Sugar imports to the Kingdom have increased in the form of sweets and sugary drinks over the last 15 years. Where once sugar was considered a luxury item throughout the world, as economic development occurs, so does the inclusion of sugar in many cheaper processed foods.
This disproportionately effects the poor, as processed foods become cheaper than fresh options, such as they have done in the United States where the occurrence of ‘food deserts’ is increasingly common.
These are areas of lower socio economic standing that are overwhelmingly not serviced by fresh food markets, but instead have easy access to a myriad of high fat, high sugar, highly processed fast food options. This has led to a rise in NCDs (non communicable diseases).
The Post took this opportunity to talk to Dr Gavin Scott, a General Practice Doctor, specializing in Tropical diseases. Dr Scott has been in the Kingdom for over 20 years, and has seen the subtle changes that are leading to this public health issue, “I tend to see younger Khmer from the ages of 25 to 40.
What I see is basically a lot more obese Cambodians, particularly among the younger generation”.
Dr Scott has seen the change in lifestyle and health first hand, “In the 90s I would go to a coffee shop, the majority of young people were slim. Now when you go to the average Starbucks or Brown coffee, you walk in, 50 percent of people are overweight or obese, and they are all looking at their phones”.
Western influenced, highly processed fast food is becoming more prevalent throughout the capital and the Kingdom. It is presenting an increasingly favourable alternative to home cooked meals, as Cambodia’s upwardly mobile middle class’ earning capacity increases, they are becoming increasingly time poor. “Western feminist values play a role here,” says Dr Scott.
“Social politics play a role, feminist values tell people that as a woman you can go out and be employed, but when this happens who cooks for the children?” Far from being a bad thing, it is just an extra part of modern life that we must adapt to.
When both parents are working, no one is there to cook, in this situation fast food becomes an appealing option but at the cost of health.
Over-consumption of these highly processed foods, with little nutritional value and high fats and sugars, have been proven to be a contributing factors in deaths from NCDs.
Given that Cambodia’s population have relatively little information about the adverse effects of a high sugar, high fat diet, what kind of role will this sudden influx of foods from other countries have on Cambodians who traditionally have one of the healthiest indigenous diets known to the world.
Malnutrition has traditionally been a major health issue in the Kingdom for many years, particularly in children under five years of age.
But as Cambodia has developed economically, so has the government’s ability to strategically approach the problem of malnutrition with excellent results.
But now that same development has brought problems of its own in terms of the new high fat, high sugar food offerings available to Cambodians, malnutrition is becoming bad nutrition.
So while the Cambodian government has introduced operational policy, strategy, and an action plan to reduce rates of physical inactivity, there is still no operational plan to reduce the prevalence of overweight citizens and obesity in the Kingdom.
There is no easy solution to the problem of overweight Cambodians, as Dr Scott points out, “the problem here is the same problem that applies to everything, it is fundamentally down to a lack of education”.
That lack of education is contributing to what will become a very real problem for the Kingdom.
Lack of education leads to poor decision making and in turn this leads to many health problems, not just obesity.
The rate of overweight people in the Kingdom is still relatively low by world standards. When compared to neighbouring Southeast Asian countries Cambodia still has a low rate of overweight people.
Vietnam sits bottom of the Southeast Asia (SEA) obesity statistics claiming 10.3 per cent of its male and female population is overweight. But it is only a slightly lower rate than Cambodia where the percentage is 12.1. Compare this to the rates in Malaysia, who sit atop of the overweight rates in SEA, with 44.2 per cent, and Thailand at 32.2 per cent.
Relative to these numbers, the Kingdom looks like it is doing okay, but again there needs to be more general education, “Khmer don’t understand that being slim is healthy, often they want the status of being big, showing they have money”.
The relatively low rate of obesity is no reason to be complacent.
The rapidly growing rates of obesity in Thailand have been fuelled by many of the same factors that Cambodia will face in coming years. Factors such as economic development, increased access to processed foods, and a growing preference for highly sugared drinks, when once water, or coconut juice were the only options. Increasingly we are seeing the proliferation of the US style fast food outlets as the Kingdom continues to develop.
Where once agriculture and physical work was the norm, we now have tall office blocks and large car parks.
“We are still in the stage of development, so we welcome foreign companies, there is a lot of money involved, it still comes down to education.”
As our diets change, it is important to remember that the only proven way to maintain physical health is to engage in physical activity and exercise.
But herein lies the problem, where do Cambodians exercise? There are very few open spaces for physical exercise and what few spaces there are are often crowded and may have motorbikes driving through and street sellers hawking their wares.
Why are there no public outdoor spaces? Dr Scott explained, “To be blunt, it is about the price of land, land is so valuable. Having a space to exercise is not a consideration”. How then do we avoid this issue and facilitate spaces for the general public to exercise? One solution is to mandate the creation of public spaces by developers, “They ought to, when they make contracts with state developers, they should allocate some space for exercise”.
Without plans such as this, public spaces may disappear leaving the Kingdom’s population with very few outdoor exercise options. “To have your own private exercise room is partly about status, it is not practical for most Cambodians.”
Another issue that plays a significant role in the health and nutrition of the Kingdoms’ populace is money, “Whether you’re talking about health or law, without money, without resources, you get nowhere”.
Given that the average wage in Cambodia is still quite low, this poses a potential problem for future generations of Cambodians. Again Dr Scott points out that, “If the general population are educated, they can make the right choice”. Education works, with or without money.
Even with the barriers that stand in the way of a healthy lifestyle in Cambodia, there are still ways to maintain your health in a changing social climate, if you are trying to figure out how to exercise, Dr Scott’s advice is to begin by walking. “I think the easiest [form of exercise] is walking, if you walk for thirty minutes every day, it does give you protection against many diseases, and it will make you feel better psychologically.”
Dr Scott advises against exercising in heavy traffic, due to the potential pollutants, “You don’t want to be stuck in traffic, if the traffic is moving, you will minimize pollution.”
Increased nutritional education will help curb the growth of NCDs, but with obesity in Cambodia on a steady incline, time is of the essence.