When Forrest Davis left his job in 1985 to set up the Goliath Casket Company, he probably didn’t imagine his business making extra-large coffins would be so successful. The obesity rate in the US was less than 15%, and the market was faltering: at the end of the 1980s Davis’s little firm in Lynn, Indiana, was selling just one “triple-width” coffin a year. Now it sells five a month: various colours are available and the deluxe model has gilt handles and a padded lining. With more than a third of adults classed as overweight and another third as obese (1), the US today is one of the fattest countries on the planet.
The market has adapted. Some companies provide products and services for larger consumers: bigger seats for sports stadiums and theatres, reinforced ambulance stretchers, king-size mattresses, dating sites for larger singles. Others offer pills to make the pounds melt away, military-style “fat camps” and surgical operations costing $10,000. The fat market is worth tens of billions of dollars. Books on obesity (miraculous recipes for losing weight, analyses of the phenomenon) are so popular that The New York Times has given them their own category in its best-seller list. Yet the cause of this weight gain in the US is well known: it’s the American lifestyle of the past 30 years — eating more calories and burning fewer.
The American way of life, based on the cult of consumption and technological progress, encourages physical inactivity. Thanks to lifts, escalators, remote controls, automatic garden-watering systems, vacuum cleaners, washer-dryers and electric tin openers and carving knives Americans “are burning far fewer ‘accidental’ calories” claim Eric Finkelstein and Laurie Zuckerman. “Throwing your clothes in the washing machine versus washing them by hand is estimated to result in 45 calories fewer being expended” (2). Having been freed from chores, Americans could have taken up leisure activities that burn calories but, over the last few decades, they have spent most of the time saved sitting in front of the TV or behind the steering wheel.
Urban life in the US encourages ever-greater use of cars. After the second world war, the rising cost of housing in town centres prompted a mass exodus to the outskirts. This led to the development of monotonous, straggling suburbs, with few or no pavements and poorly marked pedestrian crossings. In the absence of adequate public transport networks (except in the largest cities), the increasing distances to be covered made cars essential for getting about. Since 1960 the number of people commuting to work outside the county they live in has tripled, and the average distance travelled by car each year has increased by 250%. Americans spend over 10 hours a week in their cars. This encourages weight gain: according to a survey in the Atlanta area, all other lifestyle factors being equal, every hour of the day spent in a car increases the risk of obesity by 6% (3). Residents of the 25 US counties where the residential density is lowest weigh 2.7kg more on average than residents of the 25 counties where it is highest (4).
But car time is far less significant than the 40 hours a week that Americans spend sitting in front of a screen (TV, computer or game machine). The television is the focus of many households, and the average household has more sets (2.9) than people (2.57). Watching it makes people move less and eat more. It’s a totally sedentary activity, which encourages nibbling, and the constant flow of adverts pushes viewers, especially young people, to over-consume.
The limits of human metabolism should mean that the food market grows slowly, in line with population growth. But it is possible to make people eat more than they need. In 1970 American men ate 2,200 calories a day (sedentary men aged 31-50 are estimated to need 2,200-2,400); 40 years later they were eating 2,700.
Poorer means fatter
The agrifood industry has found a way to free itself from this demographic straightjacket and boost its profits: creating a constant desire for discovery by flooding the stores with new products. Between 1990 and 2010 more than 116,000 new products appeared on US supermarket shelves. The beverage aisle illustrates the inventiveness of this “product diversification” — energy drinks in bright colours, sold in packs of six sachets in a cool bag or in decorated cans (including one brand with a picture of Bob Marley); soft drinks in ever more flavours, including many varieties of Coca-Cola (sugar-free, caffeine-free, cherry, lemon, lime or vanilla); fruit juices, with or without bits, organic or with “fruit extracts”. It has been a highly effective strategy: every year, the average American consumes 178 litres of soft drinks, compared to 85 litres in 1970 and 135 litres in 1980.
Manufacturers have also targeted new customers. The poor, whose purchasing power rose with economic growth during the post-war decades, have become the ideal target. Fresh food used to be expensive in the US, and the working class had difficulty affording a proper diet. Then agricultural mechanisation and industrial production made food plentiful. Its relative price started to fall, but not at the same rate for all products.
The sophistication of packaging, storage and distribution techniques means that high-calorie processed foods now cost less than fresh foods rich in nutrients (minerals and vitamins): a dollar’s worth of potato crisps is more filling than a dollar’s worth of carrots. If Americans followed government dietary advice to eat more potassium, calcium and vitamin D, and less saturated fat and added sugar and salt (found mostly in processed foods), they would have to spend an extra $400 a year (5).
The poor, being price-conscious, consume more foods that are ultra-high in calories and low in nutritional value, and are more likely to suffer from obesity. According to The WallStreet Journal (7 July 2011), over a third of adults living on less than $15,000 a year are obese, but only 24.6% of those earning more than $50,000. The highest ratios of overweight and obese people are found in poor states with large Hispanic and Afro-American minorities (Alabama, Kentucky, Louisiana, Tennessee, Texas).
The supersizing strategy
The fall in production costs has not only reversed the relationship of the poor to food (from under-consumption to over-consumption of calories), but has upset the natural economic order. Actual food now accounts for such a small proportion of the price of a product as compared to packaging, marketing and design that it has become more profitable to sell larger portions. At Walmart, a 321g bag of chocolate-coated peanut and caramel candy bars costs $3.58, while a 1,100g bag costs $8.98, nearly four times as much product for less than three times the cost. Many customers will choose the larger pack. It’s cheaper to buy milk by the gallon, potato crisps in a family-size bag and cheese in a shrink-wrapped 500g block.
This might seem a good thing — not only cheaper but kinder to the environment — but “there is something about our psychology that makes us eat more if it’s put in front of us,” says nutritionist Marion Nestle (6). To prove this, Barbara Rolls, a nutritional scientist at Pennsylvania State University, recruited a group of slim young men who watched their weight and gave them different-sized servings of macaroni and cheese each day, recording how much they ate. If the serving on their plate was 450g, they ate 280g; if it was 700g, they ate 425g — 50% more.
Well aware of human psychology, the fast food chains have introduced “supersizing”. For a few dollars more (giving the impression of a bargain), customers can “supersize” their menu: a bigger drink, an extra burger in their bun or a double portion of fries. Forty years ago, the only size of drink at McDonald’s was 20cl; now the smallest cup holds 35cl and the largest nearly a litre. The only hamburger on offer then is now served to children (or to adults as a snack). As the US has five times more fast food outlets than supermarkets, this trend has contributed to obesity. Changing consumer expectations have forced restaurants to follow the example set by the fast food chains, and their standard portions are growing too.
And there are always adverts to remind consumers — especially children — of the joys of eating high-calorie foods. Young Americans are a relatively new market. In the past, all spending decisions relating to food were made by parents. Greater purchasing power and changing attitudes to children’s wishes have turned the youngest into consumers in their own right. The high priest of marketing to children, James McNeal, emeritus professor of Texas A & M University, said inThe New YorkTimes (20 April 2011) that children influence more than 8% of food and drink purchases made in their entourage, amounting to $100bn.
Children are a prime target for advertisers and the average American child sees 25,000 TV adverts a year, more than 5,000 relating to food (7). Specially designed to appeal to a young audience, these adverts often use characters from popular programmes to create an emotional association with the product. SpongeBob advertises Kraft macaroni and cheese, Breyers ice cream and Hershey’s chocolate bars. Even the Teletubbies — from a show aimed at children under three — have been used in advertising.
Slow to take action
But consumers’ associations have been attacking TV adverts, and the agrifood multinationals have turned their attention to new media. Mobile phones and the internet have brought smartphone apps, online video games and electronic quiz games, which are hard to regulate: there is no law to prevent a child from becoming a “friend” of Ronald McDonald on Facebook, or spending hours on Honeydefender.com helping to “save” the honey used to make Honey Nut Cheerios breakfast cereal, or on McWorld.com, drawing with SpongeBob.
The authorities have been slow to take action against these aggressive practices. The junk food market is huge — according to the FinancialTimes (9-10 June 2012), global sales of fast food reached $706bn in 2011 — and the big brands are willing to spend vast sums on defending their interests. But obesity is now so widespread that the problems it causes (depression, discrimination, health risks, loss of productivity) have become a concern to all of society. Obesity kills 200,000 people a year, which puts it behind tobacco (over 400,000 a year) but well ahead of alcohol and road accidents: it is now the second biggest cause of avoidable deaths in the US. Treating obesity-related illnesses (type 2 diabetes, cardio-vascular disease, high blood pressure, pulmonary embolisms, high cholesterol, cancer) costs more than $147bn a year (or 10% of all medical care spending in the US), of which $61.8bn is paid for directly by the Medicare and Medicaid programmes (8).
Over the last few years, the federal government has encouraged children to be more physically active, introduced labels that show the nutritional content of food products, and banned soft drinks machines from schools. State and municipal governments, too, have been adopting stricter legislation. Following the example set by California, Maine and Oregon, New Jersey has, since 2010, required fast food retailers to show how many calories their products contain. In May 2012 the city of New York banned the sale of supersized soft drinks in restaurants, cinemas and sports stadiums. In its 2010 annual report, Coca-Cola cited the adoption of stricter legislation as one of 30 factors that could affect its future profits (along with water shortages, the global credit crisis and climate change). To secure their future, the multinationals are turning to new markets, which are less saturated than the US, and less regulated.
Once the prerogative of western countries and the Gulf states, obesity is now a global phenomenon. In Mexico 30% of adults are obese, in South Africa 18.1% and in Brazil 13.9%. Even India and China are affected. Economic development — urbanisation, mechanisation, the industrialisation of food production and the spread of mass retailers — is pushing lifestyles closer to the American model.
Belly as a mark of success
In India, the proportion of the population living in cities has risen from 23% to 31% in less than 30 years. Tens of millions of people who used to earn their living by manual labour in the countryside, and eat what local products they could afford, are gradually gaining access to mass consumption. Cars, televisions and washing machines are encouraging a sedentary lifestyle; because of the spread of the refrigerator, supermarkets, selling processed, packaged, frozen and often imported foods, are springing up in the cities. Mass retailer sales are estimated to be growing by more than $27bn a year. This recalls Latin America, where the supermarkets’ share of food sales rose from 15% in 1990 to 60% in 2000.
The fast food chains are applying techniques learned in the US and Europe to the emerging markets. All they have to do is nod to local culture. In India, adverts feature Bollywood stars and cricketers instead of Hollywood stars and baseball players. At McDonald’s, the Big Mac, unsuitable because 80% of the population are Hindus and don’t eat beef, has been replaced by the Chicken Maharaja Mac. At Domino’s Pizza, pepperoni and ground beef has been replaced by paprika and goat’s meat. National restaurant chains (Moti Mahal, Nathu’s Sweets, Sagar Ratna) compete with US fast food giants for share of a market that is growing by 25-30% a year (9). In 2011 Yum! Brands — which owns Kentucky Fried Chicken (KFC), Taco Bell and Pizza sHut — announced that it planned to open 1,000 new restaurants in India by 2015. In China, it hopes to open as many as 20,000 restaurants over the next few years.
Obesity is as yet limited in China and India but it is spreading, and the number of overweight people has already reached a significant level. In India, the average rate among adults is 15% — more women than men — with peaks of 30% and 40% in cities such as Chennai (Madras), Jaipur, New Delhi, Mumbai and Kolkata (10). In China, 31% of adults are classed as overweight and 12% as obese (11). Expensive private clinics modelled on America’s “fat camps” have appeared, but although 6-10 million adult Chinese become obese each year, there is still no real public prevention programme. Chen Chunming, a nutrition expert at the ministry of health, feels powerless: “If you tell people not to eat hamburgers or other high-calorie foods, they say, ‘I’ve got money now, I’ll eat what I want’” (12).
In the poorest countries, huge wealth gaps, and gaps between city- and country-dwellers, have led to a double nutritional problem: food is scarce and expensive in the countryside, and many smallholders are undernourished; in the cities, where there is an abundance of industrial food, the new middle classes are adopting a high-calorie diet. In Niger, 30% of people in cities are over the recommended weight, while 20% of those in the countryside suffer from malnutrition. In Namibia, the ratios are 40% and 18%; in India they are 25% and 50%. In most western countries, the adage that the rich are fat and the poor are thin is no longer true, but it still is in emerging countries. In Chennai, being fat is almost a sign of success, and for a time one fast food outlet advertised a product with the slogan “Are you too fat? Congratulations!” In some rural communities in African countries, where Aids affects one in two (and many believe it to be a disease that affects thin people), being overweight is even regarded as a sign of good health.
The distribution of obesity and under-nutrition does not always mirror the divide between town and country, rich and poor: they can sometimes be seen side-by-side, within the same social group, the same geographical location, or even the same household — among Palestinian refugees in Lebanon or smallholders in Peru, in the favelas of Brazil and in the cities of Mali and Senegal. This can be explained by generational differences and changes in diet. If a woman is malnourished in early childhood, her metabolism will change permanently: she will develop a tendency to store fat. Later in life, if her diet is higher in calories but still poor in micronutrients (iron, vitamins), she will gain weight rapidly, while her babies will suffer from nutritional deficiencies. This is why, in Egypt, 12% of children are stunted but have obese mothers.
At global level, the number of overweight people (around 1.5 billion, of whom 500 million are obese) is now greater than the number suffering from malnutrition (around 1 billion) (13). Europe and the US are beginning to fight back, but many countries have yet to take action. Yet Coca-Cola is worried that “obesity and other health concerns may reduce demand for some of our products.”