Overweight in Phnom Penh, no laughing matter

Phnom Penh (Cambodia), 19/12/2008. Physical exercise – here at the Olympic stadium – remains the best way to fight obesity, a growing problem among Cambodians
© John Vink / Magnum

Ka-set
By Corinne Callebaut
22-12-2008

In Phnom Penh, people are getting bigger, just like the cars or buildings proliferating in the capital city. Following in the steps of other Southeast Asian capitals, Cambodia's main city faces a health problem caused by physical inactivity, changing lifestyles, and high-fat and sugar diet. Malnutrition continues to take a terrible toll in the Kingdom. But in the urban context, it is taking the shape of an increase in people's body fat and does not just reflect a cosmetic issue. It is also contributing to the emergence of new health problems or the worsening of existing ones like diabetes.

Both children and adults affected by overweight
No relevant statistics are available yet in Cambodia. However, one cannot fail to notice that residents in Phnom Penh are gaining weight. In the capital, seeing children and adults with fat bellies is not uncommon any more. “I have worked in this school for five years and children have been getting bigger for the last two years at least”, Narith Preth, a teacher at the Newton Thilay School IV on Monireth Boulevard, observed. “Some of them have to wear uniforms twice as large as the usual size for their age!”

The same observation was made by Dr. Jacqueline Dicquemare, chair of the association Micadev (Mission Care Development Organisation). “Many Cambodians in the capital enjoy a better economic situation. They have less children but spoil them much more. Also, controlling their eating is seen as deprivation, which may stir up bad memories”, the endocrinologist explained, who regularly goes to the Preah Kossamak hospital for medical humanitarian visits. Scenes in swimming pools paint a similar picture. At the VIP water sports centre, an employee pokes fun at the “many flabby tummies” there, more than he had ever seen before.

"In some cultures, especially in Southeast Asia, being fat is associated with being rich and this is a problem", Trisha Dunning, professor of endocrinology at the University of Melbourne, Australia, explained. "In these countries, having diabetes can even be considered as a status symbol because it is seen as evidence of a person's ability to afford expensive high-sugar food, which is not necessarily true." 9-year-old Mae Li is already quite portly for her age, but she is rather proud of her paunch. "Some children sometimes make fun of me, but most of the time, they show me more respect. They know I eat good food because my parents are rich."

Physical inactivity and bad dietary habits
The problem is nowhere near as serious as it is in Western developed countries. However, doctors are starting to be concerned. For instance, Marc Frère, a French diabetologist-endocrinologist who also works for Micadev, is alarmed by the weight gained by Phnom Penh residents. “Only a few years ago, this problem did not even exist here. Now, you see more and more overweight people, children in particular. But actually, it is not really surprising. Everybody used to cycle around, but today most people drive motorbikes or cars, even to take children to school. People have settled into a more sedentary lifestyle.”

Jacqueline Dicquemare believes the problem also stems from new dietary habits. “People in Phnom Penh are less active physically. But they have kept their old dietary habits and continue to eat a lot of white rice. This is fine when people only eat rice. But it becomes a problem when they also have other food like eggs, meat, sugar or sweet drinks, the way wealthier people do.”

Health risks
The risk is real. Excess weight may cause a cosmetic problem, but most importantly, it is a significant contributing factor for diabetes, which many Cambodians already suffer from. “Cambodia already has a high incidence of diabetes, which is close to its level in developed countries”, Dr. Dicquemare said, “although the weak life expectancy in this country [around 60 years] should result in a lower number of diabetic people, as the much more frequent Type 2 diabetes is usually diagnosed among people who are forty and above”.

The expert also cited Canadian studies which “impute this high incidence to the so-called 'thrifty gene hypothesis'. It argues that within populations exposed to situations of food scarcity for several generations, people with a thrifty metabolism had a better chance for survival because they were able to maximise fat storage. However, in situations of abundance, the same individuals suffer from a propensity for excess weight and insulin resistance which sedentary behaviour only aggravates.”

Finally, the high prevalence of viral diseases like hepatitis or HIV/AIDS also contributes to the early occurrence and deterioration of diabetes. This makes the weight gain of Phnom Penh residents a serious cause for concern.

Undernourishment much more widespread
In spite of all this, no public health policy has been initiated yet in Phnom Penh. One of the reasons is that undernourishment and its continuing ravages in Cambodia are still keeping nutrition medical experts busy. In contrast, the issue of excess weight remains sporadic and only affects urban areas.

To Dr. Ou Kevanna, director of Cambodia's National Nutrition Program, “the issue does exist, especially since men are gaining weight due to a significant increase in the consumption of alcohol, including beer, and lack of exercise. However, our priority is to take care of children and mothers suffering from malnutrition, which is still responsible for too many deaths in the Kingdom.” Nowadays, about 50% of children in Cambodia – but up to 80% in rural areas – do not get enough food, a situation that has deteriorated in the last 15 years.

Phnom Penh residents take things into their own hands
People in Phnom Penh seem to become increasingly aware of their overweight problems. They are increasingly going to the gym but also to open spaces, like the gardens in front of the Ministry of Defence, the park of the University of Phnom Penh, or the Olympic Stadium. Mrs Pheap, a 30-year-old mother of three is one of these self-conscious residents: she weighs 183 lbs for 5.1 ft and has been coming to the stadium for the last two months to exercise to the sound of techno music. “After my third child was born, I suffered depression and gained a lot of weight. The doctor told me it was because I was staying at home without doing any exercise and that I was eating too much. He said all this fat was not good for my body, so I started to come here. I have already lost 26 lbs but I still need to lose 22 more!”

And she is visibly not an isolated case. “Many of my friends are in a similar situation. They have to lose a lot of fat”, she says. Further away, 57-year-old Heng Y has been practising sport for 14 years and notes that the stadium is always full nowadays. “Since 2003, more and more people have been coming here. I think people realised they have to take care of their body for physical and mental reasons.”

But it is yet to be seen whether this sporting fervour will be enough to curb the overweight trend in Phnom Penh and whether the Cambodian capital will successfully avoid following the example of its neighbouring countries. In Thailand, 7% of children under the age of five are overweight according to UNICEF, while a recent study showed that in Jakarta (Indonesia), 16% of preschool children from the wealthiest families were obese. Although Phnom Penh and Cambodia are not there yet, the warning in these statistics should be heeded.