Malnutrition, over-nutrition, and a prosperous China

The other week I had a chance to discuss nutrition with the doctors at my hospital. As we looked at beverages and snacks, many of them were surprised to see that the healthy choices they thought they had been making, weren’t so great. For example, every single one of the 30 doctors was shocked to learn that a bowl of instant noodles had twice as much sodium and much more fat than a grilled chicken sandwich from KFC.

The general agreement was that if they were misinformed about nutrition, than the public would probably be even less informed. A large part of the problem was that nutritional information was either absent or not in a standard, easy to understand format.

China’s urban areas are now facing nutritional problems similar to those seen in developed countries. Hypertension is one of the biggest killers in China, which isn’t surprising given smoking rates, but is also greatly influenced by the Chinese diet. Recent studies have showed that sodium consumption in China is nearly 3x higher than the recommended maximum of the WHO, and 50% beyond what the average American consumes.

Diabetes has also become a major concern in urban areas, rates of those affected are now similar to what we are seeing in the US. Childhood type 2 diabetes, something that was “unimaginable” in the US 30 years ago, is now appearing in both countries. One local doctor told me that she was currently working with two women under the age of twenty who had been diagnosed with type 2 diabetes. They reported that they had switched to drinking only iced tea and soft drinks, completely unaware of the repercussions it may have on their health.

Data from a presentation on diabetes in China and from the American Diabetes association*

Meanwhile children of poorer families in China, who are largely in rural areas, suffer from a variety of problems related to malnutrition. China has the second largest number of underweight children world wide (this is due partially to China’s massive population, and the fact that ~125 million Chinese still live on about $1/day). Additionally, 20% of rural children are anemic. Malnutrition has been linked to a number of physical and mental development problems, and as the author of the China study points out, it could easily be treated for a few cents per child per day.

When I worked in the countryside, college students were rarely taller than me, even though I’m not tall myself (about 5’7″), and you could tell just by looking which students came from rural areas. In Nanjing however, middle school students are regularly taller than me. The same was true even just visiting the cities of Guangxi, where people were both taller and fatter than in the countryside.

I believe this physical difference is a combination of proper/over nutrition in urban areas, and the steady flow of growth hormones that comes with eating more meat in China (there have been several scandals in connection with illegal growth hormones being fed to animals in China. This had caused several foreign athletes to bring their own food to China out of fear that they would test positive for steroids if they ate locally).

This visible gap between these two groups of people is a reminder of just how big the economic gap is in China. As China continues to develop, it will struggle with these preventable diseases. In urban areas it will lead to increasing health costs, and premature deaths. In the countryside though, poor nutrition will shape children’s futures and limit their potential.

Photo essay on rural lunch programs in rural China

*China numbers did not fully account for those who have not been diagnosed due to lack of access to health care, but US numbers do estimate for such cases. This partially explains the rural/urban gap in diabetes rates. US numbers are based on pop. over 20 years old. Total US average is 8.3%

5 responses to “Malnutrition, over-nutrition, and a prosperous China”

  1. Lorin Yochim says:

    It would be interesting to know more about this issue in terms of intra-urban and intra-rural differences.

  2. James says:

    They aren’t kidding when they say, “the flavor of North China is salt.”

    I wonder if anyone has compared average sodium intakes from North and South China. In my experience, the food in the North is much more salty than in the South, where it tends to be slightly sweet.

  3. weizhongli says:

    hello,TOM! i am very like reading your articles behond two weeks. you have told us esp chinese a
    bad reality so i am glad to know not just me think like this.but how to change the bad to good,can you
    give me a way? living in china living for money have hurt everything,if no changing to die or go to
    other freedom country. thank you ! tom for you true speaking and caring about chinese people.

  4. Anonymous says:


  5. anjalipareekar says:

    This blog is very insightful. Malnutrition is the main problem associated with the infants due to lack of nutritious food. MUAC is used to measure the circumference of the left upper arm. MUAC is mainly used to assess the nutritional status. Ibis Medical is one of the major manufacturers of the neonatal products which have a worldwide distribution network.

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