Literature Review: Obesity in the West and the East.

Obesity is both an abnormal social and medical condition in which the human body accumulates excessive body fat to have an adverse effect on the human health, to lower life expectancy, to reduce the quality of life and various health problems. Obesity is simply a term that follows the term “overweight” as measured by the Body mass index (BMI), which compares weight to height. Overweight people have BMI from 25 to 30 kg/m2, while obese people have Body Mass index of 30 kg/m2 and more. Normal people have a Body-Mass index up to 25 kg/m2. Generally, obesity is caused by the inappropriate diet and unhealthy lifestyles; although in some cases genetic factors may contribute greatly to obesity in humans. Obesity is an ever-increasing problem around the world, especially in the developed and rich nations, such as the USA and Europe, where these rates continue to increase. In Japan, on the other hand, the rates are extremely low, so the problem of obesity is not as widespread as in the USA.

childhood obesity

Article #1. US obesity rates.

A study by Flegal et al (2012) examined growing obesity rates in the USA from 1999 till 2010 and determined and upward growing trend, meaning that over the past ten years of the chosen period Americans gained more and more weight.

The Purpose(s) of the study was to determine the changes of the BMI among US adults to see if there were any changes to the obesity and overweight rates in the USA. The importance of the study is in the direct relationship between the growing obesity and excessive weight in the US adults and the obesity-related diseases and disorders, such as diabetes, cardiovascular diseases and various cancers. Obesity, therefore, can be viewed as impacting the cost of medicine and healthcare, too. The study relates to the body of literature cited in the article directly since it provides an extensive informational coverage of the obesity growth rates, trends and data for the US adults over the period of 1999 till 2010. This information allows effective analysis and understating of the situation with excessive rates in the USA to determine the current problem.
The study by Flegal et al (2012) effectively covers a nation-wide pool of participants. The participants included 5926 adult men and women from a nationally representative sample of the civilian non-institutionalized US population in 2009-2010 and for 22 847 men and women in 1999-2008. Description of the interventions or measurements used involved measurements of heights and weights. The NHANES program of the National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention focused on the relationship between weight/height (BMI) and various population specific traits, such as race, ethnicity, wealth, income, etc. In this case the BMI is a dependent variable, while social status, eating habits, and race are the independent variables that affected the BMI. The study was conducted in a scientific manner. Weight and height data was measured in a mobile examination center using standardized techniques and equipment across the nation. The figures were rounded to the nearest tenth. Age, race, and other data were based on the information provided at the interview, while statistics were collected using SAS software (Flegal et al 2012).
The important statistical findings suggest that the age adjusted obesity rates were 35.5% and within the race/ethnicity groups the rate rose to 36.2% and to 38.8% among non Hispanic black men. For women the obesity rates were 35.8% among white women and up to 58.5% among black women (non Hispanic). The racial minorities, who also represent lower status citizens with smaller incomes were more likely to become obese. This is especially true for black non-Hispanic women (Flegal et al 2012). The findings of the study suggested that not only Americans over the course of ten years 1999 till 2010 became more overweight and obese, but also that this trend appears to continue into the future. Furthermore, positive correlation between obesity and poverty, lower status, and skin color were observed. Obesity and excessive body weight, although may appear as only extra physical mass, in reality involve numerous dangers. For instance, obesity and excessive weight in general is positive correlated with various chronic diseases and early death. What is more important excessive weight not only lowers the quality of life of people but also makes them abuse the healthcare, since obese and overweight people usually use healthcare services more often than people with normal weight. Excessive weight may result in diabetes, cardiovascular diseases, hypertension and things like stroke or heart attack (Flegal et al 2012). Things like osteoarthritis and various types of cancer are more likely to affect people with excessive weight. The findings are generally consistent with previous studies on obesity rates. The factors that affect obesity involve eating habits, prices, availability of food, lifestyles, access and resources and many others. Also, one should note that although the BMI effectively measures obesity, it is also important to measure how the fat is distributed around the body. The most “dangerous” is the abdominal fat, the presence of which is positively correlated with many most obesity-related health issues (Flegal et al 2012). The author’s suggestions for future research calls for additional exploration of the topic to explore the specific habits in eating, exercise and lifestyle of the minorities that contributes to the obesity rates. It appears that minorities have more unhealthy habits and less time to exercise or to afford quality low-fat, high fiber foods.

Article #2.
A study by Hawks (2003) examined a cross cultural obesity rates in the USA and Japan and focused on the role of “motivation for eating” as a potent factor in emergence of obesity. The Purpose(s) of the study is to find out the reason why obesity becomes a major problem not only in the USA but also in Japan as well as compare the eating habits of the two nations to determine their differences and their different impact on obesity trends. The study relates to the body of literature cited in the article directly by exploring the reasons or the causes of obesity as linked to excessive food consumption. On average, a Japanese consumes around 200 calories less per day than an American. On the other hand, the food prices in Japan are substantially higher than in the USA, making it more difficult even for the person with the same salary (as in the USA) to afford as much food. Japan, on average, has healthier eating habits than the USA, while the Japanese, in general, have much more active lifestyles.
A study by Hawks (2003) covers the participants and the interventions. The study was based on the 1218 participants aged 18 years attending colleges in the US and Japan. The study used the Motivation for Eating Scale (MFES) to evaluate different motivations for eating by nation and gender and to determine the differences. The interventions or measurements used in the study suggest that the researcher used the MFES scale (12 items classified into three subscales: emotional, physical and environmental eating) to evaluate the preference for eating and the motivations for overeating. Subsequently the questionnaire was used to determine motivation to lose weight, frequency of dieting, presence of previous or existing eating disorders, and frequency of exercise (Hawks 2003). The independent variables involved the motivation to eat or overeat and the motivation to lose weight, frequency of dieting, presence of previous or existing eating disorders, and frequency of exercise, while the dependent variable involved the weight of the participants and the BMI. The study was conducted in universities by using a sample of 1218 participants aged 18 years attending colleges in the US and Japan. The researchers recorded answers in a questionnaire and MFES scale (Hawks 2003).
The important statistical findings suggest that currently, the USA has the highest obesity rates in the world and Japan has one of the lowest obesity rates not only among the first world nations, but also in the world. As noted previously less than 4% of Japanese aged 16 and more have BMI of over 30. Yet, as it is the case with many other developed nations the obesity rates, slowly but surely continue to grow in Japan, too. In Japan the BMI of over 25 means that the person is obese (in the USA obesity is characterized by the BMI of over 30). With these figures in mind, more than 24 % of the Japanese aged 16 and more had BMI of over 25 (Hawks 2003). What is more important, there is an increasing number of young females (25%) in Japan who, according to the BMI measures are severely underweight (BMI <19). Unlike in the undeveloped nations where such low BMI characterizes malnutrition and poverty, in Japan miniature female figure is considered popular and stylish, hence many females pursue these trends. In the USA more than 66% have BMI of more than 25 (Hawks 2003). Furthermore, Women in the US were more likely to eat for emotional reasons, while women in Japan were more likely to eat for physical or environmental reasons. Also, the US women and men were more likely than the Japanese respondents to eat in response to watching TV or movies (Hawks 2003).
The findings of the study suggested that there are substantial differences between US and Japanese populations with regards to food consumptions. That means that Americans are likely to eat for different reasons (emotional), especially US women and that is likely to affect their weight and contribute to the growing obesity rates. The findings compare with previous studies and suggest that indeed, the eating habits directly affect the person’s age and can be one of the main reasons for growing obesity rates in the USA (Hawks 2003). What is more important, as Japanese people adopt the western culture, one can suspect that obesity rates will also grow there, when, for instance, the Japanese start to eat in response to watching TV or movies. The author’s suggestions for future research call for additional exploration of the role of culture, habits and traditions to consume foods. As it turns out that the Japanese and Americans had different culture to consume food, it is the cultural role that should be explored in the future to learn about the obesity and overweight rates
Article #3.
A study by Kanazawa et al (2002) examined obesity rates in Japan and the existing methodology to determine the obesity rates according to the BMI criteria. The purpose(s) of the study was to see how Japan scored on the BMI scale and what differences it had with other nations in the region and with the comparative figures around the world. The study relates to the body of literature cited in the article directly, as it explores the overweight and obesity rates in Japan, the culture-specific reasons for obesity and the factors that influence obesity in Japan, in addition to making prognosis for the growing obesity trends in the future (Kanazawa et al 2002).
Kanazawa et al (2002) focused on the information collected in 1997 by the WHO, when it initiated the formation of the International Obesity Task Force (IOTF). It was during the period when the Task Force proposed the cut-offs for overweight and obesity as BMI 25 and BMI 30. The nation-wide research, in which the researchers accept the criteria of BMI ≥ 30 to indicate obesity, showed that the prevalence of obesity in Japan of less than 3% has changed little during the last 40 years (Kanazawa et al 2002). The participants were the same that researched by the WHO. The interventions or measurements used in the study suggest that the researchers measured the weight and height of the participants in mobile measurement centers and recorded the information to determine the BMI. The independent variable involved eating habits, the number of calories consumed and the frequency of food consumption, and dependent variable was the BMI and the obesity-related diseases such as hypertension, heart diseases and diabetes.
The important statistical findings of Kanazawa et al (2002) suggest that people in Japan consume less food and ingest fewer calories than people in the USA. If BMI of 30 was used to show obesity than there are less than 4% of obese people in Japan (Kanazawa et al 2002). It is for this reason JASSO decided to define BMI ≥ 25 as obesity, something that shows “overweight” according to American standards. The Japanese also consume less fat than Americans. Furthermore, the food prices are much higher in Japan than in the USA, so the invisible hand of the free market economy makes the Japanese to buy less food and thus consume less food and be less likely to gain weight (Kanazawa et al 2002). Western culture and food consumption lifestyle affected the Japanese, too, so obesity rates increased four times in men and three times in women during these last 40 years (Kanazawa et al 2002). Also, just like in the USA the inactivity can be viewed as one of the reasons for growing obesity rates in Japan, even though they are still among the lowest obesity rates in the world and the lowest in the developed world (Kanazawa et al 2002).
The findings of the Kanazawa et al (2002) study suggested that the analysis of obesity and excessive weight gets down to simple physics. If the person takes more calories than she/he spends, that person will sooner or later will become obese or overweight. Thus the comparison of obesity rates between the USA and Japan is about comparing how people in these countries acquire calories (eating habits) and how these people spend calories (lifestyle, physical activity) (Kanazawa et al 2002). The person spends calories through both the metabolism and physical activity and for every 3500 calories a person consumes in excess of a daily recommended amount she/he can expect to gain around 1lb. Likewise, if the person burn 3500 calories, it means that the person will lose approximately 1 lb.
The findings compared with previous studies and show that the Japanese have special diet culture that encourages consumption of fish, vegetables and rice, the very foods that can help to lose weight or to eat healthy in the first place. On average the Japanese males consume 2140 calories per day and Japanese females consume only 1750 calories per day, which makes the national average of 1900 calories per day only. It is the Japanese specific culture, habits and food traditions that reflect such low obesity rates (Kanazawa et al 2002).
The author’s suggestions for future research calls for additional exploration of the role of physical activity, since not only changing food consumption preferences but also the growing inactivity of the Japanese contribute to the changing and growing obesity rates (Kanazawa et al 2002).

Article #4.
A study by James et al (2012) examined the topic of obesity on a global scale to determine what was called to be “epidemic” proportions of obese people worldwide. Nowadays, the number of overweight and obese people in the world is greater than the number of people who are chronically hungry and do not have access to food. Yet, obesity, just like malnutrition is unhealthy and it involves tremendous social, medical and psychological costs. It noted that in Asia the obesity as measured by the BMI is lowered to 25 (as opposed to 30 in the USA) because of the high prevalence of co morbidities, particularly diabetes and hypertension associated already with the BMI of 25.
The purpose(s) of the study is to assess the obesity rates worldwide as well as obesity prevalence in some countries around the world. Furthermore, the researchers make an effective attempt to find the reasons and the causes of obesity, i.e. what forces people to consciously engage in overeating and inactivity, thus gaining extra weight and get obesity-related problems. The reason why obesity was called “epidemic” is because of the health dangers of obesity. The study relates to the body of literature cited in the article directly by exploring how obesity rates increase each decade and how obesity grows together with the cultural western habits linked to overeating and inactivity (James et al 2012).
The study by James et al (2012) is based on the WHO report on obesity conducted in over 191 countries around the world. The participants involved in the study represent the national averages for the selected 191 nations. The interventions or measurements used in the study by James et al (2012) focus on the collection of weight/height/BMI data for various nations, as well as prevalence of the associated diseases. What is more important the study by James et al (2012) also focused on child obesity, another important problem that previously was ignored by most researchers, who focused on only adult obesity. Nevertheless, obese children are more likely to grow into overweight or obese adults, unless they change their activity and eating habits. The independent variables involved food consumption, calorie intake, the amount of physical activity and exercise (James et al 2012). The dependent variables represented the BMI rates (obesity) and the obesity-related disorders and illnesses for both adults and children groups. The study was conducted by the WHO and related organizations, and subsequently analyzed, and summarized by James et al (2012). It is a meta-study of the obesity and related co-morbidities (James et al 2012).
The important statistical findings of James et al (2012) show that in most countries, women show a greater BMI distribution with higher obesity rates than do men. Furthermore, obesity is usually now associated with poverty, even in developing countries (James et al 2012). That further shows that racial, ethnic and other minorities usually are more likely to become overweight and obese (James et al 2012). What is more important, recently Asian researchers proposed an alternative classification system of obesity, because of the high prevalence of diabetes and hypertension at very modest increases in BMI. They suggest the upper limit after which health problem starts to be 22.9 BMI (upper limit), so a BMI cutoff point of 25 kg/m2 already shows obesity (James et al 2012). Furthermore, obesity rates were measured among children to show that social status of the family is directly responsible for childhood obesity.
The findings of the study suggested that high obesity rates in the first world nations, like the USA can be explained by decreasing cost of food and the availability of high-calorie foods, rich in fats. The price of food did decline overtime because of the technological innovations, and improvements that increased efficiency and effectiveness of agriculture, food processing and food distribution (James et al 2012). Likewise, the growing cost of physical activity further contributes to obesity since people start to walk and engage in physical activity more rarely than in the past .The same technology is responsible for less physical activity, as it virtually eliminated the need for it. It is always better and easier to get anywhere by car. Therefore, physical activity, or enough of physical activity, nowadays requires conscious commitment to it. Conscious commitment to exercise requires people in the first world nations to find that extra hour or more to do that exercise, to dedicate one’s time, which in many cases also has some monetary value. It partially explains why low income families and minorities are likely to become obese. Indeed, unlike the middle and upper class people, who can find an extra hour for exercise, low status families spend that time on work to get more money. In addition to unhealthy habits of consuming foods rich in fats and sugars, they tend to exercise less (James et al 2012). The findings compared with previous studies and suggest that obesity is a growing problem in the first world nations because of the falling costs of food and the availability of technology that allows people to remain inactive and thus gain weight. The author’s suggestions for future research calls for further analysis of the important cultural and family habits with respect to food consumption, and exercises, the role that food and exercise plays in the family and the importance of the mass media that can not only form the habit of accepting obesity and excessive weight as a normal part of life, but also to propagate unhealthy eating habits.

Article #5.
A study by Zhou et al (2003) examined nutrient intakes of middle-aged men and women in China, Japan, United Kingdom, and United States in the late 1990s in a comprehensive INTERMAP Study to draw comparisons between the chosen nations and to determine the growing problem with obesity-related illnesses. The purpose of the study is to “compare nutrient intakes among Chinese, Japanese, UK, and US INTERMAP samples, and assess possible relationships of dietary patterns to differential patterns of cardiovascular diseases between East Asian and Western countries” (Zhou et al 2003). In other words, the researchers wanted to find out how dietary habits and patterns related to obesity rates in the UK, Japan, US, and China. The study relates to the body of literature cited in the article directly by providing additional important information on the causes of obesity in the chosen 4 nations as well as the explanation as to why obesity rates continue to grow (Zhou et al 2003).
A study by Zhou et al (2003) explored INTERMAP samples of Chinese, Japanese, US and UK populations. China provided three samples, Japan provided four samples, UK provided two samples, and USA provided eight samples. The number of participants was 260 men and women aged 40–59 years per every sample to make a total of 4680 (Zhou et al 2003). The participants were selected haphazardly for each sample to make the study scientifically valid. The interventions or measurements used in the study involved thorough assessment of the existing food pyramids, food preferences and even specific products consumed by the 4 nations and put into a 76 nutrient database. The independent variables were the food preferences, different types of foods consumed, amounts of foods consumed, calorie intake, and frequency of use. The dependent variables involved the BMI rates (obesity/overweight) and the associated problems related to obesity found in the chosen 4 nations (UK, US, China and Japan). The study was conducted under the aegis of the INTERMAP Research Group that conducted research in these chosen destinations. The use of questionnaires, and interviews helped researchers collect the necessary data (Zhou et al 2003).
The important statistical findings by Zhou et al (2003) show that the average body mass index was higher in Western nations than in Eastern nations. The nutrient intake also differed substantially across samples. For instance western diet had more fat, more saturated fats, more trans fatty acids, high in sugars and lower in total carbohydrates and starches. It also means that western diet included more serum total cholesterol and higher rates of cardiovascular diseases, as well as greater mortality rates from cardiovascular diseases (Zhou et al 2003). Eastern diet was lower in protein, especially animal protein, as well as lower in calcium, selenium, phosphorus, and vitamin A. the Na/K ratio was higher in Asia/Eastern samples than in Western samples because of higher sodium and lower potassium intakes. This shows remarkable differences in vitamins, fibers, minerals and other important microelements that characterize eastern and western foods and diets and their relevance to not only obesity but also to cardiovascular and other diseases (Zhou et al 2003).
The findings of the study suggested that the traditional Japanese or Asian diet is another important reason why the Japanese consumer fewer calories and therefore are less likely to be obese, unlike the Americans and Westerners in general. The traditional Japanese diet with the focus on fish, rice and vegetables keeps people thin and healthy in comparison to other nations, including the USA. The food pyramid in Japan is similar to the food pyramid in the Mediterranean diet habits (Zhou et al 2003). Both pyramids focus on grains, abundance is vegetables, fish and fruits. On the other hand, they greatly limit meats, animal fats and sweets. Furthermore, the Japanese, for instance, give a lot of attention to the aesthetics and how the food is served and presented, not only how it is cooked. The food does not only have to taste good, it has to have the right shape, texture, temperature, color, visual appeal and other characteristics. This certainly entails higher food prices and as a result, less consumption of foods. These findings compare with previous studies and corroborate the notion that western and eastern cultures, traditions and customs affect the food preferences and habits, which in turn result not only in different amounts of foods consumed, but also in different foods preferred. Eastern diets focus more on rice, fish and vegetables, while western diets focus more on animal protein, fats and sweets (Zhou et al 2003). Also western diets result in greater food consumption than eastern diets, thus stipulate higher calorie intake. The author’s suggestions for future research call for additional exploration of the importance of exercise that is also responsible for the high obesity rates as well as for the exploration of the role western mass media has in building western diets in the east and thus contributing to the growing obesity rates in the East (Zhou et al 2003).

CDC, (2005). Obesity, Department of Health and Human Services,
Flegal, K, Carroll, M, Kit B, Ogden, C, (2012) Prevalence of Obesity and Trends in the Distribution of Body Mass Index Among US Adults, 1999-2010, JAMA, Vol 307, No. 5
Hawks, S. Madanat, H., Merrill, R, Goudy, M, Miyagawa, T. (2003). A cross-cultural analysis of ‘motivation for eating’ as a potential factor in the emergence of global obesity: Japan and the United States, Health Promot. Int. 18 (2):153-162.
James P., Leach R., Kalamara E., and Shayeghi M., (2012). The Worldwide Obesity Epidemic, Obesity research magazine, Volume 9, Issue S11.
Kanazawa M., Yoshiike N, Osaka T., (2002). Criteria and classification of obesity in Japan and Asia-Oceania, Asia Pacific Journal of Clinical Nutrition, Volume 11, Issue Supplement pages S732–S737.
Zhou B., Stamler J., Dennis B., Moag-Stahlberg A., Okuda N., Robertson C.,(2003). Nutrient intakes of middle-aged men and women in China, Japan, United Kingdom, and United States in the late 1990s: The INTERMAP Study, Journal of Human Hypertension, 17, 623–630. doi:10.1038/sj.jhh.1001605

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