For many years, obesity had been seen as a problem of the more affluent Indonesians who could buy any food they wanted to eat, but many studies, including the latest national health survey, have shown that the trends have shifted as it has now also become a problem for the poor.

The 2018 Basic Health Research (Riskesdas 2018) released last week shows that the proportion of overweight people in the population of adults aged 18 and above reached 13.6 percent this year, up from 11.5 percent in 2013.

According to the survey, adult obesity rates are highest in the North Sulawesi province where they are 30.2 percent, followed by Jakarta with 29.8 percent and East Kalimantan with 28.7 percent.

West Papua, the province with the second highest poverty rate in the country, comes in fourth position with 26.4 percent. Gorontalo and Aceh, which stood in the ninth and 10th ranks as the provinces with the highest obesity rates, also come in the fifth and sixth positions among the provinces with the highest poverty.

The head of the Research and Development Department of the Health Ministry, Siswanto, said there were differences between the obesity cases that occured in developed provinces, such as Jakarta, and less developed provinces such as West Papua.

While people in Jakarta get obese by “eating a lot and not exercising enough”, he said, the obesity trends that happened in West Papua could be connected to the prevalence of stunting.

Five years ago the Riskesdas reported that West Papua, along with East Nusa Tenggara and West Sulawesi, were the three provinces with the highest number of stunting cases in the country. West Papua’s stunting cases are no longer listed among the highest in the recent Riskesdas, but the obesity problem has become alarming.

“Stunting walks hand in hand with obesity, especially in the developing provinces. People who suffered with stunted growth in their childhood have a great potential to suffer from obesity in their adulthood,” he told The Jakarta Post.

A recent report published by the Asian Development Bank Institute (ADBI) entitled Wealthy but Unhealthy showed that while wealthy people in Indonesia tended to be more likely to be overweight and obese, the obesity rates of the least wealthy and second-least wealthy groups shown a large increase between the years 2000 and 2007, resulting in the smaller gap between the groups.

The report also showed that the total indirect cost that is due to obesity in 2016 was US$28.3 billion, while the total medical expenditures of in-patients caused by obesity-related diseases in Indonesia in 2016 was about Rp 1.5 trillion ($102.1 million). “High BMI [body mass index] is a major risk factor for noncommunicable diseases such as cardiovascular diseases, diabetes (type 2), musculoskeletal disorders [...] and chronic kidney disease, as well as some cancers,” the report said.

The Healthcare and Social Security Agency (BPJS Kesehatan), which has announced that the company’s deficit is projected to surpass Rp 10 billion this year, spends more money on non communicable diseases, with kidney failure, cancer and cardiovascular disease the top three.

Iqbal Anas Ma’ruf, the BPJS Kesehatan spokesperson, said Indonesians, especially those in the middle to low income brackets, must manage their lifestyles to prevent themselves from becoming obese.

“Sure, these additional [non communicable diseases] will add the burden on the nation and BPJS [Kesehatan], but remember BPJS is not the only pillar. The healthy life campaign must be intensified because it is more efficient to prevent the disease than to treat it,” he told the Post.

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