Photo: SCIENCE PHOTO LIBRARY
"In Chinese culture, they love kids to be chubby," says Sydney dietitian Lisa Chen.
Given the history of famine and poverty in China, she said spoiling children with food was the way parents had traditionally showed how well they cared for their kids.
It's believed to be one of the reasons for the superpower's growing obesity problem.
Rising obesity is a worldwide problem, but it's happening particularly rapidly in China, outpacing even wealthy nations.
"Close to 70 percent of the US population are overweight. But soon China may catch up," said professor Yanzhong Huang, senior fellow for global health at the US-based Council on Foreign Relations.
China's rate of overweight and obese children has quadrupled since 2000 and - if current trends continue - is projected to exceed 60 percent by 2030, according to UNICEF and Peking University.
Overweight kids often become overweight or obese adults, putting them at higher risk of cardiovascular disease, diabetes and some cancers.
According to state media, more than half of Chinese adults are already overweight, and government budgets risk being strained by increased health costs.
Due to its vast population, the country already has the largest number of overweight or obese individuals in the world, though it uses slightly stricter body mass index (BMI) classifications than Australia.
In China, a BMI of over 24 is considered "overweight" and over 28 "obese" while in Australia the cut-offs are 25 and 30.
Chen, who used to live in Guangdong, said the trend was a big concern and China's food and exercise culture needed to drastically improve - and quickly.
What's caused China's obesity issue?
Huang said the country's economic development was one of the main causes of what he termed a "looming obesity crisis".
"There's fewer people doing farm work, which means fewer calories burned," he told the ABC.
"Rapid urbanisation has provided more sedentary lifestyle options."
He said China's statistics were "really scary" and "in just five or six years" the country's proportion of overweight citizens would rival the United States.
The increase in desk-bound jobs has happened concurrently with rising incomes and a clear shift towards more consumption of meat, refined grains and processed foods.
Obesity is more prevalent in China than in other Asian nations, and Chen highlighted the country's business and social eating culture as a key factor.
She said restaurants in China were often family-run and frequently used excessive amounts of oil and condiments, causing a higher kilojoule count.
The fast-food market has also skyrocketed, set to double in just eight years.
Photo: Pixabay
That was no surprise, said Chen, as "996" workplace culture meant convenience and food delivery had become mainstream.
"Workers don't have time to prepare their own meals," she said.
"Consuming unhealthy food is a quick way to boost their energy level, or make them - temporarily - feel good."
Huang agreed long hours could cause "stress eating", adding that the obesity problem had likely been exacerbated by China's post-COVID economic slowdown, causing some to adopt cheap, unhealthy diets.
The lasting impact of famine
One theory is that China's past experience of famine may have had a lasting impact.
"A study shows how food shortages in China's past actually led to metabolic and epigenetic changes that influenced future generations' risk of obesity and exposed them more to a high-calorie diet," Huang said.
But, he added, the hypothesis was "difficult to prove conclusively" and required more research.
The history of undernourishment nevertheless looms large for older generations.
"Even now, when I see older Chinese patients, they say they don't think about what food they eat, because in the past they were starving," Chen said.
"They just want to feel good.
"I spend quite a lot of time trying to convince them to consider their health."
While obesity in Australia was associated with lower education and incomes, in China it was more common among the wealthy, who had the means to eat and drink to excess, she said.
There are also regional variations in obesity rates, with local diets influential.
Professor Huang said that generally speaking northern Chinese diets were traditionally dominated by kilojoule-rich wheat-based foods like noodles, buns and dumplings.
Food in many of the southern provinces was seen as healthier due to the prevalence of vegetables, rice and seafood, he said.
How are people combating obesity?
Private camps dedicated to weight loss are growing in popularity, with around 1,000 now operating across China.
They often include strict daily exercise regimens and rigid surveillance against snacking, reports AFP.
But they have also sparked controversy - last year an influencer died while attending a facility as part of efforts to shed more than 100 kilograms.
Professor Huang said many camps operated without proper regulation or qualified staff, potentially causing more harm than good.
He said citizens may be more tempted to take a pharmaceutical route to weight loss, with a growing market for anti-obesity drugs such as diabetes medication Ozempic (semaglutide).
The drug doubled sales in China last year, which now makes up 5 per cent of total global sales.
"Though the side effects of using of these drugs should also be taken into account," the professor added.
What's the government doing?
In June, Beijing launched a three-year campaign to address obesity, recommending healthier foods in school canteens and encouraging employers to support staff fitness.
Primary and middle school students will have to do two hours of physical activity per day.
State media quoted experts suggesting "it's time for youngsters to say no to the allure of candies, cakes and barbecues".
But will it make a difference?
"The implementation is the key," Huang said.
"Meanwhile more needs to be done - like considering sugar taxes, strict controls on junk food in schools and training more professionals in obesity management."
Given the prevalence of unhealthy packaged foods, Chen recommended authorities implement glycaemic index (GI) labelling and a health star rating system like Australia.
She backed calls for more formally trained professionals, noting that dietitians were almost non-existent in Shantou - a city of 5.5 million that she used to call home.
"Even in the hospital, they don't have a dietitian," she said.
Chen emphasised education was particularly important given Chinese and South-East Asian people had a higher genetic risk of type 2 diabetes.
She said one-to-one dietitian consultations, typically rare in China, could significantly address health misinformation.
"There's so much misleading information on the internet and WeChat," she said.
"A couple years ago, a post on the Chinese internet encouraged people to eat more pork fat. People actually followed that."
* This story was first published by the ABC.
