Running head: OBESITY IN BEIJING

THE IMPACT OF FAST FOOD INDUSTRY ON OBESITY IN BEIJING Name University

THE IMPACT OF FAST FOOD INDUSTRY ON OBESITY IN BEIJING Fast Food Industry Development in Beijing

Fast food industry in China, a few decades ago did not exist. However, it has become large enough to impact on the daily lives of considerable percentages of the Chinese population. Western companies have interacted so well with the Chinese culture in such a way that fast food appears more of a Chinese product. Chinese traditional convenience foods existed for decades until China opened its boarders to the western fast food chains that penetrated in their market with ease. According to Tsung and Cheng (2003), the first Kentucky Fried Chicken (KFC) became operational in Beijing on second of November 1982. To their surprise, they had a 50-meter long line of customers. On the first day, they sold 2,200 buckets of chicken, an aspect that was contrary to the companys expectations. At that time, Kentucky Fried Chicken foods were not affordable to most of the Chinese population, but their stores were flocked despite the exorbitant prices. This encouraged Kentucky Fried Chicken management to open similar branches in other major towns of China. In 1986, Kentucky Fried Chicken had been operational for three years and the company was flourishing and thriving (Tang, 2001). During the same year, a competitor company, McDonalds, was opened in Shenzhen, which is the busiest area of in Southern China. Following this phenomenon, a similar store opened in Beijing, China, on April 23, 1992 and attracted approximately 40,000 customers. The 28,000square-foot restaurant had 29 cash register stations to handle the large number of customers. McDonalds restaurant having been located in the busiest shopping district in the city, registered 800,000 potential customers who sought such services frequently (Tang, 2001). The success of McDonalds propagated due to its partnership with Beijing Agricultural Industry, and Commerce. The partnership ensured the local farmers, suppliers and manufacturers supported the restaurant.

THE IMPACT OF FAST FOOD INDUSTRY ON OBESITY IN BEIJING

The same year that McDonalds opened a Pizza Hut, a chain belonging to Kentucky Fried Chicken, also opened its first store in Beijing. All these joints were considered too expensive for an average Chinese to regularly eat there. This made the perceptions of fast foods to be luxurious and of high demand. Further stereotyping of such foods as special and desirable aggravated. Fast food restaurants are now a common sight in the streets of China. By 2005, Kentucky Fried Chicken was the largest western fast food chain in China. It had 1,200 locations in mainland of China. The growth rate of Kentucky Fried Chicken was as high as 200 new locations opening each year. Currently there are about 2,000 Kentucky Fried Chicken locations in China today. McDonalds occurs second with more than 600 locations in 2005 and a target of 100 new locations every year. Currently, McDonalds locations in China are around 1050 stores. Currently, China has become one of the most developed countries; this translates to more Chinese population moving to middle class lifestyle. This makes fast foods more affordable and accepted as constituents of everyday life (Tsung and Cheng, 2003). The emphasis on quality service and cleanliness made most Chinese people perceive that fast food restaurants meals are prepared in a clean environment. This makes the food to be preferred over that purchased at the roadside food stalls. When McDonalds Corporation decided to invest in China, they never perceived the Chinese populous and wealthy enough to support their business (Tang, 2001). Thus during their second market research trip they opted for children as their target market. With the one child policy in China, every parent wanted his/her child to be successful; being western is an ingredient of the postulated success. Cheng (2001) refers to a Chinese saying: 248 (pronounced er, si and ba) you get fat. The saying refers to one child having 2 parents, 4 grandparents and 8 great grandparents. The parents may not be in a position to grant their child expensive education but they can afford taking

THE IMPACT OF FAST FOOD INDUSTRY ON OBESITY IN BEIJING

them to a fast food restaurants. It is now a common phenomenon to see parents or grandparents watching their children eat in fast food restaurants. Currently fast food restaurants have now become number one location for Chinese children. Thus, McDonalds has been very successful in capturing their target market. In the rural provinces of China, the labeling of western fast food restaurants as a cultural experience is intensifying. The residents view western fast foods as an exotic food they can swank of when they get back to their villages. Sometimes back, food in China was a scarce commodity a trend that is still prevalent in Western Chinese provinces. The cities in Eastern China are now experiencing financial wealth plus excessive food. The major effect of fast food to human health is the gaining of weight. Although traditionally, being overweight was something praiseworthy and as such a fat baby was considered healthy. This belief is however unfounded and has seen cases of obesity rising in China rising by 97% from 1992 2002. Of more concern is childhood obesity and all the diseases associated with this condition such as heart disease and diabetes (Cheng, 2001). Obesity is a problem in urban areas. Contrary to this in the rural areas of China, famine and malnutrition remain a major concern as stated by Tang (2001). During the Great Leap Forward in the last45 years, 30 million people starved to death. The parents whose children suffered the famine want their children eat adequately through the adoption of western foods. According to Maheshwari (2011), malnutrition is still a problem in western China. When people from the poorer rural areas of China get an opportunity to travel to the urban centers, a stop at McDonalds is a considered worthwhile. From research reports of fast food market analysis in China, Chinese fast food industry has experienced fast growth rate compared to other emerging markets. China, being one of the largest economies of the world is also one of the largest countries in terms of retail industry. Chinas retail

THE IMPACT OF FAST FOOD INDUSTRY ON OBESITY IN BEIJING

sector makes over 37% of its GDP and in future, it is anticipated to expand further as the economy grows. With increasing acceptance of westernization, the growth of China retail sector and the increase in the middle class population will immensely contribute to the fast growth of such industries in China will keep growing (Cheng, 2001). With the exemption of the above factors, it is evident that the change in the Chinese eating habits and the transforming lifestyle is translating to growth in the Chinese fast food industry. To be specific, the change of lifestyle is what stirred the rising demand of fast food in China. With better and busier lifestyles, the Chinese in Beijing look for convenience foods such as fast foods. The number of people who find it difficult to prepare a meal at home keeps rising every day. Such people buy foods that are ready to eat. This translates to an increasing demand and acceptance of fast foods. Presently in China, food flavors and franchising routes are the fastest emerging trends (Maheshwari, 2011). Health Conditions Records of Chinese in Beijing Before 1982 More than 30 years ago China people celebrated obesity as a sign of prosperity and good health. Many successful people worked hard to put more weight by eating calorie-rich meals at any given opportunity. Plumb babies were an admiration and symbols of good luck to their parents. Thinness was an abomination avoided at all costs given that emaciated body meant bad luck, early death and susceptibility to illness. Emaciation stigma was such that even during affluent years those people who were thin had difficulty in getting life partners. Postulations were that they would not live long to bear children or otherwise support them. When the bulking diet does not help, recommendations to consult supernatural forces occurred. Such powers turned out to be aggrieved ancestors who were ensuring poor health as retaliation of neglect or mistreatment.

THE IMPACT OF FAST FOOD INDUSTRY ON OBESITY IN BEIJING

Perceptions on plumpness as a clear indication of blessings from the supernatural world contrary were a common misconception (Tsung and Cheng, 2003). Thus, until recently Chinese people were more worried on how to increase their body weight rather than reducing it. Obesity was not a recognized pathology to most people until late 1980s. China's principal crops are corn, soybeans, cotton, and wheat in addition to apples as well as other fruits and vegetables. However, Tsung and Cheng (2003), confirm that from 1978 China moved to a diet of Laden with red meat, sugar and edible oils. The consumption of vegetables dropped more in early 1980s with the introduction of western fast foods. More expensive vegetables and fruits were readily available in the urban markets. Most young people at this time were dictating their own health and controlling their own food expenses. Formal meals (breakfast, lunch, dinner) were no longer relevant to the young teenagers. They were eating whenever and whatever they so wished. Before 1980, health care systems in China were under the control of socialist planned economies. By 1980, this picture had translated to having 85% - 90% of the Chinese populations health issues catered for by either a state or a collective health care system. Collective health care centers received funds from income earned and community cooperatives whereas state health care was funded by the central government. There was increase in average life expectancy and a reduction in infant mortality (Maheshwari, 2011). From early 1980s, the health care system in China went through several cycles of marketoriented reforms. Between 1980 and 2003, health care costs had multiplied drastically. During this time, the percentage contribution from the government decreased from 36 percent to 17 percent whereas the collective and SOE contributions decreased from 42 percent to 27 percent. The

THE IMPACT OF FAST FOOD INDUSTRY ON OBESITY IN BEIJING

hospitals became too expensive in that half of urban patients were forced into self-medication, whereas more than 60 percent of rural patients forwent medication (Cheng, 2001). This increased the number of rural households that lived below poverty line rose to approximately 21 percent. From 1975 to 2001, the number of doctors in the rural areas abridged from 1.5 million to about 1 million while the total number of nurses in the rural areas decreased from 3.28 million to 270,000. Diseases that were once under control such as tuberculosis and HIV/AIDS made a very strong comeback. In the 2000 World Health report, China was ranked number 144 out of 191 countries in overall performance of the health care sector. Health Conditions of Chinese in Beijing during the Development Period According to Luo (2002), 10 percent of the children in China suffered from obesity by 2004 and the numbers are ever increasing every year at a rate of 8 percent. In large cities such as Shanghai and Beijing, one child in every five is obese. The media had propaganda on superiority of highly processed food. One of the media article even claimed that an increase in fast foods is one of the benefits of joining the World Trade Organization (WTO). The same article went further to state that fast food is good for ones health and substandard foods will become extinct in the market to pave way for the more nutritious fast foods. This implies that ignorance and misinformation contributes significantly to nutrition problems in Beijing and the whole of China (Cheng, 2001). This has a lot of impact on the health of many Chinese citizens. For instance, individuals one who take fast food most of the time have an ever increasing prevalence in vitamin A deficiency despite the readily available carrots and vitamin A rich vegetables. On the other hand, despite heightened awareness about breast-feeding among the educated class of people, adverts brainwash such people that formula is better for their newly born.

THE IMPACT OF FAST FOOD INDUSTRY ON OBESITY IN BEIJING

Upcountry, there have been cases of mothers selling eggs at the market to buy sugar or chocolate for their children, thinking that such processed foods will be more beneficial. Tang (2001) says that many children in the rural areas, especially girls, are dropping out of school because their families find it impossible to pay the increasingly high fees. This contradicts the official data that indicates increment in the literacy level and number of people enrolling in schools. On the ground, the real situation indicates otherwise. Chinese residents report that it is a common phenomenon for local officials to round up all children into schools every beginning of a school year and guarantee a good government evaluation, but soon after these inspections, these children drop out of school (Cheng, 2001). In 1999, public spending on education in the world on average was 4.38 percent of GDP whereas for Chinas was 2.7 percent. Government funding occurs unevenly. The urban sector receives around 75 percent of the educational investment with more funding being channeled to higher education relative to basic education. A good example is in 1999 and 2000, where the government reduced its funding towards primary education and increased tertiary education funding by 9.4 percent (Tsung and Cheng, 2003). From 1978 to 1990, the rate of advancement from primary school to junior high decreased by 14 percent while rate of advancement from junior high to senior high school was as low as 25 percent. This emphasis on higher education affected the education content profoundly. Educational focus gears increasingly to book knowledge and passing of college entrance exams. Education has been completely detached from community needs and conditions. For the poor families, education is now a risky venture especially with the minimal chances of upward mobility. The riddle of fierce competition has few winners and many losers (Cheng, 2001).

THE IMPACT OF FAST FOOD INDUSTRY ON OBESITY IN BEIJING

This brings us back to ignorance and misinformation as the major contributors of nutrition problems in Beijing and the whole of China. Currently China has registered obesity rates of three million schoolchildren and weight gain of over one million expectant mothers. From a study carried out it shows that with a fast food restaurant situated within a tenth of a mile of a school, the restaurant will affect 5.2 percent increment in the obesity rates. The impact lessens with the increase in the distance. This implies that policies restricting fast food restaurants near schools will go a long way in ensuring improved health of the schoolchildren (Maheshwari, 2011). The Chinese government has gone ahead to build playgrounds and made it a law that each student should exercise for at least an hour every day at school. The prevalence of obesity come with obesity related ailments. Some of the symptoms of obesity include large body frame, high cholesterol, breathlessness, snoring, hypertension and many more. Currently there is a hospital called Aimin Fat Reduction Hospital in the Chinese city of Tianjin. This hospital hopes to help the obese Chinese people to loose weight. Currently it is hosting more than 100 patients. Apparently, this is not the only place. There are several clinics and camps with the same goal. The camps blame Chinas family policies for the health of their children. During summer breaks, some of the parents in the urban areas take their kids to Shanghai physical education institute. This camp runs a four-week session and the fee is one thousand dollars per child. Similar camps exist in Beijing, Shenzhen and Qingdao. Obesity is linked to a range of illnesses and one of them being diabetes.

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Currently, more than 90 million diabetics in china consider the root cause of their ailment to obesity and overweight tendencies. This is a burden to the entire society since they will have to spend money to treat the ailing. It is a bigger burden to the health care system since most of these illnesses are treatable individually and for quite some time (Tsung and Cheng, 2003). Currently one fifth of the one billion obese in the world are Chinese. According to Cheng (2001), data from national nutrition and health survey showed that14.7 percent of the Chinese were overweight while 2.6 percent were obese from 2002. Over the past 20 years, observations indicate that the proportions and nutrients in the diet of most people have changed. Energy intake from animal sources has increased from 8 percent to 25 percent in 2002 whereas average intake of fat among urban Chinese has increased from 25 percent to 35 percent, which is above the 30 percent upper limit recommended by World Health Organization. The deteriorating health of the Chinese people also coincides with the continuing modernization of China. Modernization comes with reduced physical activity and labor intensity in both rural and urban setting. Traditional forms of transportation are extinct while the popularity of buses, cars and motorcycles is increasing. In 1980 China produced 5,400 vehicles, in 2003 over 2 million cars were produced, for which, almost all of them were sold in China. By this year, there was obesity explosion in China (Maheshwari, 2011). Fast Food and Health Condition

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Obesity has indeed proved to be a challenging medical condition in China. It has been because of accumulation of body fat through the consumption of fast foods. This fat causes adverse effects on health. Obesity puts one at risk of suffering from heart disease, type two diabetes, specific cancer and obstructive sleep apnea. Obesity is a result of by combinations of excessive food energy (food rich in calories) intake, lack of exercising and genes inheritance. Some of the symptoms of being overweight include; difficulty in doing daily activities, lethargy, snoring, facial features often appear disproportionate, adiposity (which are the fat cells) in the breast region in boys, increased adiposity in the upper arms and thighs, knock knee, increased weight, increased abdominal girth, increased body mass index and hypertension (Maheshwari, 2011). Obesity management through dieting and engaging in physical exercise amongst the Chinese patients is effective and ongoing. As usual, its definition is determined by the body mass index (BMI) and the waist hip ratio mass distribution. BMIs calculations occur by dividing ones mass by square of the subjects height. World Health Organization came up with a chart to categorize the body mass index for easy distinction between the healthy and obese (Tsung and Cheng, 2003). Relationship between Fast Foods, Geographical Locations and Obesity According to Luo (2002), geographical location of fast food restaurants affects the obesity rates of 3 million schoolchildren and the weight gain of over 1 million pregnant women. For pregnant women, a fast food restaurant within a half mile from her place of residence translates to 0.025 probability of her gaining over 20 kilograms. Contrary to this, the presence of non-fast food restaurants is uncorrelated with weight gain and obesity. Moreover, proximity to future fast food restaurants has nothing to do with current obesity and weight gain, with reference to current

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proximity to a fast food restaurant. For mothers, the implied effects of fast-food intake on caloric levels are less by one magnitude compared to schoolchildren. From the facts above, it means implementing policies that restrict access to fast foods near schools and especially in China will have significant effects on obesity among school going children. However, if similar policies are applied to adults by restricting availability of fast food restaurants in residential areas, the effects will be minimal. These effects vary across races and educational levels. For instance, the trend is predominant in mothers with a high school education or less while for mothers with university degrees or higher education it is zero. Fast food restaurant management is likely open new restaurants where they experience strong demand, and higher demand for unhealthy fast food is almost certainly associated with higher risks of obesity. Several features make fast food industry less healthy than other types of foods. Fast foods have a high percentage of calorie and high energy density that makes it difficult for those individuals consuming them not to exceed their average dietary intake. However, Maheshwari (2011) argues from observational studies that it is not possible to rule out potential confounders of obesity such as lack of physical activity, consumption of sugary beverages, reduced food prices (and increased consumption) and many more. Obesity has increased rapidly in the Beijing since 1980s. During this same period, the number of fast food restaurants has doubled. This confirms the hypothesis that these two facts are related. Availability of fast food restaurants in urban China may have caused at least some percentage of the increase in obesity. Obesity has close association with high blood pressure, cardiovascular disease, diabetes, and some specific cancers. This has made obesity to be a serious public concern. However, most of the existing evidence on the causal link between the fast food and obesity is not obvious because it is based on correlations. The opening of fast food occurs in

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areas where their demand is high. In such areas consumers have access to unhealthy food from different sources, thus it is possible that the rate of obesity would be higher in such localities even in the absence of fast food restaurants (Tsung and Cheng, 2003). Considering the effects of fast food restaurants to a pregnant mother and schoolchildren, we find that the impact is not the same. This data implies that it is evident that the availability of fast food contributes to obesity and weight gain in pregnant women. Secondly, it shows that proximity affects students differently (who stay within the school during school day) compared to mothers, who are assumed mobile all day. Therefore, any attempts to limit the presence of fast foods in residential areas are unlikely to have any impact while same policy if applied near schools will have a sizable impact on the affected students. China in the antique had slender people but this trend has apparently changed. It was very hard to see a fat individual from China until recent times. It is thus amazing how China is engaged in a battle against obesity, something that was unheard of in the history of China. There is definitely a reason for the growing trend in health complications and more particularly with obesity in China (Luo, 2002). Many researchers have embarked on studies that have singled out fast foods as the main cause of obesity in Beijing and China at large. The effects of fast food have negatively affected the health of the Chinese people. The management of most of these obese conditions in Chinas children population are similar to the rest of the world. There is empirical evidence that statistics shows that obesity among children below fifteen years of age has increased to almost 30% from a previous 15% in 1982. The statistics have almost doubled from this time. Change of lifestyles and eating habits have been a major contributory factor to the current situation. China slowly began being westernized, an idea that did not work on well for the Chinese people. The people adopted the western eating habits

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with the introduction of fast food restaurants. Physical inactivity and fast foods occur as the highest factors that have contributed to the increasing prevalence of obesity in children in the nation of China (Tsung and Cheng, 2003). The efficiency of the fast food advertisements has won the appetites of many people in China and thus resulting in current obese situation in China. There is an increasing appetite for the American fast foods than ever before. Kentucky Fried Chicken and McDonalds have been on the lead in the fast food market. The image of Ronald McDonald is highly noticeable and recognizable by Chinese children even without the capacity to read English. The consumption of fast food amongst Chinese children has reached uncontrollable limits. Aggravation of the apparent situations occurs due to physical inactivity. The condition is more persistent in urban areas than in the rural areas as urban children taken on many fatty foods than their rural counterparts. Rural Chinese children are more engaged in fieldwork owing to economic necessity than their urban counterparts are. All the same, fast food plays a central role in the increasing prevalence of obese among the Chinese population. Recommendations With the apparent findings on the increasing incidents of obesity, the dire situation in Beijing and the rest of China requires urgent mitigations. Recommendations on weight loss through weight loss programs to reduce the elevated cholesterol levels and reduce the susceptibility to hypertension and type 2 diabetes is core. This process however must use effective and stringent dietary plans that advocate for frequent monitoring and premeditated contemplations on the foods ingested and their ultimate effects in the body. Such plans should take core meals as significant particularly breakfast and focus on calorie reduction in the small amounts of foods within short durations and concurrently ensure the maintenance of balanced diets. Another core

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recommendation is the increase in physical activity to facilitate the utilization of most in taken calories other than their storage as adipose tissue. These aspects require various behavioral adjustments, parental interventions and medical interventions. According to Matthew et al (2007), parents must take their obligation objectively to reduce obesity through partnerships. Such partnerships entail community knowledge dissemination on obesity and its affiliated diseases, its deleterious aftermaths and preventive measures to impede its spread. These trends fosters good parenting styles, adoption of lifestyles behavior from exemplar elites and the inculcation of effective dietary habits in schools as constituent parts of the syllabus and in communities as a continuum. Such approaches alleviate the incidences of ignorance, misinformation and cultural misconceptions that exacerbate the apparent situation in obesity prevalence in China. The challenge thus lies to the Chinese government to enforce such policies as such approaches are infeasible without their mediation as key policy makers. Matthew et al (2007) also recommends a variety of behavioral and cognitive strategies to impede obesity. Individual goal setting, selfassessment, positive reinforcement and cognitive restructuring are transformational in obesity prevention as they form the basis for change prior community, government and school initiatives. This is a holistic approach towards obesity management and if implemented can cause effective reduction in its prevalence rates. Conclusion The findings of this dissertation highlight an existing problem of obesity in Beijing and the rest of China as evident from the increasing prevalence rate and the escalating incidence of affiliated diseases such as hypertension, cardiovascular diseases and diabetes. The apparent situation occurs due to the adoption of western cultures that advocate for binging and the establishment of companies offering such products as is the case with McDonalds and Kentucky

THE IMPACT OF FAST FOOD INDUSTRY ON OBESITY IN BEIJING Fried Chicken. The authors also document that the problem established rapidly due to the

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accommodating trends of Chinese individuals that had ignorance, misinformation from the mass media, cultural misconceptions and a brainwash in fast foods contrary to their indigenous foods as dominant. These characteristics resulted to a high demand for fast foods that ultimately effected the compliance to this trend as an everyday behavior. The ramifications of these trends is an increasing incident rate of this disease and its iatrogenic diseases causing healthcare to be expensive and overburdening as the number of patients subdue the proficient health practitioners available. As such, the prognosis of this condition is an increased mortality and morbidity rate and an overwhelming blow to the economy of Beijing and the entire China. Evidence also supports that such predispositions are evident in Beijing and majority of the urbanized regions in China and most specifically based on the geographical location of such fast food stores leading to selective bias with schoolchildren and pregnant mothers being the major victims. Beijing and the rest of China is taking this issue gravely and seeking for mitigations to counter it via increased community and school education, adoption of novel and better lifestyles that precedence planned diets and exercise and the incorporation of behavioral and cognitive habits through the help of the government, elites and other community and medical practitioners. Effective implementation of these approaches is practical and their encouragement should be priority in Beijing and the entire China.

THE IMPACT OF FAST FOOD INDUSTRY ON OBESITY IN BEIJING References Cheng T.O. (2001). An obesity epidemic in modern China. Am J Cardiol. 88:721722 Luo Z. (2002). Obesity: a warning to Chinese children. Beijing Review; 45:1416

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Maheshwari, S. (2011).Chinese Fast Food Industry to Grow at CAGR of 13% by 2014. Retrieved from October 26, 2011 from http://www.free-press-release.com/news-chinese-fast-foodindustry-to-grow-at-cagr-of-13-by-2014-1296969121.html Matthew, D. et al (2007). Recommendations for prevention of childhood obesity. Pediatrics, 120, pp. 229-253. Tang Y. (2001). Affluenza: rising problem endangers Chinese health. Beijing Review.44:1721 Tsung O. and Cheng. M. (2003). Fast food and obesity in China. American College of Cardiology Foundation