Fast food: An issue of class, knowledge

By Jules Bell

Fast food, multinationals, mass production and marketing: What is this cocktail's impact on our health and environment? Should people be wary of the associated dangers of a fast and convenient lifestyle imported from the West? The Jakarta Post looks into the issue.

JAKARTA (JP): Today the Kentucky Fried Chickens, Pizza Huts and the golden arches of McDonalds blend unremarkably into Jakarta's urban landscape. The speed at which Western culture -- including film, music and nightlife -- swept though Indonesia during the 1990's, is perhaps no more evident than in the fast food industry.

Modernization has seen Indonesians take to Western fast food with a vengeance. For example, the number of McDonalds outlets now totals 70 across the archipelago, since the first outlet opened in Jakarta in 1991. While Western derived marketing practices promote fast food with fervor, franchises continue to mushroom throughout Indonesia's larger cities.

The regular crowds, lines and 24-hour accessibility of McDonald's outlet on Jl. Thamrin, Central Jakarta, exemplify Western fast food's popularity in Indonesia.

"I have a six-year-old son who always begs me to take him to fast food restaurants," said Arini, his 36-year-old mother. "He cries if we refuse," adding that as he is a growing child, she would prefer him not to eat McDonalds food.

So, is Western fast food detrimental to the health of people? Is it really that bad for you? It depends on which side of the counter you are standing, who you talk to and consumer awareness. The fact is, fast food can only damage your health if you can afford it.

According to Dr. Muhilal, director of the Indonesian Nutritional Research and Development Center, Indonesia is faced with a double burden. Socioeconomic class distinctions have created a nutritional juxtaposition for the country. Less wealthy people continue to suffer what used to be the primary health problems: infectious diseases and undernutrition. Iodine deficiency and anemia are the two leading manifestations of malnutrition for the poor.

Dr. Muhilal says the middle and upper classes with their modernized lifestyles, including an increasing tendency to consume fast food, are more prone to equally dangerous health problems. These include degenerative diseases such as heart and circulatory system diseases and obesity.

Prof. Kamanto Sunarto, a sociologist at the University of Indonesia, describes the fast food phenomena in terms of globalization and class structure.

"Everything becomes the same," he said, "the same food and fashion brand names". And the same diseases? "In a sense it is a form of globalization linked to multinational organizations and international food chains."

What is it then about fast food that makes it unhealthy, and how does it compare to traditional cooking?

In the opinion of Prof. Johanna Rumawas from the Southeast Asian Ministers of Education Organization (SEAMEO) at the University of Indonesia, and the Department of Nutrition in the university's School of Medicine, it depends on consumer knowledge about nutrition.

Healthy fast food is not an oxymoron, says the professor, who draws a distinction between meals high in fat and salt, such as fried chicken combined with french fried potatoes, and rice and salads. She stressed that an educated selection within the bounds of fast food is both important and possible, and that fast food is not necessarily always unhealthy.

Nutrition education needs to be given more attention. "The general population are not aware of what constitutes good nutrition. Fast food is relatively cheap, the service is fast and it tastes good," she said.

Fat content

This is an opinion shared by Evodia Iswandi, a nutritionist and specialist in public health, who promotes moderation. "(Fast food) is bad if you eat too much. Once or twice a month is all right," she said. "If you eat it everyday, then this is no good because of the fat content."

She said chicken nuggets have a 55 percent fat content, or 1,050 calories, almost half the recommended daily intake of fat. If you couple this with french fries and a coke, a "trendy food" lunch approaches 2,000 calories, she said. "It is not difficult to eat well with Indonesian food," suggesting gado-gado (boiled vegetables and peanut sauce) as an example.

Tuti Sunardi, a nutritionist and health food writer, further differentiates Western style fast food and traditional Indonesian cuisine. "If you compare the two, traditional food has an average of 20 percent fat," she said. "Modern fast food averages 40 percent fat, twice that of traditional food."

Lifestyle diseases are becoming increasingly problematic for Indonesia, stressed Dr. Muhilal. Citing a study that surveyed eating habits in 10 large Indonesian cities two years ago, he said, obesity, a major problem associated with overeating, had only marginally increased.

"There is a tendency for obesity to be a little higher, but I don't think it is a big problem yet." The other major lifestyle health problem is cause for more worry.

"Heart and cardiovascular (circulatory system) disease is now the number one killer of Indonesians, responsible for 23 percent of all deaths in Indonesia," he said.

So are hamburgers, pizza and fried chicken responsible for this? In the 1990s, diseases related to lifestyle choices have displaced those related to infectious agents as the leading cause of death in the country. Simultaneously, increasing modernization has been reflected in lifestyle practices.

It is possible to accuse, but difficult to state, that there is a definitive link between Western fast food and this emerging health problem for Indonesia, said Dr. Muhilal. He said stress and smoking were also relevant contributors to lifestyle diseases and there was very little data investigating the link between fast food and ill health.

Prof. Sumila from the Regional Center for Community Nutrition at the University of Indonesia adds to this holistic perspective.

"With modernization, women are also working. Therefore, families have more of a tendency to eat outside the home," she said. The professor said dietary intake overall was changing, and was reflected in menu patterns, the unconscious consumption of more fat and a more routine consumption of fast food in the upper classes.

Local fast food is not necessarily healthier though, said Prof. Sumila, referring to research in West Sumatra which found a causative link between the use of high fat coconut oil and cardiovascular disease.

Despite a consensus of expert opinion, there is an absence of research addressing the effect of Western fast food on an individual's health. This in itself is a problem, said Dr. Muhilal. "In the long-term, we should be afraid of increasing cardiovascular disease and over-nutrition."

Challenge

McDonalds, however, challenges any links between their food and lifestyle diseases.

"McDonalds does not cause heart disease or any other diseases, because our protein source is very pure and our food is fat free," said president of McDonalds Indonesia, Bambang Rachmadi.

So is Western fast food bad for Indonesians who can afford it? Eaten in moderation within a balanced diet, together with education about its nutritional value, perhaps not. At least that is the theory. In practice, a correlation between Western fast food consumption and the emergence of lifestyle diseases here is suspected but is yet to be established. Why is this the case when evidence from developed countries suggests that poor dietary habits are indeed one of the causative factors in lifestyle diseases?

It is therefore timely, considering the country's mooted economic recovery, that the Ministry of Health recently unveiled its new paradigm for the future. The central theme is a focus on prevention of disease and health education, including nutrition. Is this a positive step in diffusing what could be a potential health time bomb?