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Over the past 20 years a dramatic transition has altered the diet and health of hundreds of millions of people across the Third World. For most developing nations, obesity has emerged as a more serious health threat than hunger. In countries such as Mexico, Egypt and South Africa, more than half the adults are either overweight (possessing a body mass index, or BMI, of 25 or higher) or obese (possessing a BMI of 30 or higher). In virtually all of Latin America and much of the Middle East and North Africa, at least one out of four adults is overweight. Although undernutrition and famine remain significant problems in sub-Saharan Africa and South Asia, even desperately poor countries such as Nigeria and Uganda are wrestling with the dilemma of obesity. Worldwide, more than 1.3 billion people are overweight, whereas only about 800 million are underweight—and these statistics are diverging rapidly.
The obesity rates in many developing countries now rival those in the U.S. and other high-income nations. What is more, the shift from undernutrition to overnutrition—often called the nutrition transition—has occurred in less than a generation. When I return to villages that I visited 15 years ago in India, China, Mexico and the Philippines, I see enormous changes: kids guzzle soft drinks and watch television, adults ride mopeds instead of walking and buy their food from supermarkets. In addition to adopting more sedentary lifestyles, people in the developing world are also consuming more caloric sweeteners, vegetable oils and animal-source foods (meat, poultry, fish, eggs and dairy products). The combination of lifestyle and dietary changes has paved the way for a public health catastrophe, with obesity leading to an explosive upsurge in diabetes, heart disease and other illnesses.