Everything is Goreng

by Rebecca Distler:

That’s what Melna Saraswati, a communications officer at UNICEF, tells me. I’m sitting in her Banda Aceh office, listening to her describe Indonesian food: “Fried banana, fried sweet potato, fried everything.” Literally, goreng means “fried” in Bahasa Indonesia, but for the nearly 18 percent of Indonesians who are obese or overweight, it is a word symbolic of a rapidly changing diet and widening waistbands.

Often, people are confused upon hearing that I traveled to Indonesia to study obesity. For many, images of gaunt, malnourished children still drift through their minds when they think of developing nations; they often ask, “Does obesity even exist in that part of the world?” As our group explored Jakarta, many were surprised to see fast food restaurants lining the streets, some laughing aloud at the sheer number of them. We watched children make mad dashes for doughnut carts after school and found a Dunkin’ Donuts virtually everywhere we went.

The increase of obesity in developing countries is a phenomenon of particular importance on the horizon of global health: as obesity rates soar in countries traditionally afflicted by undernutrition, related illnesses—hypertension, diabetes and heart disease—rise as well. Many of these countries lack the necessary health infrastructure to deal adequately with the dual burden of nutrition issues and are likely to see increased pressure on already thin health resources.

In Indonesia, nutritional issues begin at birth. According to UNICEF, 36.8 percent of Indonesians suffer from stunting, undernourishment during youth and young adulthood that prevents them from reaching age-appropriate heights. Studies have shown that stunted children who consume high fat diets are more susceptible to becoming overweight than non-stunted children who consume comparable diets.

Obesity is cropping up in several different Indonesian populations. KFC is a popular spot amongst higher-income groups. Pizza Huts have valet parking. At the other end of the spectrum, street vendors mimic fast food delicacies, providing fattening treats for merely a few coins; some vendors offer “Acehnese Fried Chicken,” Banda Aceh’s street-food response to KFC. Traditional, home-cooked Indonesian cuisine has also become highly fattening because of increased access to cheap palm oil. People of all socio-economic backgrounds have been introduced to unhealthy food, and without education on the nutritional value of such foods, they are indulging in unprecedented numbers.

But this isn’t a tirade against fast food: It’s one about health policy, or lack thereof in Indonesia’s case. Dr. Ah-mad Syafiq, head of the Department of Public Health Nutrition at the university of Indonesia, explained that “obesity is a newcomer in the area of nutrition problems,” adding that politicians rally supporters by promising to combat malnutrition in their political platforms, while ignoring obesity. “It’s dangerous,” he said. “Politicians don’t know the full issue.” The Indonesian Ministry of Health has focused on malnutrition for so long that obesity is barely on their radar. According to the Indonesian Consumers Organization (yLKI), there is no national standard for nutritional labeling, preventing consumers from making healthy choices. Furthermore, no official data on obesity exists in Indonesia. Statistics vary, ranging from 13 to 39 percent of the general population, but most of the data is outdated or error-ridden. The Ministry of Health has no programs specific to obesity. According to Dr. Titi Sekar Indah, a nutritionist at the Central Pertamina Hospital in Jakarta, insurance companies will not pay for people to seek treatment for obesity because they believe it is “an aesthetic problem,” not a medical issue.

There have been improvements: In 1996 the Food Act was instated to regulate food labeling and advertising, though it lacked adequate nutrition guidelines for determining what is healthy. Nutritionists have begun using lower BMI cut-offs to define obesity, to encourage people to lead healthier lifestyles. But as Syafiq and his colleagues are finding, with the increase of fast food consumption, decrease in physical activity, and the globalization of processed foods, these steps are not nearly enough.

As I wait outside of Indah’s office at the hospital, her door opens, and a young boy with a round belly walks out with his mother. As Indah ushers me in, she tells me that the mother is very concerned about her boy’s weight, and worries that food advertisements are contributing to his weight gain. Indah sees more than 300 obesity cases per year, and while she offers nutrition advice and gives out diet plans, she understands that she will continue to see this trend grow until wide-scale policy changes are implemented.

Rebecca Distler ’12 is a Political Science major in Davenport College. Contact her at rebecca.distler@yale.edu.