk of obesity-related diseases such as diabetes.
Around the region, the scale of the problem today is clear. New Zealand's ministry of health says more than half of the country's adult population is either overweight or obese and in Taiwan more than 30 percent fall into the category.
Vietnam today also reports rising obesity, as does Singapore, where 52 percent of the adult population consume a high fat diet and 58 percent are declared physically inactive.
According to Dr Edmund Li, a nutritionist with Hong Kong University, in China's cities where incomes have risen quickly, up to 30 percent of children and young adults are overweight. The South Korea health industry development institute says one third of South Koreans aged over 20 are overweight or obese, up from 26 percent in 1998.
"With changes in lifestyle, as well as globalization, modernization and urbanization, there are a lot of factors that can contribute to the higher rate of obesity," WHO representative to Thailand Kumara Rai said.
With that in mind, Asian delegates to the WHO meeting in Geneva last weekend agreed to an anti-obesity drive that calls on governments and industry to promote better diets and more exercise, by advocating less fat, sugar and salt in food, as well as 30 minutes of moderate daily exercise.
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