Urban Growth

Obesity threatens the health of 1.6 billion adults – nearly a third of the world’s population – and millions of children. In 1997, the World Health Organization declared it a global crisis. Ironically, it affects not only residents of affluent nations, but urbanites in developing countries such as Indonesia, whose changing diets and lifestyles have them piling on the pounds. Maggie Tiojakin reports.

The theater is packed. Fifty minutes into Pixar’s Wall-E, the screen shows digitally enhanced humans living in the very distant future who have grown simply too heavy to move. Everyone sits on a giant air-seat and has everything they need at a chubby-fingered push of a button. It gets a big laugh from the audience, although some larger viewers may chuckle a bit more self-consciously.

A recent report released by the World Health Organization (WHO) found 400 million adults around the globe are clinically obese, with 1.2 billion more heading in the same direction. And dealing with it isn’t cheap: According to an estimate by the U.S. Surgeon General, the United States alone spends about $117 billion a year to treat obesity-linked illnesses, including heart disease, stroke, high blood pressure, sleep apnea and gall-bladder disease – and this has the potential to increase over the next few years.

It is predicted that children will have a lower life expectancy than their parents, as our collective waistline balloons from medium to frighteningly huge. In short, the world is fat. And developing countries are not exempt: The fattening trend is found here in Jakarta and other major cities, with a growing middle class battling the bulge. The Indonesian Society for Obesity Studies estimates the incidence of obesity has swelled 21 percent in the past 10 years in the major cities of Jakarta, Bandung, Semarang and Surabaya. Leading dailies carry stories of children hospitalized for malnutrition in remote areas, while their classified sections offer slimming pills and weight-loss programs catering to overweight city dwellers.

Poor diet and lack of physical activity are probably the most common explanations for obesity, but several studies point to the rise of urbanization in major cities around the world. The transformation of our urban environment has had no small part in creating a bigger, less active society.

A U.S. Center for Disease Control study shows a direct link between urban settings and the development of obesity among their inhabitants. The study contends that within artificial environments, such as those found in industrialized countries, cases of acute obesity are most prevalent. This is because technology has significantly reduced the amount of physical exercise in people’s daily lives and provides a wide selection of high-calorie, high-convenience foods.

“I would say that we are witnessing a regression in our society,” says Wulan Marini, a dietitian who works with the Indonesian Society for Obesity Studies. “This is a time when people will do just about anything to do absolutely nothing. Technology has made it possible for us to sit and stare at our computer screen 16 hours a day, five days a week, and live without having to lift a muscle.”

It’s clear attitudes toward being overweight are changing, at a time when we are increasingly embracing fast-food eateries and processed packaged munchies. In economically leaner times, a little extra weight was a sign of success and that a person was living well. Today, however, health clubs and slimming centers have sprung up in Jakarta to help the overweight get back in shape in the image-conscious modern world. A laxative manufacturer uses a famously svelte singer to promote its product’s effectiveness in getting rid of that “heavy” feeling (“It’s not just for women,” she tells a man at the end in a nod to fitness-conscious metrosexuals). A prominent weight-loss food producer holds an annual contest to find the queen who has managed to shed the most undesired kilograms.

“There are 18 million people in [Jakarta],” says Angga Gunawan, a community liaison officer at the Health Ministry. “The number of people who fit the profile of healthy makes up less than 10 percent of the population. The other 90 percent are overweight, obese or severely malnourished. I think the problem is we’re underestimating the effects of urbanization – on both the social and the psychological fronts – because we seem to care less about how we live and the way it affects our health.”

In an urban setting such as Jakarta, time is largely spent inside an office, a car or a mall. Between getting stuck in a traffic jam, completing a pile of job-related reports and waiting in line for a cup of mocha latte, we spend about the same amount of energy each day as a toddler who is learning to walk.

As a result, we expect instant services that enable us to navigate our lives through an incredibly hectic schedule. We become fast-food junkies and caffeine addicts who eat out and on the run.

“There was a time when we relied on our mother’s cooking,” says Wulan. “In those days, the rates of obesity were fairly low, because our food intake came from a source that was fresh and high in nutrition. Believe it or not, meals that are prepared at home make a great difference. Today it’s another story: We go to a (fast food restaurant) and order a quick fix of hamburgers and fries, neither of which is beneficial to our health.”

Santi (not her real name) is an account executive who is dealing with her own weight woes. Thin throughout college, the 28-year-old has gained about 12 kg since having her first child and returning to work. A typical day for her includes the commute from her Bekasi home to her office, when she eats a snack from the coffee shop downstairs or from one of the street vendors downstairs. She grabs lunch with colleagues at one of the surrounding restaurants, either fast food or Indonesian cuisine, and has dinner at home.

“It’s so hard to control my weight these days because I’m in the office most of the day, there are sweet snacks around all the time and I can’t say no when people invite me out to eat,” she says. “And there aren’t many healthy choices out there.”

The same poor eating habits are being adopted by children who crave sugar, protein and fat. School cafeterias, food vendors and the malls are nutritional danger zones. From greasy snacks to ice cream to sugary sodas, children are making unsupervised food choices. Even worse, at home they are often given the freedom to repeat the same mistakes.

“Childhood obesity is the most alarming part of the epidemic,” says Angga, who adds that while there are no definite numbers on the incidence of obesity among children, a stroll around local malls confirms that middle-class children are getting bigger. “It means that within the next five to 10 years, children will be exposed to some serious diseases like diabetes, heart attacks or cancer, which is heartbreaking. But people are not aware of this, because they think such diseases can only affect adults.”

In 2005, WHO introduced a program called Global Diet, Physical Activity and Health meant to battle the epidemic in urban and suburban communities. The campaign is ongoing, as an addition to the Global Health Security Initiative already running in more than 150 countries.

Health experts are hoping that just as anti-smoking and anti-drugs campaigns have dramatically reduced the number of deaths related to those two lifestyle choices, the same results will be achieved by an anti-obesity campaign.

Many private schools in Jakarta are making gradual changes to the way they reach out to children about health concerns and food choices. Cafeterias have been redesigned to promote a healthier atmosphere, as menus are altered to fit the dietary needs of children.

“We recognize the danger,” says Vijay Shah, the principal of a Singapore-based elementary school in Jakarta. “We’ve establish programs that concentrate on overweight students and, particularly, those who are obese. We get them to exercise, eat healthier food, and advise their parents to be consistent to these principles at home.”

So the war against obesity continues. Of course, it will not end overnight, as more studies and research are conducted to find a solution or, at least, a method that works to our benefit.

But changing social attitudes to food and body image have another side: eating disorders such as anorexia and bulimia, which were virtually unheard of in Indonesia 15 years ago.

“This war (on obesity) is not about starving yourself to death. It’s about finding the balance between what you want and what your body needs,” says Vijay.

Wulan believes the answer lies in the approach to the problem.

“There has to be a clear distinction between what’s normal and abnormal,” he says. “Awareness can’t be raised by saying ‘this is good and that is bad’. It has to be raised by examples.”

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