Prevention Of Obesity Among Young Adults In Hong Kong: Strategies For Educational Programs

Background

1). Background

Obesity is one of the leading health concerns on a global scale at present due to its high prevalence as indicated by statistical figures. The condition has been associated with an augmented risk of chronic diseases such as cardiovascular diseases, diabetes, cancer, asthma and hypercholesterolemia. Reports point out that that around 937 million adults are obese and around 396 million overweight adults across the globe. China has faced fast growth in the country’s economy in the recent ten years. This has led to major changes in the lifestyles of individuals and successive alterations in health patterns. The issue of growing prevalence of obesity is not confined among adults only. Children and young adults also contribute to the total number of obese individuals in the country to a significant extent (Hu et al., 2017).

According to Zhang et al., (2016) childhood obesity has been linked with increased risk of obesity in adulthood that puts the individuals at risk of suffering comorbid conditions such as hypertension and dyslipidemia. Much to the consternation of healthcare researchers both developed and developing countries demonstrate dramatic increase in obesity prevalence in recent times. China is one of the largest developing countries and has joined the world obesity epidemic due to the rapid urbanization and economic growth. Hong Kong, an autonomous territory in South China has recently come into focus for the high prevalence of obesity among children and young adults. The prevalence of obesity among the youth and young adults in Hong Kong has drawn significant attention in the recent past. The obesogenic environment encompassing individuals aged between 18-25 years has been much discussed about recently due to the possible burden on healthcare system. According to national report, the Census and Statistics Department survey was noteworthy in bringing forward the issue of obesity among young adults. The survey in 2015 accounted for the obesogenic environment among the youth in Hong Kong. Around 13% of youth aged 18-24 had been suffering from obesity or overweigh condition in the time frame between 2004 and 2014. The extent of physical activity carried out by the target group was considerably less as per the reports, with the numbers between 51.3% and 61.1%. Coming to the overall health condition of the population, it was noted that 1.3% had been suffering from a chronic disease, most of which are linked with obese condition (coy.gov.hk, 2015).

Sun et al., (2014) analyzed the prevalence of overweight and obesity among children in China as indicated between the years 1985 and 2010. The study mentioned that individuals aged between 7 and 18 years reported obesity and overweight condition at 8.1% (95% CI, 8.0–8.3%) and 19.2% (95% CI, 19.1–19.4%). The data holds prime importance in the present context since children who are obese in their early years have more chances of remaining obese in their adulthood. Further, the increase in public health costs on the longer run is also noteworthy.

Data gap

Much discussion has been put forward at different spheres to understand the contributory factors for obesity and overweight. The literature of Ho et al., (2013) point out that the obesity pandemic encompassing children and young adults in China has a distinct association with under-activity and over-eating. Further, obesity has been denoted as a socially patterned issue. The underlying concept is that socioeconomic status leads to a temporal rise. With the growing trends in urbanization there has a rapid change in the dietary intake of individuals. This, together with the lack of adequate physical exercise, has contributed to the patterns of weight gain among youth. Change in lifestyle has diminished the scope of engaging in physical exercises in the recent times. Advancement of technologies has been repeatedly blamed for the condition. Further, cultural belief that youth who have increased body mass are healthier has also contributed to obesogenic environment. Social misunderstandings regarding obesity being a predominantly genetic condition is also an issue (Thompson et al., 2015).

Analysis of the obesogenic environment in Hong Kong needs a robust framework that can successfully gain insight into the contributory factors for high prevalence of obesity. The Analysis Grid for Environments Linked to Obesity (ANGELO) has been pointed out to be a suitably defined and consistent framework that brings into limelight the key reasons behind the obesogenic environment. The framework can be perceived as the conceptual model that establishes a link between the fundamental elements of the environment connected with obesity. The four spheres that are considered for the analysis are socio-culture, political, economic and physical. The ANGELO is an efficient and flexible method of deciding upon a palan for obesity prevention in communities (Simmons et al., 2009).

Data gap

Obesity prevention initiatives in China have attempted to integrate different approaches derived from the understanding of the contributory factors of the condition. While research has strived to highlight the suitable measures for obesity prevention, gaps in data pertaining to different domains have been criticized often (Yang et al., 2017). Not much has been done to understand the extent to which educational programs are effective in bringing about health behavior changes among the target population. There is an urgent need of collecting accurate data on how educational programs can motivate young adults to adhere to a healthier lifestyle in future. Further, there is a need of understanding the impact of educational sessions on different age groups among the population.  

Goal for data collection

Prevention of obesity has been associated with changes in health behavior among the target population across literature from different countries. As pointed out by Zhang et al., (2018) educational programs have the potential to bring about changes in level of motivation and impetus to adhere to a healthier lifestyle. The researcher support that the underlying principle of educational programs is directed towards educating the individuals about the negative impact of obese condition. Reduction in obesogenic environment has been achieved in a number of countries after successful implementation of prevention programs focused on educational sessions.

Goal for data collection

Based on the above discussion it is imperative to state that the goal for data collection that can act as the basis for obesity prevention program would be to conceptualize the efficacy of educational sessions in bringing health behavior modifications among individuals aged between 18-25 years. The effectiveness of such sessions is to be studied in relation to motivation level of individuals to reduce intake of unhealthy food and adhere to a healthier dietary intake pattern. The sessions are to have the objective of promoting the importance of eating healthy and supporting self with nutritious food options (Hawkins et al., 2018).

Objectives and strategies

Objective 1

S- Evaluation of appropriateness and efficacy of an educational session in promoting the need of healthy dietary intake for preventing obesity  

M- Positive changes in motivational level of individuals aged between 18-25 years to demonstrate healthy dietary intake     

A- Data collection with appropriate tool  

R- Suitable changes in health behavior

T- One month

Strategy 1.1

Changes in motivation level to ensure healthy dietary intake on the basis of education imparted through the conducted sessions is to be measured for individuals in major high schools in Hong Kong. Data collection is to be done with a close ended questionnaire at the before the sessions and after the completion of the same.

Strategy 1.2

Changes in motivation level to ensure healthy dietary intake on the basis of education imparted through the conducted sessions is to be measured for individuals in major colleges in Hong Kong. Data collection is to be done with a close ended questionnaire at the before the sessions and after the completion of the same.

Strategy 1.3

Changes in motivation level to ensure healthy dietary intake on the basis of education imparted through the conducted sessions is to be measured for individuals in workplaces in Hong Kong. Data collection is to be done with a close ended questionnaire at the before the sessions and after the completion of the same.

Objectives and strategies

Objective 2

S- Evaluation of appropriateness and efficacy of an educational session in promoting the need of avoiding unhealthy food for preventing obesity  

M- Positive changes in motivational level of individuals aged between 18-25 years to demonstrate avoidance of unhealthy food

A- Data collection with appropriate tool  

R- Suitable changes in health behavior

T- One month

Strategy 2.1

Changes in motivation level to ensure avoidance of unhealthy food intake on the basis of education imparted through the conducted sessions is to be measured for individuals in major high schools in Hong Kong. Data collection is to be done with a close ended questionnaire at the before the sessions and after the completion of the same.

Strategy 2.2

Changes in motivation level to ensure avoidance of unhealthy food intake on the basis of education imparted through the conducted sessions is to be measured for individuals in major colleges in Hong Kong. Data collection is to be done with a close ended questionnaire at the before the sessions and after the completion of the same.

Strategy .3

Changes in motivation level to ensure avoidance of unhealthy food intake on the basis of education imparted through the conducted sessions is to be measured for individuals in workplaces in Hong Kong. Data collection is to be done with a close ended questionnaire at the before the sessions and after the completion of the same.  

Evaluation framework

Evaluation of the education sessions is to be done at the end of one month and at two weeks interval for next four months. Regular data collection would ensure that the data collection is apt. questionnaires are to be filled in by the participants that would have close-ended questions. Data collected through such questionnaires would be straightforward. Statistical data analysis would be easier for the same nature of data. The main advantage would be that the evaluation results would be produced promptly.

 2). 

Background

Poor nutrition is a silent emergency in many parts of the globe, as it emerges to be a significant public health concern in the respective countries. As an indicator of poor health status, poor nutrition has a drastic impact on the health conditions of individuals suffering from the issue, as well as on the economic and social development of the population. Poor nutritional status has been denoted to be a common cause of mortality and morbidity among certain populations across the world. Though Australia is making attempts to achieve good health status of the population, poor nutritional status has been drawing attention in the recent past, demanding an early response to address the issue (Cash et al., 2015).  

Selected issue

Research indicates that poor nutrition among Australia’s population is a key concern at present since the exact status remains under diagnosed and under recognized at different levels. The impact of poor nutrition is drastic on the individual suffering from it. Individuals suffer from physical and psychological impairment (Barker et al., 2011).  The researchers point out that malnutrition has a direct negative impact on the healthcare costs in the country owing to the nature of the funding system adhered to. An increased length of stay in hospital due to poor nutritional status is noteworthy. Further, healthcare providers are also subjected to increased work load and service provision burden. The repercussions suffered by the individuals are serious, as the key body changes include weight loss and comorbid conditions.

The prevalence of poor nutrition among the Australian population and the consecutive impact can be understood from the reports of Australian Institute of Health and Welfare. Poor nutrition has drawn the attention of public health researchers as 35-43% of patients suffer from poor nutrition when considered for providing treatment in different healthcare facilities of the country. The report pointed out that a survey carried out with eight residential aged care facilities denoted 32-72% of malnutrition prevalence. This finding was successful in highlighting the poor nutritional status of the individuals of the country (aihw.gov.au, 2012).

The economic burden of health conditions suffered in relation to nutrition had been noteworthy. The direct costs of nutrition related diseases in the 1990s were approximately $1.5bn. After addition of the indirect costs for lost earnings and premature deaths the amount is at $2.25bn. There is a lack of updated data on the same context. Nevertheless, the figures are likely to increase at the contemporary era (extranet.who.int, 2010).

Priority population and health determinants

Aboriginal malnutrition has become a national disgrace at the present times. It is a shame for the country that even though the country is a major food producer of the world, a significant number of Australians do not have access to adequate affordable and nutritious food. Research indicates that indigenous women have more chances of suffering miscarriages and low weight births as a result of poor nutrition. Almost 30% of the total indigenous Australian population report to have restricted access to nutritious food. Further, individuals belonging to the culturally and linguistically diverse (CALD) group are also at increased risk of suffering from poor nutrition. The underlying reason is that people from this population have limited access to transport facilities, and have low education level (aihw.gov.au, 2012).

Individuals from the lower socio-economic class have more chances of suffering from poor nutritional status in Australia (Bryceson et al., 2016). Individuals who are unemployed or come from poor economic households have limited access to nutritious food. The undeserved population lives in areas where lack of access to food underscores how the determinants of health influence nutritional status. In addition, those from single parent families also suffer from poor nutritional status owing to limited access to food and limited awareness level.

Effectiveness of strategies

The Australian Health Ministers had put forward the ‘Eat Well Australia’: An Agenda for Action for Public Health Nutrition 2000-2010, as a national nutrition strategy for combating the high prevalence of poor nutrition across the country. Further, the National Aboriginal and Torres Strait Islander Nutrition Strategy and Action Plan (NATSINSAP)’ was endorsed as the strategic plan for addressing the poor nutritional status of the indigenous population. The two strategies were implemented in such a manner that they complemented each other. The common goal was to bring remarkable improvement in the health status of the country’s population in relation to nutrition. The contribution of Strategic Inter-Governmental Nutrition Alliance (SIGNAL) in this regard was appreciable. The Eat Well Australia initiative had been set in place in collaboration with different other public health strategies. One of the most praiseworthy among them is the ‘Acting on Australia’s Weight strategy. Others include the National Mental Health Plan, the National Alcohol Plan, the National Diabetes Strategy and the National Breastfeeding Strategy (extranet.who.int, 2010).

A critical analysis is to be carried out for understanding the reason for limited success of the Eat Well Australia initiative. Bastian (2011) analyzed the effectiveness of the strategy through an interpretive approach considered in relation to the Bacchi’s method of problem representation. The key concern that was brought into the limelight was that Eat Well Australia initiative was ot successful to its maximal potential owing to different structural and economic barriers. In addition, inadequate allocation of human resources was a key reason for the failure of the strategy. Without the support from a robust healthcare professional workforce, it was not possible to implement the strategy in practice to the optimal extent. In addition, the professionals entitled with the tasks outlined in the strategy lacked professionalism and clear understanding of roles and responsibilities.

Australia had come forward to implement policies in the past aiming to improve nutritional status of individuals across the country. One such policy was the Food and Nutrition Policy of 1992 that had the focus on improving provision for nutrition. In spite of attempts made to enhance the provision of nutritious food for the communities, there existed certain drawbacks in the approaches made. The most noteworthy among these was the lack of focus on structural circumstances that were to be improved for improving the condition (Cullerton et al., 2016). Hegedus and Mullan (2015) in this regard had highlighted that policies implemented in relation to access to nutritious food lacked the support of social and cultural factors at the core level. The policies were not based on the cultural factors and social attributes that led to the limited access to care provisions in the country.

Willis et al., (2016) have highlighted that many individual states in Australia have implemented distinct strategies to address the concern of poor nutritional status. The primary aim of such strategies has been on treating the populations facing poor nutritional status in the country. One noteworthy form of initiative has been the support for communal meal provisions. The fundamental aim had been to put in place a robust provision for meal assistance in the communities. However not many initiatives have been put in place till data that encompass a robust nutrition screening for individuals at risk of poor nutrition status. Screening conducted for identifying individuals who suffer from malnutrition is imperative for carrying out a detailed assessment.

Recommendations

Since the aboriginal population is most vulnerable to suffer from poor nutrition, effective strategies are to be put in place that addresses the specific needs of the population. This entails a custom made approach that can adjust the nutritional strategies as per the specific needs of the indigenous population. Most of the indigenous population lives in remote and rural areas. The government must therefore come up with strategies that can be accessed by those living in the remote and rural areas. In this regard it is also to be mentioned that the CALD population must also be considered in this alignment (Edelman et al., 2017).

There is an urgent need of allocating funds for nutritional screening and assessment among different populations in the country. The government must come forward to spend more economic resources as well as appoint human resources for identification of the nutritional status of the population so that related nutrient requirements can be addressed. The findings of the screening initiatives are to be correlated with other health conditions to state a global determination. The screening would give a clear picture of the contributory factors of interest, the educational goals and need for future support. Additional systematic and comprehensive data collection methods are to be used in future for categorizing available data (Wenhold, 2017).

References:

Barker, L. A., Gout, B. S., & Crowe, T. C. (2011). Hospital malnutrition: prevalence, identification and impact on patients and the healthcare system. International journal of environmental research and public health, 8(2), 514-527.

Bastian, A. (2011). The future of public health nutrition: a critical policy analysis of Eat Well Australia. Australian and New Zealand journal of public health, 35(2), 111-116.

Bryceson, K., Fitzgerald, M., & Annison, G. (2016). ‘Stakeholder views in the development of food and nutrition public policy in Australia’. European Journal of Public Health, 26, 280-280.

Cash, T., Desbrow, B., Leveritt, M., & Ball, L. (2015). Utilization and preference of nutrition information sources in Australia. Health Expectations, 18(6), 2288-2295.

Cullerton, K., Donnet, T., Lee, A., & Gallegos, D. (2016). Exploring power and influence in nutrition policy in Australia. Obesity Reviews, 17(12), 1218-1225.

Edelman, C. L., Mandle, C. L., & Kudzma, E. C. (2017). Health Promotion Throughout the Life Span-E-Book. Elsevier Health Sciences.

Hawkins, S. S., Oken, E., & Gillman, M. W. (2018). Early in the life course: time for obesity prevention. In Handbook of Life Course Health Development (pp. 169-196). Springer, Cham.

Hegedus, J., & Mullan, J. (2015). Are we adequately providing support services for optimal infant nutrition in Australia? A study in regional NSW. Australian journal of primary health, 21(3), 293-298.

Ho, D. S. Y., Lai, Y. K., Lam, T. H., Chan, V., Mak, K. K., & Lo, W. S. (2013). Risk factors and outcomes of childhood obesity in Hong Kong: a retrospective cohort study. Hong Kong Medical Journal.

Hu, L., Huang, X., You, C., Li, J., Hong, K., Li, P., … & Bao, H. (2017). Prevalence of overweight, obesity, abdominal obesity and obesity-related risk factors in southern China. PloS one, 12(9), e0183934.

Policy – Eat Well Australia: An Agenda for Action for Public Health Nutrition | Global database on the Implementation of Nutrition Action (GINA). (2010). Retrieved from https://extranet.who.int/nutrition/gina/en/node/8511

Simmons, A., Mavoa, H. M., Bell, A. C., De Courten, M., Schaaf, D., Schultz, J., & Swinburn, B. A. (2009). Creating community action plans for obesity prevention using the ANGELO (Analysis Grid for Elements Linked to Obesity) Framework. Health promotion international, 24(4), 311-324.

Sun, H., Ma, Y., Han, D., Pan, C. W., & Xu, Y. (2014). Prevalence and trends in obesity among China’s children and adolescents, 1985–2010. PloS one, 9(8), e105469.

Thompson, A. L., Adair, L., Gordon-Larsen, P., Zhang, B., & Popkin, B. (2015). Environmental, Dietary, and Behavioral Factors Distinguish Chinese Adults with High Waist-to-Height Ratio with and without Inflammation–3. The Journal of nutrition, 145(6), 1335-1344.

Wenhold, F. A. (2017). Nutrition screening: science behind simplicity. South African Journal of Clinical Nutrition, 30(3), 5-6.

Willis, E., Reynolds, L., & Keleher, H. (Eds.). (2016). Understanding the Australian health care system. Elsevier Health Sciences.

Yang, T., Yu, L., Barnett, R., Jiang, S., Peng, S., Fan, Y., & Li, L. (2017). Contextual influences affecting patterns of overweight and obesity among university students: a 50 universities population-based study in China. International journal of health geographics, 16(1), 18.

Youth in Hong Kong A Statistical Profile 2015. (2015). Retrieved from https://www.coy.gov.hk/filemanager/template/common/images/archive/research

Zhang, J., Wang, H., Wang, Z., Du, W., Su, C., Zhang, J., … & Wang, Y. (2018). Prevalence and stabilizing trends in overweight and obesity among children and adolescents in China, 2011-2015. BMC public health, 18(1), 571.

Zhang, Y. X., Wang, Z. X., Zhao, J. S., & Chu, Z. H. (2016). Prevalence of Overweight and Obesity among Children and Adolescents in Shandong, China: Urban–Rural Disparity. Journal of tropical pediatrics, 62(4), 293-300.