HONG KONG/SHANGHAI: As China builds fewer houses and bridges, its consumers buy cheaper, less healthy foods, and as factories and farms invest in automation, a new fiscal challenge is emerging: the country’s obesity rate may rise much faster and increase health care costs.
Work stress, long working hours and poor diet are increasingly risk factors in cities, while in rural areas agricultural work is increasingly less physically demanding and inadequate health care leads to poor screening and treatment of overweight problems, doctors and academics say. China faces a dual challenge fueling its weight problem: In a modernizing economy fueled by technological innovation, more jobs have become sedentary or desk-bound, while a long-term slowdown in growth is forcing people to embrace cheaper, unhealthy diets.
With housing and infrastructure already abundant, for example, millions of workers have switched from construction and manufacturing jobs to driving for ride-hailing or delivery companies in recent years.
In a deflationary environment, consumers prefer cheaper foods that may be unhealthy. Parents restrict swimming or other sports classes. China’s fast food market is expected to reach 1.8 trillion yuan ($253.85 billion) in 2025, up from 892 billion yuan in 2017, according to Daxue Consulting.
“Economic downturns often lead to changes in people’s lifestyles,” said Yanzhong Huang, senior fellow for global health at the Council on Foreign Relations. “Eating habits may become irregular and social activities may decrease.”
“These changes in daily routines may contribute to the increased incidence of obesity and subsequently diabetes,” he said, adding that he expects obesity rates to continue to “rise exponentially and burden the health care system.”
In July, Guo Yanhong, a senior official at the National Health Commission (NHC), said obese and overweight people were a “serious public health problem”. The NHC did not immediately respond to a request for comment.
China’s official Xinhua News Agency reported in the same month that more than half of the country’s adults are obese or overweight, higher than the World Health Organization’s estimate of 37 percent. A study by BMC Public Health estimates that weight-related medical costs are expected to rise to 22 percent of the health budget, or 418 billion yuan, by 2030, up from 8.0 percent in 2022.
The estimate was “conservative” and did not take into account increases in health care costs, it said. This will put further pressure on indebted local governments and reduce China’s ability to direct resources to more productive areas to stimulate growth.
INFORMATION CAMPAIGN
China’s NHC and 15 other government agencies launched an anti-obesity campaign in July. The campaign, which will last for three years, is built around eight slogans: “lifelong commitment, active monitoring, balanced diet, physical activity, good sleep, reasonable goals and family action”.
In July, health guidelines were distributed to primary and secondary schools, calling for regular screening, daily exercise, hiring nutritionists and implementing healthy eating habits – including limiting salt, oil and sugar.
The WHO defines overweight as having a body mass index (BMI) of 25 or higher, while the BMI threshold for obesity is 30. Only 8.0 percent of Chinese people are considered obese, which is more than neighboring Japan and South Korea, but far lower than the 42% rate in the United States, WHO data show.
Partly because this is a relatively new problem in China, which experienced a large-scale famine in the 1960s.
“China has gone through an epidemiological transition where diseases associated with malnutrition have turned into an increase in disease with unhealthy diets and sedentary lifestyles,” said Christina Meyer, a health policy analyst at RTI International in Seattle.
STRUCTURAL FACTORS
As consumers and workers adjust to structural changes in a rapidly urbanizing economy in the coming decade, many overweight Chinese could cross the obesity threshold, doctors say.
“The economic downturn in China could lead to an increase in consumption of low-quality food such as fast food due to a drop in income,” said Jun Sung Kim, an economist at Sungkyunkwan University in South Korea.
“This in turn can contribute to obesity.”
China’s fresh push to increase its rate of urbanization raises particular concerns in light of its “996” culture of working 12-hour shifts six days a week. Pui Kie Su, a general practitioner at Raffles Hospital in Beijing, says some patients report eating to “de-stress” from work.
