Every January, scores of people storm the doors of their local fitness studios. Their will is resolute, their aim simple — to finally get into shape, as they had promised themselves at the stroke of midnight on Jan. 1. Yet weeks later, the resolve behind this tide will have ebbed away, as old habits reassert themselves. Such is the reality of modern life in the early 21st Century, a life defined by long stretches of physical inactivity and the ready availability of food high in calories.
It was not always this way. Not many generations have passed since physical toil and nutritional insecurity defined life across much of the world. Today, a growing percentage of people struggle with being overweight and obese. In fact, the World Health Organization has found that being overweight and obese are linked to more deaths worldwide than being underweight, as most of the global population resides in countries where being too heavy kills more people than being too thin. This list includes all high-income and most middle-income countries. In this context, we have surveyed the 10 “fittest” countries in the developed world, as measured by obesity figures published by the Organization for Economic Co-operation and Development (OECD).
The WHO defines being overweight and obese as “an abnormal or excessive fat accumulation that may impair health,” as measured by the Body Mass Index (BMI), a height-to-weight ratio in which the weight of a person in kilograms is divided by the square of his height in metres. An individual with a BMI that is equal or greater than 25 counts as overweight, a person with a BMI equal or greater than 30 is considered obese.
In 2014, more than 1.9 billion adults qualified as being overweight. Of these, more than 600 million were obese, according to the WHO. Notably, it has found that global obesity rates have more than doubled since 1980. Statistics of this sort have led researchers to speak of an obesity epidemic whose annual financial cost alone has reached $2 trillion, according to a report published by the McKinsey Global Institute in 2014.
Fundamentally, being overweight or obese constitutes an “energy imbalance between calories consumed and calories expended,” according to the WHO, which identifies two causes: an “increased intake of energy-dense foods that are high in fat” and an “increase in physical inactivity due to the increasingly sedentary nature of many forms of work, changing modes of transportation and increasing urbanization.” New research published in the Journal of Sports Medicine has since refined, if not complicated, this calculation by noting that excess carbohydrates and sugars, not physical inactivity, bear responsibility for the surge in obesity. Recent developments have sinced recognized this new thinking. The Canadian and U.S. governments have proposed new food-labelling measures that would help consumers identify added sugar in food products.
This commentary links obesity to socio-economic conditions and a number of scholars have investigated the societal dimensions of obesity by tracking it against measures such as gross domestic product (GDP), happiness levels and environmental sustainability. Scholars have found an initially positive relationship between rising BMI and economic growth. Research shows people living in poor countries with under-developed economies generally have low BMIs, as their main industries (agriculture, textiles and tourism) require hard, but low-paying forms of physical labour. Examples include countries such as Bangladesh and Burundi.
Not surprisingly, these countries also report relatively low levels of happiness and low life expectancies. In short, some people in those countries may be physically fit, but also may be poor and miserable, condemned to live short lives. It is for this reason that we have excluded developing countries. Their populations might be lean, but for all the wrong reasons. This means low-income countries can lift themselves out of poverty and unhappiness through economic growth, with long-term health benefits. As Garry Egger, Boyd Swinburn and F.M. Amirul Islam write, “[economic growth] has…undoubtedly been one of the single biggest influences on health improvements throughout human history.”
It is for this reason that we have chosen to focus on developed nations. Their economies can free their people from extreme physical toil and provide them the (potential) means to enjoy lives of leisure. But as Egger, Swinburn and Islam note, “by the law of diminishing returns, beyond a point, the benefits from continued economic growth start diminishing and ‘costs’ start arising.” They include obesity and environmental decline. The researchers came to this conclusion as they attempted to find the sweet spot where GDP is sufficiently high, CO2 emissions sustainable and BMI healthy. Unfortunately, they write, “it seems unlikely that any country has, or will ever pass through the theoretical ideal that we have proposed during its development.” That said, our list nonetheless shows that some countries are closer to this ideal than others.
1. Japan
Countries that compete to host Olympic Games continually claim the Games will inspire their citizens to get off the couch. This trickle-down theory of fitness argues that the prospect of hosting the games will push current and future generations of athletes to go faster, higher and stronger. Their preparations and subsequent performances will then rub off on the public. Olympic Games certainly provide governments with opportunities to encourage more physical activity, as was the case in Britain, whose government saw the 2012 Summer Olympic Games in London as a catalyst to raise low levels of physical activity.
Research published in The Lancet in July 2012 led the Guardian to call Britain the “third most slothful country in Europe.” Not much has changed since then, but the full verdict remains outstanding.
Research published in the aftermath of the 2010 Winter Olympic Games in the International Journal of Behavioral Nutrition and Physical Activity sums it up best: “The 2010 Olympic Games had no measurable impact on objectively measured physical activity or the prevalence of overall sports participation among Canadian children. Much greater cross-government and long-term efforts are needed to create the condition for an Olympic legacy effect on physical activity.”
Which brings us to Japan, where the Summer Olympic Games of 1964 inspired the annual Health and Sports Day, a national holiday during which communities across Japan stage mini-Olympics. First held in 1966, the Health and Sports Day is part of a larger agenda to maintain high levels of fitness in an aging society that condemns idleness. Armies of Japanese factory workers continue to perform calisthenics before work. As Laura Spielvogel writes in her analysis of Japan’s fitness culture, the “tremendous success of Japan’s post-war economy was built on the unflagging efforts of a physically fit workforce.” The Japanese government also meticulously tracks levels of physical activity among its citizens as it deals with the challenges of continued economic uncertainty and the greying of society. “Corporate managers and government officials recognize that by maintaining a high standard of health and fitness not only for company employees,” Spielvogel writes, “[but] for also for the elderly and their caregiving children, the health of the economy is assured as well,” True, this society-wide commitment to physical activity sounds foreign, even invasive, to western ears. Nor is it the sole reason for Japan’s low level of obesity of around 3.8 percent. Genetic factors and a fish-based diet that emphasizes portion control also account for it.
2. South Korea
As mentioned, research identifies a positive relationship between economic growth and body mass index (BMI) that eventually produces diminishing returns. The world’s 13th largest economy neatly demonstrates many aspects of this theory, at least when it comes to obesity. In the 1960s, South Korea’s GDP ranked alongside the GDP of poorer countries in Asia and Africa. South Korea has subsequently used an export-based strategy — exports currently account for roughly half of its GDP — to develop one of the world’s leading economies. In 2014, Korea’s total GDP was just under US $1.2 trillion.
While this development has undoubtedly lifted South Koreans out of poverty, it has also “resulted in considerable lifestyle changes, such as increased consumption of western food and sedentary behaviour with less physical activity,” a 2014 article published in the Journal of Epidemiology notes. One telling change is the popularity of e-sports, namely competitive video gaming. In October 2014, 40,000 South Koreans filled a soccer stadium in Seoul to watch two teams of five players compete for the world championship for League of Legends, a popular video game.
Millions more follow various e-sports leagues, if they are not playing video games themselves. Video game clubs rather than movie theatres have become popular destinations for couples, the New York Times reports. Accordingly, researchers have found a growing rate of obesity among South Koreans.
A 2014 study by South Korea’s National Health Insurance Service found the number of obese Koreans has gone up to 4.2 per cent in 2012 from 2.5 percent in 2002, with the rate of increase pronounced among men in their 20s and 30s. As of 2013, 32.4 percent of adult South Koreans counted as overweight, an increase of 60 percent. Peer-reviewed academic journals and other sources, including the OECD, confirm these findings. Obesity rates in South Korea may be among the lowest in the OECD, but have been rising steadily. Accordingly, South Korea’s government has taken steps to stop this trend. They include, among others, legislation to combat video gaming addiction.
3. Switzerland
The Swiss are getting heavier, but Switzerland still ranks among the most active countries. That is the conclusion from OECD figures published in 2014. They show that approximately nine percent of Swiss people qualify as obese, eight percentage points below the OECD average of 17.9 percent. This relatively low rate is not surprising. OECD figures show the Swiss have 7,142 hours of available leisure per annum. Their high economic productivity — Switzerland’s per-capita GDP reached almost US $58,000 in 2014 — gives them the financial resources to enjoy their time away from the office. Switzerland’s prosperity also allows the government to generously support measures that ensure and enhance access to various forms of recreation. Consider the numbers:
Approximately two out of three Swiss engage in either “active” or “moderately active forms” of exercise, according to a 2010 report by Switzerland’s federal office of public health. In its 2014 report, it found that the Swiss preferred sporting activities such as hiking, bicycling, swimming and skiing. The popularity of jogging and weightlifting has also increased. Nearly 25 percent of Swiss people regularly lace up their running shoes and one out of five hits the weights. Overall, the Swiss participate in more than 250 sporting activities. Of notable interest are OECD statistics that show the number of overweight Swiss children is below the OECD average. The International Association for the Study of Obesity reports that 19 percent of boys and 17 percent of girls are overweight or obese in Switzerland, compared with 23 percent of boys and 21 percent of girls in OECD countries. One likely factor behind this figure is Switzerland’s education system. It mandates that children receive three hours of compulsory school sports weekly.
No such measure exists in Canada, where only a handful of provinces mandate some level of physical activity among school-aged children. Yet, all of these figures come with caveats. Nearly one third of Swiss people do not engage in any form of physical activity. This has led the government to conclude Switzerland still has a “long way to reach the objective of an ‘exercising, physically active population’.” These findings also point to various differences in behaviour. Individuals with below-average incomes as well as immigrants are demonstrably less active compared with the rest of the population. Female immigrants appear to be particularly inactive.
4. Netherlands
Popular North American culture perceives bicycling as an expensive form of exercise popular among lean, Lycra-wearing members of the elite. The “perpetual insult machine that is Donald Trump” (Washington Post) riffed on this view last summer when he mocked U.S. Secretary of State John Kerry after he had broken his leg while cycling near Geneva, where he helped negotiate a deal to curb Iran’s nuclear ambitions. “I won’t be doing that,” Trump said. “And I promise I will never be in a bicycle race.”
Cycling’s elitist image is not without basis. Cycling is booming among the wealthiest Americans, who cycle for fitness, but also show off their bikes as “road jewelry” as Business Insider reports. This status-seeking does not happen in the Netherlands, where cycling is part of everyday culture, rather than an exclusive cult. Personal bicycle ownership is 100 percent among the Dutch, who regard their “bikes as trusty companions in life’s adventures,” according to the BBC’s Anna Holligan. Consider the following numbers. Figures from the European Union show bicycling accounts for 28 percent of all trips in the Netherlands. This rate rises to 70 percent in major cities such as Amsterdam, which consistently ranks among the most bicycle-friendly cities in the world. Holland’s flat terrain and dense urban space admittedly encourages cycling as a convenient transportation form.
Such conditions do not exist in most corners of North America, including Canada, where urban sprawl and inadequate infrastructure discourage cycling, with consequences for physical fitness. A 2010 article published in the American Journal of Public Health suggests a “significant negative relationship” between self-reported obesity and active forms of transportation such as walking and cycling. While the authors temper the significance of their findings, they nonetheless see them “as part of…mounting evidence on the health benefits of active travel.” The figures certainly confirm this. Almost 40 percent of Americans qualified as obese in 2011, the highest rate among all OECD countries. In comparison, the Netherlands reported an obesity rate of 11.4 percent.
Granted, the popularity of biking in the Netherlands does not singlehandedly account for this difference. But it is hard to deny its role in light of the following facts: The average American cycles fewer than 50 kilometres a year; the average Dutch citizen more than 860 kilometres, by far the highest rate in the world.
5. Norway
If cross-country skiing is Norway’s religion, Norwegians experienced a crisis of faith two years ago as the 2014 Winter Olympics in Sochi raced toward their end. Norwegian skiers had won “just” seven medals in eight cross-country skiing events, two fewer than their Swedish archrivals. Norwegian media used such terms as “catastrophe” and “disaster” to describe this performance and every Norwegian, including Prime Minister Erna Solberg, offered theories, most of which focused on the quality of the wax that either helps skis slide or grip snow.
A late push eventually redeemed the Norwegian cross-country skiers in the eyes of their 5.2 million compatriots as Norway tied Sweden with 11 cross-country medals, claiming victory on the strength of five gold medals versus Sweden’s two. Norway’s sporting honour was saved and so was its belief in what Norwegians call friluftsliv. This concept translates as “open-air living” and represents nothing less a philosophy that encourages people to immerse themselves in nature.
Academics have traced the practice of friluftsliv among Norwegians to their self-image as a people with a taste for outdoor activities. This image draws inspiration from a long history of living and surviving in one of the coldest corners of Europe. Archeological digs show humans have skied across modern-day Norway for several millenniums and the solitary harshness of their rugged country has instilled Norwegians with the necessary discipline and physical training to excel in endurance sports such as cross-country skiing and its cousin, biathlon. While eight out of 10 Norwegians live in urban areas, they are never far from the wilderness.
Cultural norms encourage children to play outdoors even on the coldest days and many adults commute to work on their cross-country skis during the long winter. In doing so, they engage in perhaps the most effective form of aerobic exercise, according to research published in the Journal of Applied Physiology in 2013. During the summer, Norwegians hike their countless mountains and nearly seven out of 10 own a bicycle, which they use for trips of varying lengths and purposes. Not surprisingly, Norway’s obesity rate hovers around 10 percent. In short, physical activity plays a central part in the day-to-day lives of Norwegians, first by necessity, now by choice.
6. Denmark
Participation at the amateur level is the name of the game in this Scandinavian country. Two million of its 5.5 million citizens hold membership in one of the country’s 14,000 sporting clubs, voluntary organizations of various sizes that offer a range of sporting activities to their members. The origins of these clubs date back to the first half of the 19th Century, when Denmark adopted the German model of the Turnverein (gymnastic club). These clubs have subsequently become an important part of Danish society, where they serve as practice grounds for the Danish version of consensual democratic governance that characterizes Scandinavia.
Sporting clubs receive considerable state support through national lottery revenues and municipal taxes, as part of an agenda to ensure broad access to recreation under the motto of Sports for All. One measure of this financial support is Denmark’s high number of sporting facilities per capita and most Danes think of access to public sports facilities as a “welfare right.” That said, Danish recreational tastes are changing. While popular support for the club system remains high, sports participation has shifted toward commercial sports organizations and other providers. Individual sports have gained in popularity. Denmark has also shifted resources toward elite athletes.
Overall though, the numbers show Danes are among the most active Europeans. Research published by the Danish Institute for Sports Studies in 2013 finds Denmark’s participation rate “has been on a constant rise” since 1964. In 2007, 86 percent of children participated in some form of sports or exercise — up from 84 percent — and adult participation has grown significantly since 2007, from 56 percent to 64 percent. Favourite activities among children up to the age of 15 include soccer (46 percent participation rate), swimming (38 percent participation rate) and gymnastics (27 percent participation rate). Notably, most children will engage in these activities through sporting clubs. However, Danish children have become less active.
Among adults, running has become the preferred activity, followed by strength training and walking or hiking. And since these activities are largely self-organized, they will often take place outside the club system, in public spaces or commercial facilities. These developments have raised concerns that socio-economic factors, such as income and education, will create barriers to physical activity. Accordingly, the Danish government has pushed for reforms to improve public facilities, access to recreational programs and physical education.
7. France
In his book, 1000 Years of Annoying The French, Stephen Clark mines the history between his native England and France with insight and humour to uncover an enduring love-hate relationship that manifests itself in almost every field.
Consider some of the reactions in the English media to new figures from the (WHO) that predict that three in every four men and two in every three women in the England will be overweight. Naturally, some British commentators immediately used the occasion to compare waistlines, only to discover disappointment. “It is very tiresome, but yet again the dastardly French thwart everyone, it seems, by their insistence on keeping slim at all costs,” writes The Independent’s Rosie Millard. “Even in the future, when Les Rosbifs are predicted to get a tiny bit slimmer, and Les Frogs a tiny bit wider, we still lead them by a lardy country mile in the fat stakes.”
Notwithstanding these clichés, Millard’s cheeky commentary is more or less correct. Figures from the OECD confirm obesity rates in France are among the lowest, at around 10 percent. The comparable figure for the England is 25 percent. So what accounts for this difference, despite French culinary choices that are high in cholesterol and saturated fat? Some theories have credited these choices for keeping the French (relatively) slim by pointing to the positive health effects of cheese and wine. Others have focused on how the French prepare and consume food. Mealtimes are cherished and the quality of food appears accordingly high.
French obesity specialist Jean Marc Catheline told National Public Radio (NPR) that the French obsession with food is exactly what has protected them against obesity. “The French know how to cook and prepare food,” he says. “French families have always known what’s good for them and what isn’t. We are also a country with strong rural traditions and great respect for food from the farm.” These aspects of French life have gained increased attention outside of France, including in England, where Millard has this advice for readers. “So, slim down by elevating food. Cook at home and wear chic clothes. Go a little French, in other words.” Yet French traditions are changing. As NPR reports, the “un-French habit of eating anywhere, anytime, seems to be catching on in France” and so are high-calorie processed foods.
8. Sweden
The geography of obesity in the developed world reveals three general patterns. First, it is high in English-speaking countries, as six out of the 10 most obese OECD countries have historical, linguistic and cultural ties to England. Second, it is high in North America, as the United States and Mexico top the OECD’s most obese list, with Canada ranking sixth. Third, obesity rates across Europe differ across regions, but are all pointing in the same direction — up.
Consider Northern Europe: Countries in this region, excluding England, generally boast the lowest obesity rates. This group includes Sweden, where the OECD reported an obesity rate of just below 12 percent. But new research points toward a spike in rates. The World Health Organization predicts that more than 25 percent of Swedish men and 22 percent of Swedish women will be obese by 2030. “Even in countries with traditionally lower prevalence of obesity, such as Sweden, obesity rates are predicted to rise sharply,” the WHO notes.
So what is going on? Why are Swedes following their slothful European neighours? First, let’s consider the good news. Research published in 2012 in the Scandinavian Journal of Public Health found that about two-thirds of Swedes are physically active for at least a half hour every day, fulfilling the minimum recommended physical activity requirement. But a closer look reveals Sweden’s population has become more sedentary. This development is particularly evident among Swedish children, as eight out of 10 fail to meet required levels of physical activity. Simultaneously, this research found that Swedish eating habits have “largely deteriorated” since 1980, but noted some recent improvements.
In short, Swedes are emulating their neighbours in central and southern Europe in exercising less and eating more. Peter Bergsten, a professor of medicine and cellular biology at Uppsala University, also points toward another possible factor in Sweden’s growing waistline: immigration. “Migration to the EU and between different countries is also an issue because it is making regional patterns less clear,” Swedish media quote Bergsten. “Europe is becoming more homogeneous, with different ethnicities appearing in all countries, and so there are more varied diets appearing in different nations…fewer differences between individual nations.” Bergsten noted in his remarks that different ethnicities possess different genetic predispositions toward obesity, but stressed researchers want to avoid fuelling ethnic prejudices.“These concepts are a little bit tricky to work with nowadays,” he added, “but we want to do more genetic research to work against prejudices and help people to be alleviated of certain problems and generally to be more healthy.”
9. Italy
Nutritional experts have long praised the Mediterranean diet — rich in olive oil, legumes, vegetables and fibre — as a model worthy of emulation. But recent evidence shows that the financial crisis gripping many countries in the region has altered their dietary habits.
Consider Italy. While it can claim a relatively low obesity rate, the economic turmoil of recent years has forced many families to replace healthy, but expensive, foods with cheaper, less healthy alternatives. Government statistics published in 2012 show that one out of three Italian households has cut food spending in terms of quality, quantity or both. These developments have deepened concerns about the obesity crisis sweeping the European continent, including Italy, where 36 percent of boys and 34 percent of girls qualify as overweight, according to OECD research that looked at the relationship between obesity and the financial crisis.
In fact, this research finds that the prevalence of overweight or obese children is worse in Greece, Italy, Slovenia and the United States than in the rest of the OECD. Overall, the OECD concludes that the “economic crisis is likely to have contributed to further growth in obesity.” The New York Times accordingly concludes that “Europe is discovering what many in the United States have known for a long time: When times are tough, one of the first things to go out the window is health and nutrition” in pointing to the experiences of low-income Americans, who have disproportionate levels of obesity.
So what is to be done? Research published in The Lancet argues that governments should do more to encourage preventative measures that focus on such things as diet and exercise. Instead, the opposite might be happening, according to a joint report by the OECD and the European Commission. It has found that governments have cut health-care spending. Between 2009 and 2012, health-care expenditures fell in half of the EU countries and significantly slowed in the rest. On average, health spending decreased by 0.6 percent each, compared with annual growth of 4.7 percent between 2000 and 2009.
10. Austria
Austria’s obesity rate of approximately 12 percent puts the alpine republic among the leanest OECD members. But this relatively favourable ranking obscures the declining importance of sports in a country suited for a wide variety of activities, be it skiing during the winter or hiking during the summer. “Lack of exercise is a massive societal problem,” laments Hans Holdhaus, the country’s leading fitness and sports scientist, in Der Standard. As director of the Institut für medizinische und sportwissenschaftliche Beratung (IMSB), Holdhaus has the evidence to prove this point.
A study of Austrian children conducted in 1999 revealed that they suffered from notorious weaknesses in co-ordination, general health defects, fear of movement, obesity and postural defects. Despite much talk, not much has changed since then, Holdhaus says. Followup studies found that Austrian children struggle to perform somersaults. To be fair, the Austrian government has recognized the severity of the problem. Gesundheit Österreich, the country’s national health planning office, calls the “lack of physical activity one of the greatest health risks of our time,” one that will only intensify in the future. Austria has responded to it by launching a number of measures. They include participation in a pilot project in seven cities, including Vienna, which fosters activities such as walking and cycling.
Dr. Wolfgang Depner has taught political theory and international politics at the University of British Columbia, Okanagan campus. He currently lives in Victoria.
