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Getting richer, lazier - and fatter

IN traditional Chinese culture, being fat was a sign of affluence. Fat babies were thought to be healthier and chubby husbands were thought to be good providers. But the good life has made too many people dangerously fat.

Divide your weight in kilograms by your height in meters squared: The result - the body mass index (BMI) - will help determine how much you pay for life insurance.

Life insurers in China can charge obese people, whose BMIs go beyond 30 for men and 28.6 for women, up to 200 percent more than normal premiums, as scientific research shows they are more likely to get ill.

However, all Chinese - fat or thin - will have to pay the medical costs of those who eat to excess if waistlines continue to expand, says Chen Junshi, a senior researcher at the Chinese Center for Disease Control and Prevention.

Most Chinese are not yet subject to this differentiated rating system as they mainly rely on the government-run basic medical insurance system that charges uniform premiums for all.

Under the national medical insurance system, which covers 1.2 billion people, employers and employees jointly contribute to the insurance fund, and the proportion of the cost varies from area to area.

In Beijing, for example, employers have to pay 10 percent of each worker's monthly income, while each employee contributes 2 percent of their income plus 3 yuan (44 US cents).

Chen, a long-time researcher on the effects of obesity on the economy, says that although the economic impact of obesity on China is yet to be officially counted, obesity already cost Chinese people billions of dollars each year, using cost-equivalent models for the United States.

The World Health Organization (WHO) said in a report in 2008 that excess weight and obesity are important factors behind a number of chronic diseases.

About 85 percent of people with diabetes are type 2 (late-onset), and of these, 90 percent are obese or overweight, and the risks of breast, colon, prostate, endometrium, kidney and gall bladder cancer increase rapidly as weight gains, according to the report.

Excess weight and obesity cost the United States about US$147 billion a year, according to the US Center for Disease Control and Prevention last year.

Spending on obesity-related diseases accounted for 9.1 percent of the country's total health-care expenditure in 2006, up from 6.5 percent in 1998, the US CDC figures show.

China's heavyweights lag far behind the US, where two out of three people are clinically overweight or obese, but China is on course to catch up in a couple of decades, Chen says.

The number of overweight people in 2002 was up 39 percent from 1992 to 200 million, accounting for 22.8 percent of the total adult population, according to the latest official figures released by the Ministry of Health and the National Bureau of Statistics in 2004.

But since official data lag far behind, the reality in the year 2010 is much worse.

The data also showed that the number of obese people soared by 97 percent from 1992 to 60 million, or 7.1 percent of the total adult population.

The 2008 WHO report also estimated that between 2005 and 2015, China may lose US$558 billion of national income to diabetes and heart disease, which were closely related to excess weight or obesity.

"This is not alarmist. At the end of the day, the extra price will be reflected in the forms of either higher taxes or bigger contribution from both employers and employees to the fund," Chen says.

Experts attribute the overweight and obesity epidemic to changes in the traditional diet and increasingly sedentary lifestyles.

People are expending less energy on traditional modes of travel such as walking and cycling, and spending more time in cars, buses and on motorcycles.

"Besides reduced physical activity and the increasing accessibility and affordability of food, there is a cultural element behind the soaring overweight and obesity rates," he says.

"In China's traditional cultural context, being fat has been taken as a sign of affluence. Fat babies were assumed to be healthier, a chubby husband was thought to be rich and a good provider, and it has been common for grandparents to dote and reward a child with food," Chen says.

He says more efforts must be made to raise the awareness about healthy living through public advertising that encourages people to be more physically active and labeling that shows shoppers the calorie content of the food and what it means for their health.

Economic incentives might be more effective.

Chen says a differentiated contribution system based on each employee's health indicators, including weight, could help keep more waistlines in check.


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