To the Editor:
I am pleased to read the May 1, 2008 issue of Beijing Review, which devoted a considerable amount of pages to obesity, especially childhood obesity, in modern China. As Professor Ji said, obesity is a “rich man’s disease” (p 20). In old China, people died from famine, malnutrition and infectious diseases. In modern China, people die of coronary heart disease, caused by high cholesterol levels in the blood from eating too much fast food, obesity, lack of physical exercise, excessive TV watching, air pollution and cigarette smoking.
The prevalence of coronary heart disease has changed considerably in China in the past six decades, rising from the fifth most common form of heart disease in 1948-1957 to the second most common form of heart disease in 1958-1979, and to the most common form of heart disease in 1980-1989, where it has remained till the present time. The fact that diet plays a major role is evident by the progressive rise of “normal” serum cholesterol levels in free-living Chinese men from 155 mg/dL in 1958 to 191 mg/dL in 1981.
Besides the increase in dietary fat intake in young people from Western fast food restaurants opening in China, and the increasing prevalence of diabetes in the Chinese population, cigarette smoking also plays an important role. China ranks as the first in the world in its population and also in its output of cigarette products. China today has the largest smoking habit in the world. One of every 3 cigarettes manufactured in the world is consumed in China. Three of every 5 Chinese smokers begin smoking between the ages of 15 to 20 years. China is about at the stage where the United States of America was in the 1940s and 1950s, when the smoking rate was very high. Because China’s modernization program calls for catching up with Americans, if the Chinese smoke like Americans, then they will die like Americans.
Another reason for increased obesity in China is reduced physical activities. Bicycles used to be the principal means of transportation in China and were as emblematic of China as the giant panda and the Great Wall. Now, there is an 8- to 10-fold increase in the number of automobiles in Beijing. Besides causing more traffic congestion, more air pollution, and less opportunity for exercise, automobiles in China are also responsible for a 41-fold increase in accidents, a 28-fold increase in injuries, and a 75-fold increase in deaths from 1951 to 1993. It was a sad day when I read several years ago that bicycles were banned in Shanghai in certain sections of the city.
Finally, there is another risk factor for childhood obesity that is unique to China, but seldom mentioned. It is China’s one-child policy. China is strict in allowing only one child per family. There is a saying in China: “2-4-8 (pronounced as ‘er, ‘si’ and ‘ba’, respectively), you get fat”. With only one child in the family, the doting parents (2 in number), grandparents (4 in number) and great grandparents (8 in number) pamper their only child by overfeeding the ‘little emperor’. Furthermore, food that used to be distributed among his siblings is now devoured by just one person.
There is a price that developing countries must pay for modernization. However, let the price the Chinese pay not exceed the benefits derived from modernization. Can we achieve a utopian stage in the 21st century in which the modern Chinese retain their ancestral low rates of obesity and cardiovascular disease while adapting the positive aspects of a modern Western lifestyle?
Tsung O. Cheng, M.D.
Professor of Medicine
The George Washington University
Washington, D.C., U.S.A.
July 18, 2008
The views expressed here are not necessarily shared by the Beijing Review