Levels of obesity in Morocco, the US and Japan – why the palpable differences?

I have, in conjunction with other expositions, touched on the subject of obesity. After my trip to Morocco, however, I felt that I wanted to add a couple of things in this respect and therefore I now write something very overall about the situation for Moroccans, although with a comparative outlook. Once again the US comes into the spotlight.

Here are some key facts from WHO about obesity in the world:

Worldwide obesity has nearly doubled since 1980. In 2008, more than 1.4 billion adults, 20 and older, were overweight. Of these over 200 million men and nearly 300 million women were obese.

35% of adults aged 20 and over were overweight in 2008, and 11% were obese. 65% of the world’s population live in countries where overweight and obesity kills more people than underweight. More than 40 million children under the age of 5 were overweight or obese in 2012. Obesity is preventable.

With regard to Morocco (and Tunisia), women tend to be much more obese, on average, than men, which this study shows:

Overall levels of obesity, identified by body mass index (BMI) ≥ 30 kg/m2, were 12.2% in Morocco and 14.4% in Tunisia. Obesity is significantly higher among women than among men in both countries (22.7% vs. 6.7% in Tunisia and 18% vs. 5.7% in Morocco) and prevalence among women has tripled over the past 20 y. Half of all women are overweight or obese (BMI > 25) with 50.9% in Tunisia and 51.3% in Morocco. Overweight increases with age and seems to take hold in adolescence, particularly among girls. In Tunisia, 9.1% of adolescent girls are at risk for being overweight (BMI/age ≥ 85th percentile). Prevalence of overweight and obesity are greater for women in urban areas and with lower education levels. Obese women in both countries take in significantly more calories and macronutrients than normal-weight women.


Figure 1 shows chronic energy deficiency (undernutrition) and obesity among women (age range 15 to 49 y) in NA, compared to sub-Saharan African and Latin American countries. Obesity is significantly higher than undernutrition in NA countries. Undernutrition (BMI < 18.5) is still high in the sub-Saharan countries where famine and food security are important factors. In Latin American countries, undernutrition and obesity coexist; obesity is less prevalent than in NA (9.4% in Peru, 8% in Guatemala, 9.2% in Colombia and 7.6% in Bolivia).

An important insight is to realize that undernutrition may co-exist with obesity in middle-income countries such as Morocco and many Latin American countries. A quite large share of their respective populations is still absolutely poor, but there are also parallel processes of emerging and growing middle classes – in conjunction with patterns of increased globalization and thus more import and diffusion of particular products – and consequently also greater access to relatively cheap food and drinks, especially carb- and fat-loaded foodstuffs. Hence, obesity goes hand i hand with some degree of national development.

Additionally, there are general national food-cultural dimensions to consider. For instance, the US has an obesity level of around 30% whereas Japan – another rich core country – account for only 3,5%. A massive difference indeed.

National food culture – even in the broader sense – alone cannot account for the differences between countries with similar levels of development, as measured by for instance HDI, but seems to explain at least a relatively large part in that respect. One can perhaps stress that many Moroccans, Latin Americans and Americans have no clear incentives to avoid obesity – even though there is an explicit slim-body ideal with regard to celebrities – whereas Japanese people in general are affected by both government policies and particular collectivistic ideals.

I know too little about Morroco, but the US is unhesitatingly quite individualistic and at the same time vastly heterogenous in terms of levels of income and in some senses even more so in terms of lifestyle. A large share of the middle classes and lower-income classes consume a lot of junk food, partly because of easy access to it, but also due to that a large share of other people within the same broad strata is also fat. To look more like an actor, actress or singer thus becomes something beyond reach, not even relevant to consider. Average Fat Joe will still marry Average Fat Jane (and they may live happily with their cellulitis ever after). Thus, the ‘rational’ choice for many individuals is to continue to eat crap excessively. That is partly how a vicious circle of this sort is created and entrenched.

Furthermore, of course one finds healthier nutritional patterns in Japan, with lesser amounts of calories within average people’s diets, compared to the US (and large parts of the Western civilization overall, for that matter). Rice thus beats French fries.