Traditionally, cardiovascular diseases have been considered a "Western" disease or a "disease of affluence" and not a pressing public health concern for low-income populations. Ezzati and colleagues examined when interventions should be started by looking at the relationship between nutritional cardiovascular risk factors - overweight and obesity, and elevated blood pressure and cholesterol - and three economic indicators, using data for more than 100 countries.

They found that body mass index (BMI) and cholesterol increased rapidly in relation to national income, then flattened, and eventually declined. Cholesterol showed a similar pattern, but with some delay. The authors also found that as the proportion of people living in cities increased so did BMI and cholesterol, which may be due to changes in patterns of diet and physical activity with city life. Blood pressure levels were independent of the economic development.

The authors conclude that changes in patterns of living and with economic development and adoption of clinical interventions for blood pressure and cholesterol in high-income countries mean that the burden of cardiovascular risk factors is being shifted to the developing world; as a result, low-income and middle-income countries will simultaneously face the burden of infectious disease and cardiovascular risk factors.

Unless better interventions are pursued, we will face a world in which all major diseases are the diseases of the poor, the authors warn.

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He has since been campaigning to get healthier food in school vending machines and cafeterias, something Clinton said he would like adopt in his nationwide campaign.

Clinton, who struggled with his weight as a child, said the obesity problem, partly caused by a jump in snack food consumption, was stunting growth, affecting cognitive development and spawning type-2 diabetes, so-called adult onset diabetes, which is becoming increasingly common in children. He suggests another factor could be that more parents are working longer hours, meaning more meals are eaten in restaurants, which tend to serve large portions.

Clinton, 58, suggests that careful food preparation could reduce schoolchildren's consumption of sugar and fat by 45 calories a day which works out to 2 pounds (0.9 kg) of weight loss over a year, or 20 pounds (9 kg) by the time an early elementary schoolchild graduated from high school 10 years later.

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