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Commentary: Globalization and the epidemiology of obesity

Commentary: Globalization and the epidemiology of obesity The biomedical roots of epidemiology lead most epidemiologists to examine individuals as units of analysis, typically in one population and one place, and to interpret their findings using physiological explanations. However, comparative epidemiology is increasingly contrasting the prevalence and patterns of various conditions in different places, and social epidemiology is employing social science interpretations of research findings. Like many other fields, epidemiologists are paying close attention to the rise in the prevalence of obesity in all parts of the world in what has been labelled the ‘obesity epidemic’.1,2 Much epidemiological research has examined high levels of adult obesity, and now more analysts are studying children's body weights to seek the precursors of overweight adults and examine future adult cohorts. Research by Wang3 in this issue of the International Journal of Epidemiology advances current knowledge about obesity in children by applying standardized consensus-based measures of body weight to relatively recent cross-sectional samples in three large nations: China, Russia, and the US. Comparative cross-national research designs4 may provide useful insights about processes involved in the changing prevalence of health conditions such as body weight. Wang3 found obesity and overweight were relatively common in US children while underweight was rare, the reverse was true of China, and Russia stood between the other two nations. Wang3 also identified important variations in overweight and underweight by socioeconomic status and rural-urban residence, which suggested additional complexities in the processes underlying body weight differences between the three nations. Wang's3 research opens the door for epidemiologists to incorporate the concept of globalization into the field. Cross-national data can be interpreted in several ways, including as evidence of globalization.4 Epidemiologists have typically considered national differences in health and illness as site-specific cases or as examples of a progressive modernization process that nations proceed through at different rates. Rather than considering each nation as a separate unit of analysis, however, an alternative is to consider the world as a global unit where overarching institutions and processes operate. Such global thinking has emerged as an important framework in the social sciences,5 and it would be fruitful for epidemiologists to incorporate globalization into their conceptualizations and analyses. Little global thinking is currently evident in epidemiology, with some exceptions in considering globalism in occupational health, infectious disease, and nutrition.6 Globalization is the process of worldwide integration and unification of previously local, national, and regional phenomena into global units. Globalization involves more than internationalization or cross-national, cross-cultural, or cross-population linkages. Achievement of globality makes nations components of a common global whole rather than separate units of analysis to be compared independently. Global governments, global corporations, global media, global food systems, and global diseases become the new units of analysis rather than separate national, local, or individual cases. To the extent that obesity represents a worldwide epidemic, it constitutes a global pandemic rather than a set of independent occurrences in various nations. The crucial point in thinking about globality is that global conditions have underlying global causes and also require global interventions. Global increases in the incidence and prevalence of obesity are grounded in the globalization of Western post-industrial food systems and consumer culture that has increasingly penetrated all societies of the world.5,7 Understanding the global epidemiology of obesity requires analysis of the global institutions that modify caloric intake and energy expenditure. Global corporations are establishing industrialized agro-food systems in almost all nations that will provide constant 24 hours a day/ 7 days a week/365 days a year consumer access to virtually unlimited volumes of relatively inexpensive calorifically dense foods to all people in all places at all times through supermarket, catering, vending, takeout, home delivered, drive through, and fast/snack foods.8,9 Other global processes provide increasingly universal and relatively inexpensive transportation, communication, and other activity-sparing systems through automobiles, television, and energy-saving components of the built environment that minimize physical activity levels for a growing proportion of people worldwide.8,9 Global food systems and global vehicles, appliances, and mass media are the underlying causes of increases in global obesity.6,9 To fully understand the globalization of obesity, epidemiologists need to move beyond biology and beyond behaviours to examine collective social, economic, and political structures and cultural changes rather than focusing only on individual physiology and personal characteristics. Global values, corporations, and politics transform the material conditions of life so that children and adults eat more and are less active, leading to global increases in obesity. Including questions on national surveys that ask about processed food consumption and television viewing can provide insights into the underlying processes in the globalization of obesity better than additional batteries of standard demographic and health questions. Investigation of globalization may also employ multi-level contextual analyses, examining neighbourhood or national fast food franchises and obesity levels or analysing television access in communities and mean body weights. Some nations such as the US are almost completely globalized in their food and activity patterns for all social strata. Other countries like Russia and China are currently less than fully globalized, where higher socioeconomic status individuals have become incorporated into global systems and are becoming obese while lower socioeconomic status individuals remain localized and experience undernutrition. Rural-urban differences in obesity are small in the US,3,10 where globalization approaches universal penetration, while they remain large in countries such as China and Russia where rural locations have not been as completely drawn in to global systems. Children and adolescents tend to participate in global culture more quickly than their parents, and therefore young cohorts bear watching for their involvement in global institutions that will shape their eating and activity levels and consequently their body weights. The biomedical basis of epidemiology has led the field to focus on comparisons of individuals and populations, rather than units more appropriate to analysis of globalization such as markets or cultures. The usefulness of epidemiological data is contingent upon providing information about appropriate units. Obesity interventions sometimes include local and national policy changes,2,6 but global rather than community and federal public health measures are needed to adequately deal with the globalization of obesity. Division of Nutritional Sciences, Cornell University, Martha Van Rensselaer Hall, Ithaca, NY 14853-4401, USA. References 1 Hill JO, Peters JC. Environmental contributions to the obesity epidemic. Science 1998 ; 280 : 1371 –84. 2 Nestle M, Jacobson MF. Halting the obesity epidemic: a public health policy approach. Public Health Rep 2000 ; 115 : 12 –24. 3 Wang Y. Cross-national comparison of childhood obesity: the epidemic and the relationship between obesity and socioeconomic status. Int J Epidemiology 2001 ; 30 : 1143 –50. 4 Sobal J. Cultural comparison research designs in food, eating, and nutrition. Food Quality and Preference 1998 ; 9 : 385 –92. 5 McMichael P. Development and Social Change: A Global Perspective. 2nd Edn. Thousand Oaks, CA: Pine Forge Press, 2000. 6 Zimmet P. Globalization, coca-colonization and the chronic disease epidemic: can the doomsday scenario be averted? J Intern Med 2000 ; 247 : 301 –10. 7 Sobal J. Food system globalization, eating transformations, and nutrition transitions. In: Grew R (ed.). Food in Global History. Boulder, CO: Westview, 1999, pp.171–93. 8 French SA, Story M, Jeffery RW. Environmental influences on eating and physical activity. Annu Rev Public Health 2001 ; 22 : 309 –35. 9 Sobal J. Social and cultural influences on obesity. In: Bjorntorp P (ed.). International Textbook of Obesity. New York: John Wiley and Sons, 2001, pp.305–22. 10 Sobal J, Troiano RP, Frongillo EA. Rural-urban differences in obesity. Rural Sociol 1996 ; 61 : 289 –305. © International Epidemiological Association 2001 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png International Journal of Epidemiology Oxford University Press

Commentary: Globalization and the epidemiology of obesity

International Journal of Epidemiology , Volume 30 (5) – Oct 1, 2001

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References (10)

Publisher
Oxford University Press
Copyright
© International Epidemiological Association 2001
ISSN
0300-5771
eISSN
1464-3685
DOI
10.1093/ije/30.5.1136
Publisher site
See Article on Publisher Site

Abstract

The biomedical roots of epidemiology lead most epidemiologists to examine individuals as units of analysis, typically in one population and one place, and to interpret their findings using physiological explanations. However, comparative epidemiology is increasingly contrasting the prevalence and patterns of various conditions in different places, and social epidemiology is employing social science interpretations of research findings. Like many other fields, epidemiologists are paying close attention to the rise in the prevalence of obesity in all parts of the world in what has been labelled the ‘obesity epidemic’.1,2 Much epidemiological research has examined high levels of adult obesity, and now more analysts are studying children's body weights to seek the precursors of overweight adults and examine future adult cohorts. Research by Wang3 in this issue of the International Journal of Epidemiology advances current knowledge about obesity in children by applying standardized consensus-based measures of body weight to relatively recent cross-sectional samples in three large nations: China, Russia, and the US. Comparative cross-national research designs4 may provide useful insights about processes involved in the changing prevalence of health conditions such as body weight. Wang3 found obesity and overweight were relatively common in US children while underweight was rare, the reverse was true of China, and Russia stood between the other two nations. Wang3 also identified important variations in overweight and underweight by socioeconomic status and rural-urban residence, which suggested additional complexities in the processes underlying body weight differences between the three nations. Wang's3 research opens the door for epidemiologists to incorporate the concept of globalization into the field. Cross-national data can be interpreted in several ways, including as evidence of globalization.4 Epidemiologists have typically considered national differences in health and illness as site-specific cases or as examples of a progressive modernization process that nations proceed through at different rates. Rather than considering each nation as a separate unit of analysis, however, an alternative is to consider the world as a global unit where overarching institutions and processes operate. Such global thinking has emerged as an important framework in the social sciences,5 and it would be fruitful for epidemiologists to incorporate globalization into their conceptualizations and analyses. Little global thinking is currently evident in epidemiology, with some exceptions in considering globalism in occupational health, infectious disease, and nutrition.6 Globalization is the process of worldwide integration and unification of previously local, national, and regional phenomena into global units. Globalization involves more than internationalization or cross-national, cross-cultural, or cross-population linkages. Achievement of globality makes nations components of a common global whole rather than separate units of analysis to be compared independently. Global governments, global corporations, global media, global food systems, and global diseases become the new units of analysis rather than separate national, local, or individual cases. To the extent that obesity represents a worldwide epidemic, it constitutes a global pandemic rather than a set of independent occurrences in various nations. The crucial point in thinking about globality is that global conditions have underlying global causes and also require global interventions. Global increases in the incidence and prevalence of obesity are grounded in the globalization of Western post-industrial food systems and consumer culture that has increasingly penetrated all societies of the world.5,7 Understanding the global epidemiology of obesity requires analysis of the global institutions that modify caloric intake and energy expenditure. Global corporations are establishing industrialized agro-food systems in almost all nations that will provide constant 24 hours a day/ 7 days a week/365 days a year consumer access to virtually unlimited volumes of relatively inexpensive calorifically dense foods to all people in all places at all times through supermarket, catering, vending, takeout, home delivered, drive through, and fast/snack foods.8,9 Other global processes provide increasingly universal and relatively inexpensive transportation, communication, and other activity-sparing systems through automobiles, television, and energy-saving components of the built environment that minimize physical activity levels for a growing proportion of people worldwide.8,9 Global food systems and global vehicles, appliances, and mass media are the underlying causes of increases in global obesity.6,9 To fully understand the globalization of obesity, epidemiologists need to move beyond biology and beyond behaviours to examine collective social, economic, and political structures and cultural changes rather than focusing only on individual physiology and personal characteristics. Global values, corporations, and politics transform the material conditions of life so that children and adults eat more and are less active, leading to global increases in obesity. Including questions on national surveys that ask about processed food consumption and television viewing can provide insights into the underlying processes in the globalization of obesity better than additional batteries of standard demographic and health questions. Investigation of globalization may also employ multi-level contextual analyses, examining neighbourhood or national fast food franchises and obesity levels or analysing television access in communities and mean body weights. Some nations such as the US are almost completely globalized in their food and activity patterns for all social strata. Other countries like Russia and China are currently less than fully globalized, where higher socioeconomic status individuals have become incorporated into global systems and are becoming obese while lower socioeconomic status individuals remain localized and experience undernutrition. Rural-urban differences in obesity are small in the US,3,10 where globalization approaches universal penetration, while they remain large in countries such as China and Russia where rural locations have not been as completely drawn in to global systems. Children and adolescents tend to participate in global culture more quickly than their parents, and therefore young cohorts bear watching for their involvement in global institutions that will shape their eating and activity levels and consequently their body weights. The biomedical basis of epidemiology has led the field to focus on comparisons of individuals and populations, rather than units more appropriate to analysis of globalization such as markets or cultures. The usefulness of epidemiological data is contingent upon providing information about appropriate units. Obesity interventions sometimes include local and national policy changes,2,6 but global rather than community and federal public health measures are needed to adequately deal with the globalization of obesity. Division of Nutritional Sciences, Cornell University, Martha Van Rensselaer Hall, Ithaca, NY 14853-4401, USA. References 1 Hill JO, Peters JC. Environmental contributions to the obesity epidemic. Science 1998 ; 280 : 1371 –84. 2 Nestle M, Jacobson MF. Halting the obesity epidemic: a public health policy approach. Public Health Rep 2000 ; 115 : 12 –24. 3 Wang Y. Cross-national comparison of childhood obesity: the epidemic and the relationship between obesity and socioeconomic status. Int J Epidemiology 2001 ; 30 : 1143 –50. 4 Sobal J. Cultural comparison research designs in food, eating, and nutrition. Food Quality and Preference 1998 ; 9 : 385 –92. 5 McMichael P. Development and Social Change: A Global Perspective. 2nd Edn. Thousand Oaks, CA: Pine Forge Press, 2000. 6 Zimmet P. Globalization, coca-colonization and the chronic disease epidemic: can the doomsday scenario be averted? J Intern Med 2000 ; 247 : 301 –10. 7 Sobal J. Food system globalization, eating transformations, and nutrition transitions. In: Grew R (ed.). Food in Global History. Boulder, CO: Westview, 1999, pp.171–93. 8 French SA, Story M, Jeffery RW. Environmental influences on eating and physical activity. Annu Rev Public Health 2001 ; 22 : 309 –35. 9 Sobal J. Social and cultural influences on obesity. In: Bjorntorp P (ed.). International Textbook of Obesity. New York: John Wiley and Sons, 2001, pp.305–22. 10 Sobal J, Troiano RP, Frongillo EA. Rural-urban differences in obesity. Rural Sociol 1996 ; 61 : 289 –305. © International Epidemiological Association 2001

Journal

International Journal of EpidemiologyOxford University Press

Published: Oct 1, 2001

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