The Philippines is not only facing a ballooning population but also its people, figuratively speaking, according to a new report.

“Among the six countries studied, the Philippines has the second-lowest obesity and overweight prevalence at 5.1 percent and 23.6 percent, respectively. But despite low prevalence rates, obesity has a strong impact in the Philippines due to the large number of obese persons in the country—18 million Filipinos are obese and overweight,” the report said.

The newly released report, “Tackling obesity in Asean: Prevalence, impact and guidance on interventions”, was commissioned by Asia Roundtable on Food Innovation for Improved Nutrition (ARoFIIN) and produced by The Economist Intelligence Unit (EIU).

Aside from the Philippines, other members of the Asean included in the study were Indonesia, Malaysia, Singapore, Thailand and Vietnam. The report calls for “more concerted efforts by health authorities to tackle the problem of obesity so as to avoid strains on health-care systems.”

Last year, obesity cost the Philippines between $500 million and $1 billion, or equivalent to between 4 percent and 8 percent of its health-care spending. “This makes the country the fourth-highest spender for obesity-related problems,” the report said.

Indonesia is the highest spender at $2 billion to $4 billion followed by Malaysia at $1 billion to $2 billion and then Singapore at $400 million to $1 billion.

“These costs are due to a spike in incidence of related noncommunicable diseases [NCDs] such as Type 2 diabetes, cancer, cardiovascular diseases and stroke, as well as an increased rate of absenteeism from work arising from illness and poor health,” the report said.

Apart from costs, obesity-related problems have far-reaching implications. Obesity reduces life spans by a weighted average of between 4 and 9 years across the six countries, the study found out.

“The Philippines is the worst-affected in terms of reduction of productive years among obese males—a significant eight to 12 years,” the report said. “This is followed by Malaysia at between six and 11 years, and Indonesia at between six and 10 years.”

On the brighter side: “The Philippines is the least-affected in terms of reduction of productive years among obese females—at between 0.3 and five years lost,” the report said.

Currently, the Philippines has an estimated 7 million children who still experience hunger and malnutrition.

As such, the Philippines remains very much focused on battling its long-standing problem of malnutrition, while at the same time bearing the burden of increasing rates of obesity.

While the nation recently launched the Philippine Plan of Action for Nutrition 2017-2022, with obesity and overweight as one of the pillars, the report states that obesity is still not a high priority despite it being recognised as an issue.

Other key obesity drivers in the Philippines include a lack of exercise and low dietary quality. “Many adults are not physically active, and children lack places to play in,” the report stated.

A recent study by the University of the Philippines found that young Filipinos are at a greater risk of NCDs, due to the consumption of food that is energy-dense and nutrient-poor, exacerbated by growing urbanization and increased incomes.

“Evidence shows that overweight and obese children are likely to stay obese into adulthood and more likely to develop noncommunicable diseases, like diabetes and cardiovascular diseases, at a younger age,” the United Nations Children’s Fund commented some years back.

“People who were obese as children are more likely to be obese as adults,” explains The Merck Manual of Medical Information, “largely because when weight is gained during infancy and early childhood, new fat cells form. People who become obese during childhood may have up to five times more fat cells than people who maintained a normal weight.”

The world is noticing it. “We’re in the midst of an obesity epidemic,” decries Dr. John Foreyt, one of the world-renowned authorities on obesity. “We have to start in the young and develop healthy lifestyle habits, particularly in our dietary preferences, to prevent becoming obese…”

For most people, the condition of being overweight is easy to recognize. But medically, a distinction is made between being overweight and being obese. The body mass index (BMI) is used to define these conditions. BMI is weight (in kilograms) divided by height (in meters squared). Overweight is defined as a BMI of 25 to 29.9, and obesity is defined as a BMI of 30 or more.

“Body composition—the percentage of fat and muscle in the body—is also considered when obesity is defined,” says the Merck manual. “Women who have more than 30-percent body fat or men who have more than 25-percent body fat are considered obese.”

Obesity comes from the Latin word obesitas, which means “stout, fat, or plump”. During the Middle Ages and the Renaissance, obesity was often seen as a sign of wealth, and was relatively common among the elite.

It was the Greeks who first recognized obesity as a medical disorder. Hippocrates wrote: “Corpulence is not only a disease itself, but the harbinger of others.” The Indian surgeon Sushruta (6th century BCE) related obesity to diabetes and heart disorders.

Throughout history, many cultures have viewed obesity as the result of a character flaw. The fat character in Greek comedy was a glutton and figure of mockery. During Christian times food was viewed as a gateway to the sins of sloth and lust. In modern Western culture, excess weight is often regarded as unattractive, and obesity is commonly associated with various negative stereotypes.

Today, obesity is now more of a life and death issue rather than just simply looking “bad”. As Dr. Nick Finer, an American endocrinologist, puts it: “Obesity must be considered as an important medical issue. A catalogue of diseases are caused and exacerbated by obesity.”

There are several reasons a person becomes obese. If your father or mother or both parents are obese, there is a tendency that you will become obese too.

“Obesity tends to run in families,” the Merck manual said.

Studies show that genetic factors only contribute 25 percent to a person becoming obese. Most likely, an individual becomes obese because of the choices of foods he or she eats.

“Obesity results from consuming more calories than the body uses,” points out the Merck manual. This simply means that if you consume more calories than your body can burn, you will gain weight.

The tricky part of the equation is that some people metabolize food differently from others. Why this happens is complex and not entirely clear to researchers, who continue to be surprised by each new finding. For instance, one recent study concluded that heavy people actually burn calories faster than underweight people because their metabolism speeds up as they put on pounds, and slows if they try to take them off.

“For obese people, the average-sized meal really isn’t filling,” says The Medical Advisor: The Complete Guide to Alternative and Conventional Treatments. “Not only do these people have more fat cells sending out signals for food, but their faster metabolism burns more calories, as well.”

Drinking alcohol can contribute to obesity. “Alcohol tends to increase the number of calories taken in because it is usually consumed in addition to food,” the Merck manual explains. “A single shot of liquor has 80 to 90 calories. A 12-ounce regular beer, which is about 8 percent alcohol), has 150 calories. As soon as alcohol is consumed, it is used as energy, causing the calories from food to be stored as fat.”

Physical inactivity is one of the main reasons for the increase in obesity among people in affluent societies. It is also a common cause of obesity as people age.

A new study, however, points out that weight gain is caused primarily by dietary and lifestyle choices rather than age.

The study, which appeared in New England Journal of Medicine, says adults gain weight as they age because of taking extra servings of foods, such as potato chips, French fries and sugar-sweetened drinks.

Other contributors: decreased intake of fruits, vegetables, whole grains and other minimally processed foods; less physical activity; more time spent watching television; and poor sleep habits.

Dr. Ricardo Fernando, a member of the Philippine Society of Hypertension, traced the current problem of obesity in the country to Filipinos’ passion for food. “We are almost following the practices in Western countries where our local fast-food chains offer upsized food and drinks,” said Dr. Mia C. Fojas, of the Philippine Association for the Study of Overweight and Obesity Inc.

But all is not lost yet. The new report highlighted some effective interventions. “Low glycemic, low calorie, low fat and low carbohydrate diets, as well as regular exercise, have shown to be the most promising in reducing obesity at both the individual and population levels,” the report said.

It also suggested that local governments should identify specific problem areas in which they can step in with initiatives to increase the level of physical activity.

“Within the industry, global food manufacturers have also been continuously innovating to offer affordable and healthier food products with fortified minerals, as well as lower salt, sugar and fat content,” the report noted.

“There is no magic formula to solving the growing obesity epidemic in Asia. Governments in the region need to realise that obesity will be the number one healthcare challenge that we could face over the next two to three decades,” ARoFIIN Secretary Bruno Kistner pointed out.

“Every sector has a role to play. There must be proper undertakings among industry, government and civil society—real progress can only be made by constructive, transparent and accountable engagement with all stakeholders,” he added.