Although an Oxfam study released last week claimed Cambodians to be the healthiest eaters in the world, obesity in the Kingdom is on the rise. What are the reasons for this, and how do the figures correlate? Bennett Murray found out.
From packaged Thai sweets to Whoppers from Burger King, which just opened its second outlet in Phnom Penh this week, unhealthy snacks have become more and more accessible in the Kingdom. Between 2003 and 2008 alone, imports of soft drinks and sweets into Cambodia rose by a staggering 5,041 per cent and 24,334 per cent respectively, according to the World Health Organisation (WHO). And along with the Whoppers and Haribo has come their less sugary cousin: widening waistlines and serious health problems.
According to a 2012 study, the percentage of Cambodians who are overweight jumped from nine per cent to 14 per cent for women and from seven per cent to 10 per cent among men between 2000 and 2008. Another study, conducted in 2010 by the Ministry of Health in collaboration with the WHO, found that 15.4 per cent of the country is overweight or obese.
Khims Sam Ath, WHO technical officer for non-communicable diseases in Cambodia, said that the proliferation of unhealthy food in the Kingdom could cause a major crisis.
“This is one of the causes for alarm of expected increase in the prevalence of obesity in the future,” he said.
In addition to the influx of unhealthy food, Cambodians have stopped moving around so much, taking up sedentary jobs in the city as opposed to rural work, said Ath.
“Globalisation and urbanisation make people tend to change their lifestyle – unhealthy diet and lack of physical activity lead to the development of people being overweight or obese,” he said.
“At the end they are living with chronic diseases such as heart disease, strokes, cancer, diabetes,” Ath said. According to Ministry of Health data, 5.6 per cent of Cambodian adults living in cities had diabetes in 2010.
One of those is Hok Bet, a 34-year-old security guard in Phnom Penh, who was diagnosed with diabetes last October. The disease was linked to his consumption of sugary drinks and fatty snacks.
The first symptom of diabetes is the frequent need to urinate, but Bet did not think to go to a doctor until the situation got so bad that poor blood circulation caused parts of his feet to turn purple. Without proper blood flow, even small cuts could lead to gangrene and amputation. Fortunately, he went to the anti-diabetes NGO MoPoTsyo where he now receives treatment and peer counselling.
“Before, I ate imported Thai treats and drank a lot of soft drinks. If I didn’t have diabetes, I would still very much like to have those,” he said with a smile.
Since his diagnosis in October, a strict diet of brown rice and no saturated fat has enabled Bet to shed three kilograms. He also exercises for at least 30 minutes every day, in accordance with the doctor’s orders.
While obesity is often associated with affluence – developed countries still have the highest proportion of sufferers – lowly paid Cambodian workers such as Bet, who earns $70 a month, can now afford a steady stream of cheap, calorie-packed snacks, although no studies have yet broken down overweight and obesity statistics by income in Cambodia.
An Oxfam study released last week announced that Cambodians are the healthiest eaters in the world with regards to obesity and diabetes risk. It added that Cambodia suffers from a shortage of quality food, thus preventing widespread obesity from emerging in the first place.
But it is not contradictory for a country to suffer a food shortage while simultaneously facing an emerging wave of people who are overweight or obese, said Oxfam representative Anna Ratcliff.
“The index illustrates a broken global food system, in which consumers suffer from both under-nutrition and obesity – a situation which can be often found in the same countries or communities.”
According to a study released this month by the Overseas Development Institute (ODI), there are now almost twice as many overweight or obese people in developing countries as in developed ones.
ODI research fellow Steve Wiggins said that Cambodia appears to be no exception to the trend, which will likely continue as Cambodia continues to develop economically.
“The rates and numbers are rising – and one might expect them to rise further with economic growth under the forces of higher income, more sedentary lives, and the increasing availability of cheap, quick-to-prepare processed foods and meals – too many are rich in fats, oils and sugars.”
It seems that part of the problem may be cultural, as there is a perception among Cambodian men that mild obesity is sexy, though the same is not true for women.
“The idea for Cambodian people is completely different from Western people. Here, when [men] are a little obese, they say, ‘oh, handsome!’” said Dr Yom An, a former researcher at the Institute for Public Health who now works for Handicap International.
To complicate matters, some scientists believe that Cambodians are susceptible to diseases linked to obesity, such as diabetes and hypertension, at lower body mass indices (BMI) than Caucasians. In a paper co-authored by An, he demonstrated the need to define overweight and obesity at a lower BMI level when diagnosing Cambodians.
“We found that Asian people have more fat compared to [Westerners], who have more muscle than us,” An said, adding that studies from other countries in Asia-Pacific show similar results. If a lower BMI cutoff of 23 instead of 25 is used, said An, the overweight rate in Cambodia would be 18.5 and 21 percent for men and women respectively.
The problem is worsened, added An, by general apathy towards non-communicable diseases in Cambodian society.
“We focus mostly on infectious diseases like HIV, tuberculosis, dengue fever, something like that. But for non-communicable diseases- like obesity or hypertension- it’s not really the priority for the government.”
Sam Ath said that the problem is also a result of economic development without corresponding legal changes. Although specific policy changes, such as advertisement restrictions on junk food, are not yet forthcoming, Sam Ath said that an action plan in the works will create institutional cohesiveness across government ministries to combat non-communicable diseases in general.
The food industry also has a role to play, said Sam Ath, by cutting down sugar, fat and salt content, making health foods more affordable and responsibly marketing junk food away from children.
For An, the key for people in Cambodia to combat being overweight or obese is education.
“We have to inform people of the cause of obesity – lack of exercise, not properly eating food, especially fast food. If people understand that, I think it is the best strategy to reduce obesity in Cambodia.”
But he suspects that the problems will be ignored until they become endemic.
“The economy is still growing, and people will pay more money [for food]. We give value to people, especially men, who are overweight. I think that obesity will continue based on our current strategy, because we do not pay attention.”
In Bet’s case, his education arrived too late to prevent the onset of diabetes. But the imminent threat of loss of life or limb, Bet said, has scared him into diligently keeping with the healthier parts of the food pyramid.
“If I eat from the top of the food pyramid, the future will not be good,” he said.
Burger King did not respond to request for comment in time for publication.