As mentioned in a previous blog, the rise in obesity across Asia is alarming and is fast reaching epidemic proportions in Malaysia.
When discussing the causes of obesity, you will constantly here different views as to why it is on the rise. Some people say it is simply genetics and it cannot be helped. Others say that it is a condition that affects the lower income groups within society.
The reality is, that it is a lot more complex. There is no singular cause of obesity, To help explain the causes of obesity, Prof Dr Bee Koon Poh, from UKM, and her peers developed a model that showed the determinants of obesity and their inter-relationships. The model was developed from analysing 15 studies from around the world.
Source: Etiology of childhood obesity conceptual framework
The first thing to note about the model is that there are many variables that can combine in many different combinations to cause obesity and overweight. The model places these variables into two quite distinct categories – unmodifiable and modifiable.
Unmodifiable are those determinants that you just have to live with, you cannot change.
Genetics are an unmodifiable cause of someone being more likely to have obesity. Single genes that cause severe obesity at childhood include deficiency of Leptin, POMC, and MC4R – these are associated with extremely high levels of hunger.
Ethnicity is another unmodifiable determinant of obesity. There are differences in the relationship between body mass index and percentage body fat among children from different ethnic background. These have constantly proven that Asian children have lower BMI and waist circumference compared to Caucasian children. Find out more on this topic specifically here: https://www.ncbi.nlm.nih.gov/pubmed/22941936
Modifiable Modifiable are determinants within an individual’s control. These determinants are very lifestyle centric.
Socio-economic status does play a role, as it impacts the lifestyle that we can afford to live. That is not to say that obesity is a condition of the poor. In Malaysia there is a high prevalence of obesity amongst the higher income sections of society. Greater disposable income has meant more spent towards fast food and eating out.
High income often comes with high pressure jobs, and parents unable to spend quality time with kids, leading them to become depressed and eat unhealthily.
Sleep, activity and food are the key modifiable ingredients to obesity. These are key to prevent obesity and are also the key to living healthier, happier and brighter lives.
Poor Food Choices (Diet ) Fast food and high intake of sugar have been identified as being the major determinants of the increase in obesity in Malaysia and across the world. Children are consuming more fast food items and carbonated drinks as compared to fruits and vegetables, as these food items are easily available through vending machines and school canteens.
Governments are realising the dangers of fast food and sugar and are taking action. In London, for example, fast food outlets are now paying what has been dubbed the “fat tax”. While in Singapore, there are plans to ban advertising of sugary and carbonated drinks.
Whether taxing fast food or making it difficult to advertise “dangerous” foods and beverages will actually have a significant impact, it is interesting to note that both of these initiatives are focused on the environment in which we live. They are not focused on changing people’s lifestyles and behaviours.
Less sleep more obesity Sleep plays an important role in the health of children as it helps in a child’s growth process. Children who sleep for shorter durations have lower energy intake and expenditure. This results in fatigue, daytime sleepiness, cognitive problems and low activity levels which contribute to sedentary lifestyles and obesity.
Physical Activity to drive metabolism
Physical activity has long been recognized as one of the important determinants of obesity. Human energy expenditure that has resulted from physical activity positively influences the metabolic rate. School children, especially those in Asian countries, have been reported to focus more on academics and are less involved in sports and physical activities. Getting Malaysian children to become more active in sports would have a major impact on obesity and overweight levels.
Multiple factors and multiple environments
What is telling about the framework is that parental determinants are included (correctly) as a major determinant. The phrase “Do as I say, not as I do” hardly ever works with kids. They learn behaviours from observing adults – especially adults that they look up to. One area that seems to be missing from the model, is the school environment.
Parents trying to change children’s behaviour at home and not being in control at school are unlikely to be successful, especially given the amount of time kids spend at school. There are many studies that show that educating and intervention at school can make an impact on obesity and overweight levels.
To fight the obesity crisis in Malaysia will require managing and improving many factors that impact a child’s behaviour. To successfully nurture a child’s behaviour is no easy feat!
The Vircle App and associated ecosystem is focused on assisting parents and schools to come together to nurture good food habits amongst children.
Making food a foundation for a successful life has to be a joint effort, with multiple stimuli playing a role.
Vircle is focused on doing this.