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The big picture The world is getting wider, says Charlotte Howard. What can be done about it? 夏洛特·霍华德（Charlotte Howard）指出全世界的人正在变得越来越胖，我们能够做什么呢？ Dec 15th 2012 | from the print edition of The Economist 译者：nayilus IT IS LUNCHTIME at Eastside Elementary School in Clinton, Mississippi, the fattest state in the fattest country in the Western world. Uniformed lunch ladies stand at the ready. Nine-year-olds line up dutifully, trays in hand. Yes to chocolate milk, yes to breaded chicken sandwiches, yes to baked beans, yes to orange jelly, no to salad. Bowls of iceberg lettuce and tomatoes sit rim to rim, rejected. Regina Ducksworth, in charge of Clinton’s lunch menu, sighs. “Broccoli is very popular,” she says, reassuringly. 现在是密西西比州克林顿市的东区小学午餐时间。密西西比是西方世界中最肥胖的国家里最肥胖的一个州。穿着制服的午餐阿姨站在那儿准备分派食物，而9岁大的孩子们乖乖地排成一列，手里拿着托盘。巧克力牛奶不错，炸鸡块不错，烤豆不错，桔子果冻不错，生菜？不要！大盘的莴苣和西红柿并排放在一起无人问津。负责克林顿市学校午餐菜单的雷吉娜·达克斯沃斯（Regina Ducksworth）面对此景只能叹息。她以安慰的语气喃喃：“花椰菜是很受欢迎的。” Persuading children to eat vegetables is hardly a new struggle, nor would it seem to rank high on the list of global priorities. In an age of plenty, individuals have the luxury of eating what they like. Yet America, for all its libertarian ethos, is now worrying about how its citizens eat and how much exercise they take. It has become an issue of national concern. 说服孩子吃蔬菜算不上是什么新挑战，在全球问题中这似乎也算不上是有多迫切。在现在这个富足年代，每个人都可以敞开肚子想吃什么就吃什么。但是尽管美国是一个非常主张个人自由的社会，现在它也开始担心自己国民的饮食和健身习惯。肥胖已变成一个国家问题。 Two-thirds of American adults are overweight. This is defined as having a body mass index (BMI, a common measure of obesity) of 25 or more, which for a man standing 175cm (5’9”) tall means a weight of 77kg (170 pounds) or more. Alarmingly, 36% of adults and 17% of children are not just overweight but obese, with a BMI of at least 30, meaning they weigh 92kg or more at the same height. If current trends continue, by 2030 nearly half of American adults could be obese. 有三分之二的美国成人超重。超重的定义是体重指数（BMI，测量肥胖的一种常用指标）达到25或以上。这意味着身高1.75米的人体重达到77公斤。令人警醒的是，美国有36%的成人和17%的儿童不仅超重，而且已经达到肥胖的水平，即体重指数达到至少30，或身高1.75米的人体重达到92公斤。如果继续按现在的趋势发展，未来会有将近一半的美国成年人处于肥胖状态。 Americans may be shocked by these numbers, but for the rest of the world they fit a stereotype. Hamburgers, sodas and sundaes are considered as American as the Stars and Stripes. Food at state fairs is American cuisine at its most exuberantly sickening. At the Mississippi fair, a deep-fried Oreo biscuit’s crispy exterior gives way to soft dough, sweet cream and chocolate goo. It is irresistible. 美国人也许会被这些数字震惊，但是世界其它地方的人则不会大惊小怪，因为这早就切合他们对美国人的刻板印象。汉堡包、汽水和圣代冰淇淋都被看作是道地的美国发明，和星条旗一样正宗。在州博览会上供应的食物可以充分体现美国饮食令人厌恶、过犹不及的方面。在密西西比州的博览会上，油炸奥利奥饼外面酥脆的表皮下藏有柔软的饼干、甜奶油和巧克力酱。味道简直无法抵抗。 The rest of the world should not scoff at Americans, because belts in many other places are stretched too, as shown by new data from Majid Ezzati of Imperial College, London, and Gretchen Stevens of the World Health Organisation (WHO). Some continental Europeans remain relatively slender. Swiss women are the slimmest, and most French women don’t get fat, as they like to brag (though nearly 15% do). But in Britain 25% of all women are obese, with men following close behind at 24%. Czech men take the European biscuit: 30% are obese. 美国如此，其它地方的人也不要笑得太早，因为很多其它地方的人们腰围也在日益增长。来自伦敦帝国理工学院的马吉德·艾萨提（Majid Ezzati）和来自世界卫生组织（WHO）的格莱顷·斯蒂文斯（Gretchen Stevens）提供了数据证实了这一趋势。一些欧洲大陆国家的人还依然相对保持着苗条的身材。瑞士女性是最苗条的，法国女性如她们夸口的那样，大多都不会发胖（虽然还是有将近15%的人过胖）。但是在英国有25%的女性身处肥胖状态，而男性肥胖率也相去不远，达到24%。最糟的是捷克男性，肥胖率达到30%。 And it is not just the rich world that is too big for its own good. The world’s two main hubs for blub are the Pacific islands and the Gulf region. Mexican adults are as fat as their northern neighbours. In Brazil the tall and slender are being superseded by the pudgy, with 53% of adults overweight in 2008. Even in China, which has seen devastating famine within living memory, one adult in four is overweight or obese, with higher rates among city-dwellers. In all, according to Dr Ezzati, in 2008 about 1.5 billion adults, or roughly one-third of the world’s adult population, were overweight or obese. Obesity rates were nearly double those in 1980. 而且过于肥胖这个问题也不只限于富裕国家。世界上最肥胖的两个主要地区是太平洋诸岛以及海湾地区。墨西哥的成年人肥胖率比起他们的北部领国不相上下。巴西传统上高挑苗条的形象正被胖人取代，2008年成年人有53%超重。即使是在有很多人还记得那个大饥荒年代情景的中国，成年人中每四个人就有一个超重或肥胖，在都市居民中更甚。根据艾萨提的数字，总体来说在2008年全球共有大约15亿成年人超重或肥胖，占全世界成年人口的大约三分之一。今天的世界肥胖率几乎比1980年翻了一番。 Fat of the land 肥沃之地 Not long ago the world’s main worry was that people had too little to eat. Malnourishment remains a serious concern in some regions: some 16% of the world’s children, mainly in sub-Saharan Africa and South Asia, were underweight in 2010. But 20 years earlier the figure was 24%. In a study of 36 developing countries, based on data from 1992 to 2000, Barry Popkin of the University of North Carolina found that most of them had more overweight than underweight women. 不久之前世界的主要担忧还在于人们食物不够。营养不良在世界很多地区依然是一个严重问题。2010年全世界儿童中有16%体重过轻，主要集中在撒哈拉沙漠以南的非洲地区和南亚地区。但是20年之前这个比率曾达到24%。在一项对36个发展中国家1992年至2000年的数据的研究中，北卡罗来纳大学的巴利·坡普金（Barry Popkin）发现在大多数这些国家中超重女性要多过体重不足的女性。 The clearest explanation of this extraordinary modern phenomenon comes from a doctor who lived in the 5th century BC. “As a general rule,” Hippocrates wrote, “the constitutions and the habits of a people follow the nature of the land where they live.” Men and women of all ages and many cultures did not choose gluttony and sloth over abstemiousness and hard work in the space of just a few decades. Rather, their surroundings changed dramatically, and with them their behaviour. 对这一反常现代现象的最清楚解释来自于一位生活在公元前5世纪的医生。希波克拉底（Hippocrates ）曾写过：“总的来说，人们的生活习惯和身体状况和他们所生活的环境息息相关。”来自各种文化背景的男女老少并不是在短短几十年内一起抛弃了节制和勤奋，选择了贪食和怠惰。而是他们生活的环境发生了巨变，从而导致其行为的变化。 Much of the shift is due to economic growth. BMI rises in line with GDP up to $5,000 per person per year, then the correlation ends. Greater wealth means that bicycles are abandoned for motorbikes and cars, and work in the fields is swapped for sitting at a desk. In rich countries the share of the population that gets insufficient exercise is more than twice as high as in poor ones. 大多数变化是来自于经济增长。体重指数和人均国民生产总值（GDP）是同步上升的，这种关联会一直保持到人均GDP达到每年每人5000美元为止，再往上两者就没有太大联系了。财富增加意味着自行车被摩托车和汽车取代，田地里的工作被写字台工作取代。在富裕国家运动不足人口占总人口的比例要比穷困国家的比例高一倍有余。 Very importantly, argues Boyd Swinburn of Deakin University in Melbourne, diets change. Families can afford to eat more food of all kinds, and particularly those high in fat and sugar. Mothers spend more time at work and less time cooking. Food companies push their products harder. Richard Wrangham of Harvard University says that heavily processed food may have helped increase obesity rates. Softer foods take less energy to break down and finely milled grains can be digested more completely, so the body absorbs more calories. 墨尔本迪肯大学的博伊德·斯文本（Boyd Swinburn）认为很重要的一个因素在于饮食的变化。大家有钱吃更多各种各样的食物，尤其是高脂肪和高糖分的食物。妈妈们上班时间长了，做饭时间少了。食品公司推销产品的力度也加大了。哈佛大学的理查德·郎汉姆（Richard Wrangham）提出高度加工食品可能也是造成肥胖率上升的一个原因。分解吸收较软食物需要的能量更少，而磨得非常精细的面粉吸收也更完全，因此身体吸收的卡路里也增加了。 These global changes react with local factors to create different problems in different regions. Counter-intuitively, in some countries malnutrition is leading to higher obesity rates. Undernourished mothers produce babies who are predisposed to gaining weight easily, which makes children in fast-developing countries particularly prone to getting fat. 这些全球性的变化和各地的因素结合起来，在不同地区产生了不同问题。在某些国家营养不良反而会造成肥胖率上升。营养不良的母亲生下的婴孩先天体重就很容易增加，这意味着发展迅速国家内的孩子特别容易变胖。 In Mexico unreliable tap water and savvy marketing have helped make the country the world’s leading guzzler of Coca-Cola: the average adult consumed 728 servings last year. In America junk-food calories are often cheaper than healthy ones. Suburban sprawl and the universal availability of food have made the car the new dining room. In the Middle East, Bedouin traditions of hosting and feasting have combined with wealth to make overeating a nightly habit. Any inclination to exercise is discouraged by heat and cultural restrictions. In Beijing teenagers and office workers cram the fast-food restaurants along Wangfujing. Even home-cooked Chinese meals contain more meat and oil than they used to. Doting grandparents shower edible treats on scarce grandchildren. 自来水供应不可靠加上可口可乐精明的市场营销使得墨西哥成为世界上最大的可口可乐消费国。去年平均每个墨西哥人一年喝下728小瓶可口可乐。在美国垃圾食品每单位热量价格往往比健康食品便宜。市郊扩张以及到处可以买到食品这两个现象意味着很多人开始在车里吃东西。在中东，贝都因人好客及盛宴的传统加上财富变成了夜夜大吃特吃的习惯。高温和文化限制使得人们不习惯进行任何锻炼活动。北京王府井的快餐店里挤满了青少年和白领。就算是自家做的菜含肉和含油的分量都超过从前。溺爱的祖父母辈为自己数量稀少的孙儿大买各种零嘴。 Together, these disparate changes have caused more and more people to become fat. Many cultures used to view a large girth with approval, as a sign of prosperity. But obesity has costs. It lowers workers’ productivity and in the longer term raises the risk of myriad ailments, including diabetes, heart disease, strokes and some cancers; it also affects mental health. In America, obesity-related illness accounted for one-fifth of total health-care spending in 2005, according to one paper. 所有这些互不相关的变化加在一起造成越来越多的人变胖。很多文化过去曾把肥胖看作是富足的象征而加以肯定。但是肥胖带有很高的成本。它降低员工的生产力，长此以往还会增加各种疾病——如糖尿病、心脏病、中风和某些癌症——发病的几率。肥胖也影响心理健康。据一篇论文报道，2005年在美国和肥胖相关的疾病支出占所有医疗卫生支出的五分之一。 A huge new global health study, led by Christopher Murray of the University of Washington, shows that since 1990 obesity has grown faster than any other cause of disease. For women a high BMI is now the third-largest driver of illness. At the same time childhood mortality has dropped and the average age of the world’s population has risen rapidly. In combination these trends may mark a shift in public-health priorities. Increasingly, early death is less of a worry than decades spent alive and sick. 华盛顿大学的克里斯多夫·穆雷（Christopher Murray）带头进行的一项大型全球健康新研究显示1990年以来，肥胖增长速度要比任何其它形式的病因都快。对于女性来说，高体重指数现在已是疾病的第三大引发原因。同一时期全球的儿童死亡率有所下跌，而世界人口的平均年龄正在迅速上升。这些趋势加在一起也许会标志着公共健康的当务之急正在改变，早逝已经不是那么大的问题，更大的担忧是几十年都活在疾病状态下。 It is plain that obesity has become a huge problem, that the factors influencing it are fiendishly hard to untangle and that reversing it will involve difficult choices. Radical moves such as banning junk food would infringe individuals’ freedom to eat what they like. Instead, some governments are cautiuosly prodding their citizens to eat less and exercise more, and food companies are offering at least some healthier foods. 肥胖正在变成一个巨大问题，要应付影响肥胖的因素异常棘手，扭转肥胖趋势需要做困难的抉择，这几点都很明显。禁止垃圾食品这类激进做法会侵害到个人吃自己喜爱的食物的自由。一些政府正在谨慎地采用潜移默化的措施，意图让自己的国民吃得少一点、运动多一些。而食品公司总算是开始出产一些更健康的食物了。 In a few places obesity rates seem to be levelling, but for now waistlines in most countries continue to widen unabated. Jiang He and his colleagues at Tulane University have estimated that by 2030 the global number of overweight and obese people may double to 3.3 billion. That would have huge implications for individuals, governments, employers, food companies and makers of pharmaceuticals. 在有几个地方肥胖率似乎已经稳定下来，但在大多数国家人们的腰围还在继续增长。美国杜兰大学的何江和他的同事估计到2030年全球超重及肥胖人口将会翻倍，达到33亿。这对个人、政府、雇主、食品公司和药品公司都有着巨大的影响。 |
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