Gaining a grip on childhood obesity

By Alistair Jones

SMU Office of Research & Tech Transfer – While global attention has rightly been focused on how to overcome the COVID-19 pandemic, another health epidemic has been quietly spreading for decades. It's one that's preventable, with evident causes and available remedies, yet we struggle to contain it: excess body weight.

According to the World Health Organisation, the prevalence of obesity has almost tripled since 1975. In 2016, more than 1.9 billion adults, 18 years and older, were overweight. Of these, more than 650 million were obese. The numbers continue to climb.

But obesity is not just a problem for adults. In 2016, more than 340 million children and adolescents aged 5-19 were overweight or obese. A more recent survey in 2019 found 38 million children under the age of five were also overweight or obese.

Health conditions associated with childhood obesity include cardiovascular diseases, metabolic syndrome, blood pressure, severe asthma and psychological distress.

How best to tackle childhood obesity is the subject of a research project led by Paulin Tay Straughan, Professor of Sociology (Practice) at Singapore Management University.

The study examined the social, cultural and environmental factors that influence parental styles and other agencies linked to childhood obesity in Singapore. In particular, it focused on nutrition and lifestyle.

The findings were fed into designing viable interventions to prevent and treat childhood obesity in Singapore.

And though Singapore’s childhood obesity rate is lower than many other high-income countries, the increasing prevalence of overweight and obese children during the past decades mirrors the global trend.

Switching habits

Obesity results from an energy imbalance when a person consumes more calories than their body burns. Hence, the prime villains are poor nutrition and insufficient physical activity. We know this, but why have we not been able to get on top of it?

“I suspect several reasons,” says Professor Straughan. “Many of us cannot see the invisible links of over-indulgence on weight gain until it is too late. By the time we get to the point where physical appearances are evidenced, it also means that lifestyle choices have been somewhat entrenched. And it becomes much harder to switch nutrition habits, for example.”

So it is important “to render visible between the lifestyle decisions we make every day and the implications on weight gain”, Professor Straughan says.

“For example, information such as how many calories we need each day, how much excess calories translate to weight gain, and reading nutrition labels on food items. All these are important tools that we can use to guide us. [But] therein lies the difficulties. The less educated are less likely to be able to navigate through all the data to make sense of it.

“Further, there is still a cultural myth surrounding the wellbeing of young children. There are still many who believe that a chubby baby is a healthy baby. So the visual check on a child’s wellbeing is contrary to what health promotion strives towards,” she adds.

Healthier options

Singapore has a track record in promoting anti-obesity measures for young people. Between 1992 and 2007, the Trim and Fit (TAF) schools program identified overweight students and assigned them extra physical exercise, including during recesses when their slimmer friends could be sitting and eating snacks.

TAF, known in the playground as fat club (TAF spelled backwards), was successful overall in reducing the obesity rate from 14 percent to 9.8 percent by 2002. But it came at a psychological cost of participants being stigmatised and, in some cases, reportedly diagnosed with eating disorders.

In 2008, TAF was replaced with the Holistic Health Framework for all students, with the aim of generating more interest in a healthy lifestyle. But by 2012, an upward trend in childhood obesity re-emerged. By 2014, the rate had reached 12%.

The TAF program highlighted the problems that can arise when obesity is regarded as an individual's problem, rather than a disease affecting a population. 

“I think it is important that we make changes to the larger social environment, so that the entire subgroup can be uplifted,” says Professor Straughan.

“[Such as] when the Health Promotion Board encouraged us to eat more vegetables, and all food stalls in hawker centres provide a 'more vegetables' option. Or that we can ask for less oil, less salt. This is one way of ensuring that healthier options are available to the masses.

“In particular, those from lower socioeconomic status (SES) backgrounds have more difficulty choosing healthy food options. Further, their work environment is also less likely to accord time set aside for exercise regimes. So the myth that all poor people are skinny is debunked when we see the stats that correlate rates of obesity and SES.”

The family dynamic

Children with obese parents and grandparents are more likely to develop obesity themselves. But it is hard to tell families that their parenting is not good enough.

“Well, this is always difficult,” Professor Straughan says. “I think the best approach is to first seek an understanding of the influence of their social environment on their lifestyle choices. For example, if there are no healthy food options available within walking distance in a low income neighbourhood, then one good way to shift attitudes and norms is to provide healthy options in the neighbourhood.

“Or build playgrounds and exercise stations so that there are safe options for kids to pick up healthy leisure activities.”

Professor Straughan and her team are making more a comprehensive examination of childhood obesity than other studies to date.

“We [have looked] at socio-environmental factors that shape parents’ attitudes and behaviour towards childhood obesity, particularly when parenting young children, 14 years and younger, and we have also looked at the children's perspective to provide a sense of how a teenager perceives their own wellbeing to contrast [with] the parents’ perspective,” she says.

As a general overview, a way of tackling obesity would be to make it easier to find time to exercise and to provide more options for healthier meal choices. 

Noting that we blame a lack of physical activity on a hectic work schedule, Professor Straughan posits “a good work-life balance so that we are free to make good decisions about our health and wellbeing”.

The research was funded by a Ministry of Education Academic Research Fund Tier 2 grant.

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