A decade or so ago, an American tourist emerged from the tunnel to the old Star Ferry pier in Hong Kong, surveyed the teeming crowds and asked: “Where are all the fat people?”

Well, now they’re here. And not only here but thronging the world, according to a study by the Organization for Economic Cooperation and Development, which was released last week and which determined that more than half the people in 34 of the 36 OECD countries are overweight, and almost one in four of those people are obese.

Another study by the Hong Kong government shows that those obese in the territory has risen by 30 percent over the past 10 years for ages 15 to 84. A full 50 percent of the 6.5 million inhabitants are overweight or obese. In China itself, between 1985 and 2014, obesity in rural Chinese boys has grown from 0.03 percent to 17.2 percent, with obesity in for girls climbing from 0.12 percent to 9.1 percent. Urban Chinese boys aged 6 are 2.5 inches taller and 6.6 pounds heavier than 30 years ago.

Sadly that plays against a backdrop of evidence that the numbers of hungry people are growing, with 821 million people starving or suffering from malnutrition, according to The State of Food Security and Nutrition in the World 2018. After plateauing in 2011, malnutrition has once again begun to rise, particularly in South America and most regions of Africa, while the decreasing trend in undernourishment that characterized Asia seems to be slowing significantly. Another 150 million children are said to be stunted from malnutrition.

Climate variability affecting rainfall patterns and agricultural seasons, and climate extremes such as droughts and floods are among the key drivers behind the rise in hunger, together with conflict and economic slowdowns according to the report, by the World Health Organization.

“The alarming signs of increasing food insecurity and high levels of different forms of malnutrition are a clear warning that there is considerable work to be done to make sure we ‘leave no one behind’ on the road towards achieving the SDG goals on food security and improved nutrition,” the heads of the UN Food and Agriculture Organization, the International Fund for Agricultural Development, the UN Children's Fund, the World Food Program and WHO warned in their joint foreword to the report.

Paradoxically, at the same time those agencies are warning of increaasing malnutrition and starvation, the OECD report focuses on how to deal with the situation of obesity and overweight. And despite intensive drives by governments across the world to deal with increased obesity, nothing has worked. An additional 50 million people in the OECD countries have got fat since 2010, according to the study, titled The Heavy Burden of Obesity.

The increasing numbers of people who are fat in the OECD, which is made up of more wealthy countries, means the gross domestic product is being cut by 3.3 percent annually because of health problems linked to expanding waistlines which are pushing up workplace absenteeism and lowering productivity. Obesity is expected to cut three years off average life, according to the analysis.

On average, the document says, obesity is responsible for 70 percent of treatment costs for diabetes, 23 percent of costs for all diseases and 9 percent for cancers. High body mass index individuals cost more than US$200 per person additionally annually for medical treatment.

The morbidly obese now comprise a significant share of the population in the OECD and the EU, ranging from a low of 9.7 percent in Japan all the way up to 48.1 percent in the United States of obesity prevalence. As usual in fact, the United States is among the principal offenders and Japan is almost always at the healthiest end of the scale.

For instance, regarding obesity in children, Japan ranks at the bottom of the 20 nations in the study, with 3.3 percent of its children ranked as obese and 10.9 percent ranked as overweight. Some 21.4 percent of US children ranked as obese and 30.4 percent as overweight. The prevalence has been rising in an unbroken line in every single country surveyed.

The causes are manifold, ranging from richer diets to decreasing amounts of exercise. Smartphones catch some of the blame, with users freezing in position for hours at a time while they Google and goggle. At fault also is the United States Department of Agriculture’s 1992 publication of a food pyramid which went worldwide, both offering nutritional advice and marketing the products of US farmers which is widely considered to have failed the health test. It promoted the consumption of carbohydrates, de-emphasized fats and didn’t carry adequate warnings against sugar, possibly at the behest of sugar producers. Sugar has since been identified as a major culprit in obesity.

In addition, according to a Unicef report issued earlier this week, as many as 40 percent of children in Malaysia, the Philippines and Indonesia suffer from either overweight or underweight because despite their booming economies, parents who don't know enough about nutrition fill up their kids on cheap foods like instant noodles instead of healthy diets.

It is up to governments to campaign against obesity, with national action plans to tackle the problem the OECD report says. It identifies four categories of policies to tackle the problem, including food and menu labeling, regulation of advertising of unhealthy foods to children, and the promotion of exercise by doctors and schools. So far, as the report notes, virtually all of the OECD countries have such national action plans, with specific plans aimed at child obesity.

“Despite policies and action plans put in place b countries at a global level, overweight continues to be a pressing public issue and one of the key drivers of non-communicable diseases in OECD countries and beyond.”