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Wealthy but Unhealthy: Overweight and Obesity in Asia and the Pacific: Trends, Costs, and Policies for Better Health

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Wealthy but Unhealthy: Overweight and Obesity in Asia and the Pacific: Trends, Costs, and Policies for Better Health WEALTHY BUT UNHEALTHY Overweight and Obesity in Asia and the Pacific: Trends, Costs, and Policies for Better Health Edited by Matthias Helble and Azusa Sato ASIAN DEVELOPMENT BANK INSTITUTE Wealthy but Unhealthy Overweight and Obesity in Asia and the Pacific: Trends, Costs, and Policies for Better Health Edited by Matthias Helble and Azusa Sato ASIAN DEVELOPMENT BANK INSTITUTE © 2018 Asian Development Bank Institute All rights reserved. First printed in 2018. ISBN 978-4-89974-085-8 (Print) ISBN 978-4-89974-086-5 (PDF) The views in this publication do not necessarily reflect the views and policies of the Asian Development Bank Institute (ADBI), its Advisory Council, ADB’s Board or Governors, or the governments of ADB members. ADBI does not guarantee the accuracy of the data included in this publication and accepts no responsibility for any consequence of their use. ADBI uses proper ADB member names and abbreviations throughout and any variation or inaccuracy, including in citations and references, should be read as referring to the correct name. By making any designation of or reference to a particular territory or geographic area, or by using the term “recognize,” “country,” or other geographical names in this publication, ADBI does not intend to make any judgments as to the legal or other status of any territory or area. Users are restricted from reselling, redistributing, or creating derivative works without the express, written consent of ADBI. ADB recognizes “China” as the People’s Republic of China. Note: In this publication, “$” refers to US dollars. Asian Development Bank Institute Kasumigaseki Building 8F 3-2-5, Kasumigaseki, Chiyoda-ku Tokyo 100-6008, Japan www.adbi.org Contents Figures, Tables, and Boxes v Contributors ix Abbreviations xi Acknowledgments xiii Introduction 1 Matthias Helble and Azusa Sato PART I: Obesity and Overweight Trends in Asia and the Pacific 1. The Nutrition Transition and the Intra-Household Double Burden of Malnutrition in India 15 Archana Dang and J. V. Meenakshi 2. The Obesity Pandemic in the Pacific 46 Jillian Wate 3. Economic Influences on Child Growth Status, from the Children’s Healthy Living Program in the US-Affiliated Pacific Region 62 Rachel Novotny, Fenfang Li, Lynne Wilkens, Marie Fialkowski, Travis Fleming, Patricia Coleman, Rachel Leon Guerrero, Andrea Bersamin, and Jonathan Deenik 4. Socioeconomic Inequality in Excessive Weight: The Case of Indonesia 85 Toshiaki Aizawa and Matthias Helble PART II: Cost and Policy Implications of Obesity and Overweight 5. Economic Impact of Obesity in the Republic of Korea 107 Wankyo Chung 6. Obesity in Thailand and its Economic Cost 133 Yot Teerawattananon and Alia Luz 7. Health and Economic Burden of Overweight and Obesity in Indonesia 156 Soewarta Kosen iii iv Contents 8. The Imminent Obesity Crisis in Asia and the Pacific: First Cost Estimates 171 Matthias Helble and Kris Francisco 9. Effectiveness of Obesity Prevention and Control 193 Montarat Thavorncharoensap Index 224 Figures, Tables, and Boxes Figures 1.1A Percent of Adult Women Overweight/Obese, by State, Overall 20 1.1B Percent of Adult Women Overweight/Obese, by State, Rural 20 1.2A Percent of Adult Women Obese, by State, Overall 21 1.2B Percent of Adult Women Obese, by State, Rural 22 1.3 Changes in the Probability Density Function of Body Mass Index of Adult Women, 2005–2006 to 2012–2013, by Age Group 23 2.1 Variations in Obesity Prevalence in Adult Women in Selected Countries (2016) 47 2.2 Overweight Prevalence in Adults (Aged 25–64 Years) by Sex 48 2.3 Obesity Prevalence in Adults (Aged 25–64 Years) by Sex 49 2.4 Obesity in Adolescents, Selected United States-Affiliated Pacific Islands 51 3.1 Child Obesity by Age in the Children’s Healthy Living Program 66 3.2 Obesity Prevalence (%) by United States-Affiliated Pacific Jurisdiction in the Children’s Healthy Living Program 67 3.3 Prevalence of Obesity, Stunting at Birth, and Current Stunting by Jurisdiction Income Level in the Children’s Healthy Living Program 67 3.4 Prevalence (%) of Acanthosis Nigricans in the Children’s Healthy Living Program, United States-Affiliated Pacific 68 3.5 Prevalence of Food Insecurity, Obesity, and Underweight Overall, and by Sex and Age Group in the Children’s Healthy Living Program 69 3.6 Food Security, Underweight, and Obesity Prevalence in the Children’s Healthy Living Program 70 3.7 Food Insecurity, Obesity, and Underweight by Pacific Race/Ethnicity Categories in the Children’s Healthy Living Program 71 4.1 Prevalence Rate of Overweight and Obesity, 1993–2014 (%) 88 4.2 Empirical Cumulative Distribution Function of Body Mass Index for Men 88 4.3 Empirical Cumulative Distribution Function of Body Mass Index for Women 89 v vi Figures, Tables, and Boxes 4.4 Prevalence Rate of Overweight and Obesity across Different Wealth Groups in 1993, 1997, 2000, 2007, and 2014 90 4.5 The Concentration Curve for Overweight and Obesity 96 4.6 The Concentration Curve for Excess Weight for Men and Women 97 5.1 Distribution of Infant (30–71 Months) Obesity across Income, 2015 109 5.2 Trends of Adult Obesity, 1998–2014 111 5.3 Trends of Young Adult Obesity, 1998–2014 111 5.4 Density of Adult Obesity, 2009–2013 114 5.5 Distribution of Adult Obesity across Income, 2009–2013 114 6.1 Obesity Prevalence, Gross Domestic Product per Capita, and Percentage of Urban Population in Thailand, 1991–2014 134 6.2 Estimated Obesity Attributable Fraction in Selected Diseases in Thailand 140 6.3 Economic Cost of Obesity in Thailand by Gender, Disease Category, and Cost Component 142 6.4 Historical Development of National Policies or Activities Addressing Obesity in Thailand 147 9.1 Sugar Consumption Per Capita in the World and Selected Countries 194 Tables Prevalence of Overweight and Obesity in Asia and the Pacific (% of population) 5 1.1 Adults with Random Blood Sugar Levels Greater than 140 mg/dl, Rural Areas, by State and Gender, 2012–2013 (%) 24 1.2 Adults with Blood Pressure Greater than 140/90 mmHg, Rural Areas, by State and Gender, 2012–2013 (%) 25 1.3 Cross-Tabulation of Households by Child and Mother’s Anthropometric Outcomes, by Region of Residence, 2004–05 and 2011–12 (% of households) 26 1.4 Cross-Tabulation of Households by Child and Mother’s Anthropometric Outcomes, by Region of Residence in Richer States, 2004–05 and 2011–12 (% of households) 27 1.5 Odds Ratios for Covariates from a Logit Regression of the Probability of an Underweight Child and Overweight Mother Household, Alternative Specifications 32 1.6 Relative Risk Ratio for Covariates from a Multinomial Logit Regression of the Probability that a Household has an Underweight Child and Overweight Mother, Underweight Child and Non-Overweight Mother, or Non-Underweight Child and Overweight Mother pair (relative to Non- Underweight Child and non-Overweight Mother) 36 Figures, Tables, and Boxes vii 1.7 Relative Risk Ratio for Covariates from a Multinomial Logit Regression of the Probability that a Household has an Underweight Child and Overweight Mother, Underweight Child and Non-Overweight Mother, or Non-Underweight Child and Overweight Mother Pair (relative to Non- Underweight Child and non-Overweight Mother), Alternate Specification 38 2.1 Prevalence of Overweight and Obesity in Adolescents 50 2.2 Percentage of Children under Five Years Classified as Underweight, Stunted, and Obese According to Anthropometric Measures 52 2.3 Examples of Sugar-sweetened Beverage Taxation in the Pacific Region 56 3.1 Core Model of Food Insecurity and Risk of Obesity in the Children’s Healthy Living Program 72 3.2 Core Model (Table 3.1) and Risk of Obesity Plus Jurisdiction Income Level, Household Income Level, and Education of Caregiver 73 A3.1 Race/Ethnicity of Child Participants (2–8 Years) in the Children’s Healthy Living Program According to the United States Office of Management and Budget Categories 81 A3.2 Characteristics of Child Participants with Anthropometric Measurements in the Children’s Healthy Living Program 82 A3.3 Education Level of Caregiver of the Child Participant, Children’s Healthy Living Program 83 A3.4 Annual Household Income in the United States-Affiliated Region, Adjusted for Clustering in 51 Communities and 11 Jurisdictions in the Children’s Healthy Living Program 84 4.1 Regression Analysis 94 4.2 Annual Growth Rates of the Prevalence of Overweight, Obesity, and Excess Weight across Different Wealth Quintile Groups from 1993 to 2014 (%) 97 4.3 Concentration Index 98 4.4 Achievement Index 100 4.5 Decomposition of the Concentration Index of Excess Weight in 2000 and 2014 101 5.1 Child Obesity Rate by School Level, 2009–2015 (%) 110 5.2 Adult Obesity Rate by Area, 2009–2013 (%) 116 5.3 Descriptive Statistics of Male Adults, 2009–2013 117 5.4 Descriptive Statistics of Female Adults, 2009–2013 118 5.5 Marginal Effects of Obesity on Medical Cost, 2009–2013 (2010 won) 121 5.6 Marginal Effects of Obesity at Different Percentiles of Medical Cost, 2009–2013 (2010 won) 123 viii Figures, Tables, and Boxes 5.7 Effects of Obesity on Disability (Odds Ratio from Logistic Regression), (2009–2013) 124 A5.1 Infant Obesity Rate by Premium Ventile in 2015 (%) 130 A5.2 Adult Obesity Rate, 1998–2014 (%) 131 A5.3 Young Adult Obesity Rate, 1998–2014 (%) 131 A5.4 Adult Obesity Rate by Premium Decile, 2009–2013 (%) 132 7.1 Overweight and Obesity-Related Diseases, Population- AttribuRisk, Unit Cost Per Episode, 2015 162 7.2 Number and Proportion of Deaths Attributable to Overweight and Obesity, 2016 163 7.3 Productive Years Lost Due to Diseases Attributed to Overweight and Obesity,
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