In Egypt, more than a quarter of 4-year-olds are overweight. In Zambia, between 15 and 20 percent of the preschoolers are considered obese. And in Chile, more than 25 percent of children younger than 10 tip the scales at unhealthy weights, according to the London-based International Obesity Task Force.
Now considered a worldwide epidemic, "globesity" is spreading faster in developing countries than in the industrialized world, nutritionists say. The Westernization of diets is considered a key factor.
But the World Health Organization (WHO) is having difficulty persuading governments to do anything about it. The UN agency will present a global antifat strategy at a summit in May. But it has run into vocal opposition from developing countries - particularly from the sugar producers - and from Washington questioning proposed guidelines for fat and sugar intake.
That resistance has infuriated some food experts. "This is all clearly politicized," fumes Marion Nestle, head of the nutrition, food studies, and public health department at New York University. "It has to do with the sugar industry's panic that with the obesity crisis, people will start cutting back on carbohydrates. It is so obvious that large amounts of sugar are not good for your health."
Other scientists, especially those with ties to sugar producers, argue that there is no evidence to support the WHO's suggested ceilings. There is "a very real question of whether any numerical limits should be set" says Richard Cottrell, head of the Sugar Bureau, a research group funded by the British sugar industry.
Nobody disputes the obesity trend lines. The WHO estimates that 300 million people worldwide are obese, and one billion are overweight. (Obesity is defined as when a person's weight is 20 percent greater than the sex- and age-specific weight-for-height standard).It says diseases linked to obesity, such as cardiovascular disease, diabetes, and cancer, now account for about 60 percent of all deaths.
While the rise in obesity - especially among children - has sparked concern in rich countries, experts are more concerned about the trend in developing countries. India has more people diagnosed as diabetic than any other country, and obesity rates are nearing 20 percent in some Chinese cities.
"The whole world's diet is being Westernized," says Neville Rigby, director of policy at the London-based International Obesity Task Force, part of an umbrella research group with 10,000 members in 50 countries. "Poverty is part of the problem - fat and sugar are cheap products, and people are eating the wrong stuff."
At the same time, city-dwellers in the developing countries are leading increasingly sedentary lifestyles, taking buses or cars to work rather than walking or cycling, and generally getting less exercise.
In some countries - such as the Pacific island nation of Nauru, where 70 percent of the inhabitants are obese, according to WHO studies - lifestyle and dietary shifts have happened too quickly for people's bodies to adapt to the changes. Recent research suggests that habitual food scarcity breeds a "thrifty gene" which boosts the efficiency of people's metabolism. When food becomes more plentiful, and "people are exposed to a carbohydrate-rich diet they were not built for, they run into problems," says Josef Schmidhuber, an analyst with the UN Food and Agriculture Organization (FAO).
The growing incidence of overweight people in developing countries threatens to overwhelm fragile healthcare systems. Problems related to obesity cost the US $117 billion last year, according to the US Surgeon General: Few developing countries could pay that sort of bill.
The WHO is responding with what spokesman David Porter calls "a toolbox of options" to help governments set policies on diet, physical activity, and health.
The strategy offers the sort of dietary advice mother may have given you - limit sugar, fats and salt, eat more fruit, vegetables, and legumes - and encourages daily exercise. It calls on the food industry to cut back on the saturated fats, trans fatty acids, salt, and sugar in its products, and to label them more clearly. And it suggests that governments might want to impose "Twinkie taxes" that discourage unhealthy eating habits, or to regulate the way junk food is marketed to children.
Controversy has focused on a report by a group of independent experts that provides the scientific foundations for the strategy, and particularly on the scientists' recommendation that consumers should limit "free sugars" to 10 percent of their calorie intake.
Although this proposal is roughly in line with recommendations that many national governments, including the US, make to citizens, the idea has provoked uproar among sugar producers, who say that the evidence supporting such a ceiling is outdated or inconclusive. Riaz Khan, the head of the World Sugar Research Organization, wrote in a letter to the WHO that their report "does not meet expected modern standards for a scientific review" and would have "serious, detrimental and long-lasting effects on the agriculture and the economy of those countries."
Until recently, the United States has spearheaded criticism of the WHO strategy and science. But three US senators, led by Sen. Tom Harkin (D) of Iowa, complained in a letter to Health and Human Services Secretary Tommy Thompson that the US objections "largely mirror those raised by food industry trade groups," echoing allegationsthat the administration was defending US junk food producers.
Last week, at a meeting of the FAO, the US delegation presented a more nuanced position. Some observers suggest that the shift is merely tactical, since developing countries in the Group of 77 led the charge at the FAO. "The battle against obesity must be fought through better nutritional education and not by arbitrary quantitative dietary recommendations" said Fabio Valencia, the Colombian chairman of the Group of 77. "You cannot stigmatize one food product such as sugar," says Nestor Ponguta, a spokesman for Mr. Valencia.
"The sugar industry was lobbying like crazy" at the FAO meeting, says Mr. Rigby. "They were trying to put the 'frighteners' on the developing countries."
FAO officials, however, say the impact on sugar producers would be marginal. "The recommendations would take time to implement, and there are many countries, such as China, where consumption is way below the 10 percent figure, so there is room for more sales there," says Mr. Schmidhuber. At the same time, he adds, developing countries in the tropics could take advantage of increases in fruit and vegetable consumption that the WHO wants to recommend. "It could constitute a major export opportunity," he says.