Balloon goes up on obesity problem

PUBLISHED : Tuesday, 12 July, 2011, 12:00am
UPDATED : Tuesday, 12 July, 2011, 12:00am


At 1.7 metres tall and 100kg, Jackson Lee, a freelance consultant has a Body Mass Index (BMI) of 34.6. That means he is morbidly obese.

Studies show that such a high BMI puts Lee (real name withheld for confidentiality reasons) at very high risk for life-threatening conditions such as diabetes, cardiovascular diseases, gall bladder disease, and gastrointestinal cancers. He could also suffer from other ailments such as sleep apnea, back pain, arthritis and infertility.

Worryingly, Lee is not alone. A recent study of some 30,000 people by The Family Project - an initiative sponsored by the Hong Kong Jockey Club Charities Trust in collaboration with University of Hong Kong's School of Public Health - found that one in two Hongkongers is either obese or overweight.

The survey is the largest of its kind in Hong Kong, says Professor Lam Tai-hing, director of the School of Public Health and the project's principal investigator. It's also unique because trained surveyors were sent to about 20,000 households to conduct interviews and obtain the data. Most other studies rely on participants to self-report, which may be less accurate.

There are no equivalent studies against which to compare the Project's data. But looking at the Centre for Health Protection's Behavioural Risk Factor Survey of April 2009, in which 38.7 per cent of people aged 18 to 64 were overweight or obese, the latest statistics suggest a marked increase in weight issues in the territory. 'If you look at the overall figure, it is very alarming,' says Lam.

Hong Kong's growing obesity epidemic is part of a worldwide trend. According to the World Health Organisation, obesity is the fifth leading risk of death in the world. It is considered a chronic but preventable disease.

Obesity also carries a cost to society. Dr Gary Ko Tin-choi, vice-president of the Hong Kong Association for the Study of Obesity (HKASO), wrote in the Medical Bulletin last year that obesity and its related conditions contributed an estimated 15 per cent to hospital admissions. Its related expenditure is expected to rise 47 per cent over five years.

The latest numbers reveal that more men (54.6 per cent) are overweight and obese than women (50.8 per cent). Dr Daniel Ho Sai-yin, assistant professor with the School of Public Health, says women are under tremendous cultural and social pressures to be slim. Studies have found that young males, on the other hand, prefer to have a larger physique and hence are likely to eat more and be at greater risk of being overweight.

From the age of 25, the figure for overweight and obesity in men nearly doubles, from 25.8 to 48.5 per cent. Women, though, are more likely to pile on the weight later - after age 35.

Lam suggests the timing of weight gain may be linked to different life stages. For instance, when young men leave school and start working, they have the means and the opportunity to choose their own food - this new-found freedom may contribute to poor food choices and weight gain.

On the other hand, women's priorities often change after marriage and childbirth, and watching their waistline becomes less important.

Men's weight gain also corresponds to the time their careers and work demands ramp up. A recent US study by researchers at the Pennington Biomedical Research Centre blames the changing - less physically demanding - workplace as a factor in obesity. It found that workers were expending 120 to 140 calories less a day compared to 50 years ago, which matched America's weight gain over the same period.

Marcus Chan (real name withheld for confidentiality reasons), 32, says that he turned to food to take the edge off stress at work. His weight ballooned from 80kg to 89kg in just half a year, raising his BMI to 29.1.

'The obesity phenomenon in Hong Kong is a relatively new problem that has surfaced in the past 10 to 15 years,' says Dr Chow Chun-chung, president of HKASO. 'The drastic changes are in lifestyle, and not genetic background. Chinese people generally do not have a propensity to be fat.'

Ho says: 'In the past when the population was poorer, the diet was mainly vegetable-based and you enjoyed meat or fish only on big occasions. Now, meat is served at almost every meal.' Almost four out of five Hongkongers fail to eat enough fruit and vegetables. The problem is linked to dining habits. Many people still eat out at least five times a week for breakfast (30.2 per cent) and lunch (51.5 per cent).

Affluence has fuelled growing appetites. 'People, including children, simply eat too much,' says Chow. And the combination of bigger portions of all the wrong foods is a double whammy.

Recreation has changed and now involves more kicking back than kicking a ball. A survey by the Education Bureau found that only half the students had any regular physical activity outside of school. But almost half spent four hours every day in front of a television or computer screen.

The scenario for the adult population is worse - three in four people do not engage in any form of regular physical activity.

Experts say legislation is crucial to the fight against fat. Laws for nutritional labelling on pre-packaged food, which took effect two years ago, are not wide enough, some say.

A lack of standardisation in how nutritional information is presented may confuse the public and hence limit its usefulness in helping people make healthy choices, says Lam.

Ho suggests an alternative. 'In addition to the nutritional information, we might want to use a simple 'traffic light system' where a red label is a warning, yellow is OK and green is good. That will make it easy for the public to choose,' he says. Advertising for unhealthy food could also be banned, he adds.

Lam wants tougher laws that stop the food industry misleading the public. 'How healthy are the 'healthy drinks' you see on the shelves? How much vegetable is in that vegetable biscuit?' he says. 'You need to have regulation that only allows the food manufacturers to claim their product is healthy if they can prove it.'

The Health Department's Eatsmart campaign, which started in schools in 2006 and included restaurants in 2008, has had an impact. The department says its survey in 2008 found that there were 'significant increases' in the proportion of students who chose healthier food compared to 2006.

'It takes at least 10 years to see the results of such programmes,' says Chow. 'Hopefully, we will see a drop in obesity by 2015.'

As for physical activity, experts say that increasing the energy output can be achieved easily, by commuting on foot and climbing stairs. 'Small changes can be very effective,' says Chow. 'Get off the bus a stop earlier, or walk to a restaurant 15 minutes away.'

The government can help by ensuring the connectivity of pedestrian walkways throughout the city. 'Make sure the streets are safe for walking, that they are properly lit at night, that people can easily walk to their destinations,' Ho suggests. 'Build lots of bicycle trails.'

Chow thinks that infrastructure needs to be built to properly support the obese. 'There needs to be a team of professionals to properly assess and treat obesity and its related conditions,' he says. 'We need a dedicated obesity centre.'

Ultimately, experts agree successful weight loss boils down to perception and motivation. Some people still think that obesity is mainly a cosmetic concern.

Says Chow: 'Obese people need to accept that obesity is a chronic disease like hypertension or diabetes that needs to be treated as one. Instead, the overweight turn to commercial weight loss centres that lure them with gimmicks and promise quick and easy results.'