Written by Barry M. Popkin.
In the early 1980s when the Chinese first thought of creating dietary guidelines, the average Chinese individual consumed 1 gram of sugar per day. Sweet pastries and such were not to be found in China, nor were sugary beverages, convenience stores or, for that matter, any stores other than very limited dollar-type stores for elites, and state stores. Subsequently since 1989 I have undertaken every 2-4 years a large in-depth 3 day in-home survey of the dietary intake of all household members, along with all food and recipe inventories of representative samples of Chinese provinces representing initially about 46% of the country and now about 75% (up to 15 provinces, including the 3 autonomous cities). China’s diet and food system has undergone a major revolution during this 1989 and later period. The revolution in the food system all the way from the farm to the fork, in food manufacturing and retailing, and in food marketing has changed the way the Chinese farm, process and sell food – and above all, they way they eat. It is this evolution that has shifted the face of the Chinese meal to new territory that unfortunately approaches the very unhealthy diets of many other countries. Elsewhere we have documented this historical evolution, but have ignored some key elements.
First, think about sugar in the Chinese diet. Today there is a sugar reserve; every town has pastry shops and, as we showed in one paper, sugar-sweetened beverages are growing from a very low base in exponential terms such that we held a national conference just to consider the control of these beverages in the Chinese diet.
Second, think about snacking. Before WWII and later, there is no evidence the Chinese ever snacked. Starting in the current century, Chinese and Western food companies began aggressive campaigns to sell snack foods to the country. Over a period of years from 2000 onwards, each time we ran a nationwide survey, snacking tripled, although the amount is still tiny – nothing like the 20% of the diet in all the Americas, the UK and many other higher-income countries. But this is changing with marketing, convenience and pricing, making snacking a new mode of consumption for young people across the country.
A third issue is the enormous growth of the retail food sector and a set of factors that shift the drivers of the food system from the government to food retailers, food companies, food service groups [e.g. Kentucky Fried Chicken) and agribusinesses (e.g. Cargill). As Reardon and colleagues have shown by following Chinese farmers from the farm through the system, these latter set of players now work directly with farmers. As we have shown, 28% of the calories / day of food intake came from consumer packaged and processed food in China in 2011, and this retail food sector growth is about 50% per year. This is leading to great growth in consumption of an array of junk food. Every one of the many hundreds of villages in our China Health and Nutrition Survey has at least one convenience store and the bulk of the sales are in unhealthy higher refined carbohydrate, high sugar, sodium and unhealthy fats types of foods.
A fourth dimension, which affects the globe in very serious ways, is animal-source food intake. It began with great growth in pork but more recently in poultry, eggs, and dairy among other products. China started with a very low intake level, and did need some higher quality protein in its die; food for young infants is terribly lacking in protein and is very poor in general. At the same time, they still consume minimal levels that comprise about 20-30% of the consumption level of the EEU and USA in per capita terms. Yet these changes have global implications, not only for food prices but for carbon emission and water use.
A fifth change that anyone who goes to China notices is the excessive use of vegetable oil in the diet. After the opening up of China to modern western technology, cheap vegetable oil technology began to lead to a consolidation of a sector from about 20,000 tiny and medium sized oil factories producing rapeseed and vegetable and soybean oil to thousands and now hundreds. This prepared China for the opening under WTO agreements to global oil imports from Canada, the US and elsewhere. But in the process, vegetable oil went from a tiny quota to a very cheap commodity unfettered by controls and open to purchase throughout the country. We have documented this shift and also held a national conference on just this topic in order to understand the manufacture, importation, economics and health aspect of this remarkable change. Today, the average Chinese person aged 2 years and older is almost up to 400 kcal / day of vegetable oils and the growth per capita continues. Yet China still consumes far less than Malaysia, Indonesia and other Asian countries. One other aspect of this is our documentation of the adulteration of this product. We showed that many oils labeled as much more expensive varieties were really a very cheap rapeseed oil. One outcome of this heavy intake of vegetable oil is a shift to frying, including extensive deep frying, instead of steaming, baking and boiling of food.
These diet changes are not solely responsible for the enormous increase in overweight people in China and the array of diet and obesity-related health problems. Rather we have shown that early on, the major shift in China that significantly affected increased weight was the huge decline in physical activity. However, the major solution for most of these problems will lie in major government efforts to control marketing, to shift the relative prices so the healthy choice is cheaper than the unhealthy one, and to work to shift the entire culture of eating in China. To date, no major government effort has been focused on these issues, unlike other major Asia and Latin American countries.
Barry M. Popkin is Distinguished Professor of Nutrition and Professor of Nutrition at the University of North Carolina-Chapel Hill. Of one his most known studies is “The world is fat: The Fads, Trends, Policies, and Products That Are Fattening the Human Race” (Avery Publishing Group, 2009). Image Credit: CC by Joe13/Flickr