A PARTICULAR concern is the increasing number of young children developing diabetes, of the type that — again — used to be seen only among adults. Diabetes is a life-threatening condition where the production of insulin by the pancreas is either deficient or ineffective, resulting in increased concentrations of glucose in the blood, which in turn damages many of the body’s systems, in particular the blood vessels and nerves. Diabetes accounts for some 3.2 million deaths worldwide every year. Two-thirds of all diabetes cases are directly caused by obesity. Dr Gauden Galea, WHO’s adviser on chronic diseases for Asia-Pacific, says, “The link is so intimate and is even stronger than the link between smoking and lung cancer.”

	Fast-food restaurants offer cheap, tasty and convenient — but also unhealthy — meals.

This increase in “diabesity,” is something Chan-Cua knows only too well. She says she has many adolescent patients who are obese and who have diabetes. “They’re around 12, 13, they do not even know that they have diabetes because they can get by,” she says. That is, until a simple wound festers and their parents start to worry and take them to seek medical help.

But seeing the doctor is only the first step in treating chronic diseases such as diabetes. At the minimum, says Chan-Cua, diabetic patients would need lifestyle changes including shifting to a healthy diet and keeping it and doing more regular physical exercise. Others might need to undergo medication upon diagnosis, and for some, for longer periods of time.

Chan-Cua says, though, that some patients eventually stop coming way before their treatment is completed because, she says, “they are limited by lack of time and money.” These are middle-income families she is speaking about. Given that access to medical attention is severely limited by financial resources, the problem may actually even be bigger than many of us are willing to believe.

By most accounts, the majority of those who consult specialists belong to the middle- and upper-income families. A poor family earning the minimum wage would be hard pressed coming up with the money for even just the weekly consultations. For those who would have to undergo a supervised weight management program, for instance, a minimum dozen weekly sessions with a professional nutritionist costs over P10,000. The total goes even higher once one adds the cost of medication.

But WHO warns that overweight and obesity may already be seeping into poorer families. “This is all hypothesis at this stage,” says Galea,”“but overweight is probably going deeper into the population where people do not have the funds to be able to buy foods that are healthier.” Thus, there have been accounts of what has been called “the bloating of the poor” in Asia, as ever-falling incomes lead poor families to buy more of mass-produced foods that are cheap and filling but very nutrient-poor, and less of low-energy dense foods such as fruits, vegetables and whole grain cereals that are more expensive. A recent study in the International Journal of Obesity also found that in developing countries, the burden of obesity shifts from the relatively well-off to the poor as per-capita income rises.

DESPITE THE numerous data from both government and the health industry, these have not been enough for anyone to map the prevalence of overweight and obesity in the country and, in turn, the associated health risks. The Food and Nutrition Research Institute (FNRI), for one, regularly churns out nutrition surveys that are regarded as a “beacon” by international experts such as WHO’s Galea, who says these “give us a valid and scientifically credible figure behind policy.” But for Dr Cecilia Florencio, nutrition scholar and University of the Philippines professor, too much remains unknown. “Which Filipinos are we talking about?” she asks, referring to figures pointing to increasing overweight. “We haven’t even mapped out where overweight is, where there is more of, less of, where it is rising faster, not rising so fast and so on.”

Knowing these characteristics, Florencio says, will allow the formulation of the appropriate response. Right now, the official response has been to trumpet the need for a healthy lifestyle, the main components of which are to stop smoking, do regular exercise, and have a healthy diet. From this perspective, the point of having a healthy diet is to consume enough of the nutrients needed by the body to function properly, including drinking a lot of water and eating more fruits and vegetables.

But Florencio warns that it would be naive to think that teaching nutritive values would make the problem of poor eating habits go away. After all, she says, food is not just about nutrients: “Food is a source of contentment, of pride, success, of regularity of one’s life.”

Dr. Catherine Castańeda agrees, noting that what makes people decide if they will eat a particular food is mainly whether it’s tasty and affordable. A nutrition anthropologist, she says, “We don’t go to the market to get food because it’s high in, say vitamin A.”

“People won’t even look at nutritive labels unless they’re at the age where they might get these lifestyle diseases then they start to look,” she says. Which, she adds, makes it even more important to start educating children at a young age.

Today’s Filipino children, however, are learning a rather different lesson, courtesy of aggressive marketing by the fast-food industry: that fast food is modern and hip. It’s a message that parents have heeded as well, although they also appreciate that fast food products are affordable, tasty, and convenient. Many parents thus often reward a child for having high grades with a trip to Jollibee. Florencio remarks,’“But how many would say, ‘pag mahusay ka igagawa kita ng suman (if you do well, I’m going to make you a sticky-rice roll)’?”

Fast-food goodies, however, are not always the prime suspects in the blimping of populations. WHO’s Galea cites the case of Vietnam, where traditional local cuisine still reigns. He says local dishes such as the popular chicken noodles served on the streets now contain more cholesterol: “It has more fat in it therefore more tasty, but also more dangerous.” In addition, more and more Vietnamese are now getting less exercise after abandoning their bicycles in favor of motorcycles. As a result, Vietnam is seeing increased obesity and its associated diseases such as diabetes, the rates of which have doubled between 1993 and 2003. 

The Philippine food landscape, though, is clearly influenced by the fast-food industry. Dr. Chan-Cua’s own daughter also fell under the spell of Jollibee, chasing after the toys the local fast-food chain offered. But the doctor put her foot down and made sure her child would not get used to eating too much fast food. She also made her daughter eat vegetables,’“even just one piece,” the habit of which her daughter has grown into.

Experts say parents need to remain firm and teach their children to appreciate “proper” food. Still, getting a child to eat less junk and more nutritious food can be tricky. Jay Vincent Guevarra’s parents, for example, have just about given up trying to make him eat the family’s home-cooked meals. Instead, his father Jun brings home either Chickenjoy from Jollibee or spaghetti from McDonald’s for him almost every day. The 12-year-old says he likes these because they are’“delicious.”

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