Waistlines are growing in Vietnam, along with the rate of overweight, urban children. Is the country prepared to take on the coming obesity epidemic? By Michael Tatarski. Photo by Alex McMillan.

Even though Ta Thi Thuy Trang worries about obesity and related health problems, she lets her daughter eat junk food several times a week. And 10-year-old Tran Ngoc Phuong Thao, swayed by the colourful packaging and flavour, is happy to indulge.

The contradiction is common enough among Vietnam’s growing urban middle-class. Parents know their children need to eat well, but when there are so many dining options in the city, it can be difficult to deny their kids. Many of these adults grew up in times of famine, so they try to give their offspring everything they couldn’t have. And with one- or two-child households the norm, it’s that much easier to cater to the younger generation.

Trang tries not to give in, writing by email that “I usually cook at home with healthy meals,” including vegetables and fish, or snacks of fruit and milk.

But the numbers aren’t in her favour. According to Tuoi Tre newspaper, a survey of 15 local elementary schools in the 2009-10 school year found that 38.5 percent of students were obese, double the rate 10 years earlier. The study, by the Ho Chi Minh City Nutrition Centre, cited overfeeding by parents and physical inactivity as the two main culprits.

Relatively new to Vietnam, fast food chains have become hugely popular in recent years and will play a large role in urban health moving forward. In 2011 total fast food sales reached nearly $40 million, jumping 26 percent from the previous year. Burger King recently opened its first store in central Ho Chi Minh City, with more planned, and McDonald’s is expected to arrive in the next two years. Unlike in the west, where health problems associated with fast food are widely documented, many Vietnamese consider these restaurants high-end, and the ability to eat at KFC or Lotteria is a status symbol. KFC and Burger King declined to comment for this story.

As a result of these developments Michel Guillaume, a nutritionist in Vietnam for more than 20 years, worries about the future of children’s health. “Southeast Asians have extremely efficient metabolisms, much more so than westerners,” he says. “So when we give them junk food and KFC it’s a recipe for disaster.”

In his view, the solution to the problem starts with education, particularly of parents. “Education means the responsibility of being a parent,” he says. “It is not to concede to everything … If you love your children you have a responsibility to take care of them. Being a responsible parents sometimes means to say, ‘no’.”

Guillaume says an obese 5-year-old has a 90 percent chance of developing cardiovascular disease by age 30.

“This problem then becomes cross-generational,” he says. “When you are a fat 30-year-old man and you pass your genes on, your children are more likely to be obese.”

The World Health Organisation estimates that 16 percent of Vietnamese males will be overweight in 2015, up from just 5 percent in 2005. The respective figures for females are 24 percent and 13 percent.

Diabetes, one of the most common weight-related illnesses, gets little mention in Vietnam but costs the country millions. According to the International Insulin Foundation (IIF), a group that combats the disease in developing countries, Vietnam spends roughly $606 million on diabetes treatment annually. By 2025 the figure could be $1.1 billion.

For a variety of reasons, diabetes treatment in Vietnam is considerably more expensive than the international average. The IIF has found that it costs $876 annually to treat a Vietnamese child with Type 1 diabetes, a hefty sum when the country’s GDP per capita is $1,260. The number of people suffering from diabetes is expected to rise in the future, placing even more strain on families already beset with economic problems.

Of course, no discussion on children’s health would be complete without acknowledging the opposite end of the weight scale. In Vietnam, 34 percent of children under age five are malnourished, largely in rural areas, whereas obesity prevails in the cities. That puts Vietnam in the interesting position of figuring out how to provide more food to some groups, while convincing other groups to eat less.