Extent and determinants of obesity in youth in China
Obesity is a global concern at the contemporary era, drawing attention of the public health researchers at different levels. Not only adults but children and adolescents in China are also contributing to high prevalence rate of the condition. There is a growing consensus that the drastic effect of obesity on mental, physical as well as social functioning among young individuals is noteworthy (Ko et al., 2008).
The Census and Statistics Department survey carried out in the year 2015 gave a clear picture of obesogenic environment among youth in Hong Kong. In terms of overall health status, almost 1.3% of young individuals aged below 25 years had been suffering from at least one chronic disease in the year 2014. Around 13% of youth aged 18-24 were found to be obese or overweight in the decade between 2004 and 2014. Further, more than a quarter of this population was underweight. It is to be brought into focus that the physical activity level of youths with age between 18-24 years in the years between 2005 and 2014 was around 51.3% to 61.1%. The level of physical activity was denoted as moderate. It was only after the year 2008 that the physical activity level witnessed an increasing trend (coy.gov.hk, 2015).
The study by Sun et al. (2014) examined the trends and prevalence of obesity among children among adolescents and children in the country of China between the years 1985 and 2010. It was found that age-adjusted prevalence of obesity and of overweight and obesity combined was found to be at 8.1% (95% CI, 8.0–8.3%) and 19.2% (95% CI, 19.1–19.4%) among children and adolescents 7–18 years in age. The risk of being obese was more in male RR, 1.93; 95% CI, 1.90–1.97), urban (RR, 1.99; 95% CI, 1.95–2.02), or 10–12 years (RR, 1.43; 95% CI, 1.40–1.46). The relation of this data to the present context is that obese children are likely to be at obese condition through their adulthood, suffering from the increased risk of adult morbidity and mortality.
Media articles published in China account for an increasing trend towards physical inactivity and western-style nutrition among the youth, leading to adverse health conditions. Lack of adequate physical activity has been highlighted to be the most significant contributory factor for obesity. Sedentary lifestyle is the key cause of lack of physical activity, which again is influenced by social factors such as busy academic or workplace schedule. Absence of suitable landscapes for engagement in physical exercises is also a driving factor. Young adults are often found spending times indoors in their leisure time and the advent of modern technologies has been repeatedly linked with this situation. Western-style nutrition is the need of individuals since most of the individuals in the age group of 18-25 years are in the nation’s workforces who are in search of convenient food (Liu et al., 2016).
Frameworks used to assess obesogenic environments
In spite of the understanding of the growing obesogenic environment across cities such as Hong Kong, there has been limited consensus on what makes up for the same environment that is under scrutiny. A suitable framework is essential for addressing the challenge of understanding the context of environmental research. The Analysis Grid for Environments Linked to Obesity (ANGELO) has been known as a cohesively defined framework that has the capability for highlighting the contribution of the environment in causing high prevalence rate of obesity and interpreting research findings. The framework acts as a conceptual model that helps in understanding the contributing factors to obesity. The fundamental framework divides the environment into micro and macro elements. The domains considered are physical, economic, political and socio-culture (Kirk et al., 2010).
There has been a lack of data that throws light on the driving factors that can motivate individuals aged between 18-25 activities to take part in increased physical activities and reduce sedentary behavior. It has been pointed out the data collection process is to be focused around the viewpoints and perspectives of the individuals themselves. The impact of educational sessions on the population has been less examined about. Minimal research has been done to explore the impact of educational sessions and programs on the mindset of individuals and their approach towards a sedentary and unhealthy lifestyle (Adair et al., 2014).
The importance of this absence of data can be pointed out to have a link with the fact that educational awareness brings in positive changes in health behavior. It is acknowledged that education program targeting particular populations can strive to reduce the prevalence of obesity. Educational programs have been indicated across literature to be sustainable and efficacious in guiding health behavior changes among individuals. In this regard it is to be mentioned that educational programs are to focus on the key negative impacts of obesity and the decline in wellbeing and health that a person can suffer. The implementation of educational programs in various settings has been fruitful in augmenting reduction of obesogenic environment in other countries. Community settings, schools, universities and workplaces, all act as potential sites for holding awareness programs (Zhang et al., 2018).
Goal
The goal would be to understand the effectiveness of educational sessions conducted with the target population of youth aged between 18-25 years in motivating the audience to shift from a sedentary lifestyle and take part in more physical exercise activities. Data would be collected in a quantitative manner to highlight the changes in viewpoints and motivation level to move away from the sedentary lifestyle. Data collection would be done at the beginning and end of the completion of the educational sessions so that changes in the attributes measured are highlighted appropriately. A close ended questionnaire would be used for data collection. The advantages brought about by this data collection tool would be noteworthy. It would be easier for the respondents to answer the questions included in the questionnaire. Further, the comparison of the answers would be easier in this approach. Statistical analysis after coding of data is possible in such a case, and in the present context, numerical data is of prime importance. Moving forward, the response choices can clarify the meaning of the questions for the respondents. Replication of the study in future would also be possible with such a data collection tool.
Impact of sedentary lifestyle and western-style nutrition on obesity
Objective 1
S- Evaluation of effectiveness of education program based on importance of shifting from sedentary lifestyle to an active lifestyle in educational institutes and workplaces
M-changes in motivational level to have an active lifestyle as denoted before and after the program
A-quantitative data collection tool
R-changes in health behavior
T-two months
Strategy 1.1
The first strategy would be to measure changes in motivational level to have an active lifestyle as denoted by data collected with the help of a close ended questionnaire before and after the program in high schools
Strategy 1.2
The second strategy would be to measure changes in motivational level to have an active lifestyle as denoted by data collected with the help of a close ended questionnaire before and after the program in universities
Strategy 1.3
The third strategy would be to measure changes in motivational level to have an active lifestyle as denoted by data collected with the help of a close ended questionnaire before and after the program in workplaces with young adult workforce
Objective 2
S- Evaluation of effectiveness of education program based on importance of engaging in physical activities in educational institutes and workplaces
M-changes in motivational level to take part in physical activities before as denoted before and after the program
A-quantitative data collection tool
R-changes in health behavior
T-two months
Strategy 1.1
The first strategy would be to measure changes in motivational level to take part in physical activities as denoted by data collected with the help of a close ended questionnaire before and after the program in high schools
Strategy 1.2
The second strategy would be to measure changes in motivational level to take part in physical activities as denoted by data collected with the help of a close ended questionnaire before and after the program in universities
Strategy 1.3
The third strategy would be to measure changes in motivational level to take part in physical activities as denoted by data collected with the help of a close ended questionnaire before and after the program in workplaces with young adult workforce.
Question 5
Overview
Australia is known to be one the world’s safest food suppliers as it provides sufficient nutritional food for facilitating diets minimizing risks of poor health outcomes. Nevertheless, a significant proportion of the country’s population is found to suffer from poor nutritional status. It is evident that the existing measures taken for curbing the growing condition are failing considerably to protect the best interests of the vulnerable segment. Immediate actions are to be taken for coming up with suitable preventive or interventional measures. Noteworthy improvements in quality of life of individuals and economic benefits are to be achieved through integration of innovative and evidence-based strategies into the system. The support of the local and federal government would be crucial in this regard.
Role of educational programs in addressing obesogenic environments
The issue
Poor nutrition is noted to be an under-recognized and under diagnosed healthcare concern in Australia. As a key public health concern it has led to much public discussion in recent times in the country. Healthcare researchers indicate that malnutrition is a silent epidemic in the country that affects 35-43% of patients hospitalized in different healthcare settings across the country. There is variation in the estimates of poor nutrition across the wider communities but recent studies have confirmed that the prevalence of malnutrition across eight residential aged care facilities was around 32-72%, bringing in focus the poor nutritional status of the country’s individuals. Malnutrition is having drastic implications on quality of life, leading to poor medical outcomes. The individuals facing the insidious condition are subjected to serious repercussions. Involving over-nutrition and under-nutrition, nutritional issues in the country are being repeatedly highlighted for increased public awareness. Under nutrition leads to muscle wasting and weight loss, whereas over nutrition is the cause of obesity (aihw.gov.au, 2012).
The burden of poor nutritional status is linked with the consequences for the patient. Poor nutrition leads to impairment at the psychological, physical and cellular level. It has been reported that poor nutrition is related to an increased length in hospital stay. In addition, patients are vulnerable to experience complications at the time of hospitalization. Coming to the consequences for healthcare facility, poor nutrition is a significant cause of stress for health care facilities. Malnutrition also brings in a direct impact on the costs of healthcare through case-mix funding system existing in most parts of Australia (Barker et al., 2011).
The Australian Nutrition Care Survey carried out in 2010 was effective in identifying that 30% of hospitalized patients suffer from under nutrition of which 6% suffered from severe malnutrition. Other studies carried out across the country come up with the estimation that the additional annual cost of caring for malnutrition patients in hospitals is about $1.6 to 1.8 million (Markovski et al., 2017).
Estimations of the direct cost of diseases related to diet in the 1990s attributed to nearly $1.5bn. This figure is increased to $2.25bn after adding the costs for premature death and costs of lost earnings. Though there is lack of current figures, chances are there that the figure would be more in recent years (extranet.who.int, 2010).
There is a clear indication that people belonging to the low socio-economic group, culturally and linguistically diverse groups and Aboriginal and Torres Strait Islander people are prone vulnerable to suffer poor nutritional conditions. Demographic trends in malnutrition are discrete and vicious. Poor nutrition has been time and again linked with food insecurity that is a direct measurement of nutritional issues. Reports suggest that 24% of Aboriginal and Torres Strait Islander people are subjected to food insecurity, that indicates the level of poor nutritional status (Tieleman, 2014).
Goal and objectives of the study
Around 30% of indigenous Australian report that they have limited access to food, which is a concern for nutritional status. Indigenous women are twice at risk of bearing infants with low weight at birth, which indicates a higher prevalence of malnutrition in pregnant indigenous women as compared to the general population of pregnant women in the country. Other subpopulations are those who are unemployed, low-income earners, are of less age and from single-parent households. Culturally and linguistically diverse (CALD) groups who have limited access to public or private transport, disabled people and those who are substance abusers sow more tendencies to become victim of food insecurity. Low level of intakes of folic acid, vitamin D, iodine, and iron are deficient in the mentioned subpopulations (aihw.gov.au, 2012).
The 1992 Food and Nutrition Policy marked a shift in the focus on nutrition from an individual focus towards a population health approach.
Despite this shift, many interventions within public health nutrition still focus on changing individual health behaviours rather than the social, cultural, environmental, structural and economic circumstances within which people live, known as the social determinants of health.
The 1992 Food and Nutrition Policy marked a shift in the focus on nutrition from an individual focus towards a population health approach. Despite this shift, many interventions within public health nutrition still focus on changing individual health behaviours rather than the social, cultural, environmental, structural and economic circumstances within which people live, known as the social determinants of health.
The 1992 Food
and Nutrition Policy marked a shift in the focus on nutrition from an individual focus towards a population health approach. Despite this shift, many interventions within public health nutrition still focus on changing individual health behaviours rather than the social, cultural, environmental, structural and economic circumstances within which people live, known as the social determinants of health
- The Food and Nutrition Policy of 1992 was noteworthy since it initiated a shift in the focus on nutrition from focus on individuals towards a certain population. Even though the shift towards a population health care approach was appreciable, a number of interventions still have the emphasis on change of health behaviors of individuals instead of cultural, social, economic and structural circumstances (Bastian, 2011).
- The Australian Health Ministers had endorsed the ‘Eat Well Australia’: An Agenda for Action for Public Health Nutrition 2000-2010, a national public health nutrition strategy, and the Indigenous component of ‘National Aboriginal and Torres Strait Islander Nutrition Strategy and Action Plan (NATSINSAP)’, as an action plan for poor nutrition status of the country. The two distinct strategies are known to complement each other for providing increased focus on improvement of nutrition-related health status of population. The National Public Health Partnership acknowledges the contribution that Strategic Inter-Governmental Nutrition Alliance (SIGNAL) had made in this regard. The aim of the Eat Well Australia strategy was to bring in a significant improvement in the health of the country’s population through improved nutrition.
- Eat Well Australia is linked with different public health strategies. The most noteworthy ones are ‘Acting on Australia’s Weight, the National Alcohol Plan, the National Mental Health Plan, the National Breastfeeding Strategy, and the National Diabetes Strategy’. It is built based on different health nutrition strategies of State jurisdictions together with the contribution and participation of different private organizations, government organizations and public health professionals (extranet.who.int, 2010).
- Different states of the country have come forward to implement a much needed inpatient malnutrition strategy. The key feature of such strategies is that they aim at combining nutrition screening, assessment and treatment addressing the target population of at risk individuals. Initiatives for supporting nutrition had been introduced for facilitating increased oral intake of patients. Such assistance includes communal dining, and volunteer meal assistance. The aim of the latter is to help at risk individuals with meal-time set up and socialization (Pettingill, 2016).
- Bastian (2011) had undertaken a decisive analysis of the Eat Well Australia initiative for highlighting the future of public nutrition status. An interpretive approach was taken for examining the strategies offered within the framework of Bacchi’s method of problem representation. The key concerns related to the initiative were well highlighted. It was highlighted that the economic, structural and social barriers are to be removed for enabling optimal outcomes of the strategy. It was further clear that the unclear delegation of tasks and absence of proper division of roles, lack of human workforce and dedicated resources were the cause of failure of the strategy.
- In 2010, the Western Health had considered introducing the ‘Dining with Friends’ program with the underlying concept of forming a supportive and encouraging communal dining environment in subacute and aged care settings.. It was inferred from the program that there is a need of future research for analyzing the influence of nutrition programs on individual outcomes. The main factors that are to be assessed are complication rates like hospital acquired malnutrition, progression of identified malnutrition risk, incidence of pressure injuries, infection rates, and length of stay (Markovski et al., 2017).
- Build the evidence for intervention- There is a limitation in research that point out the exact scope of nutritional interventions and programs. Detailed data is required about the exact prevalence of poor nutrition status in the country. Allocation of funds is required for carrying out research on a wider demographics basis. Inputs from multiple organizations, agencies and bodies would be crucial in this regard. Amalgamation of reports prepared by these stakeholders would ensure that a thorough needs assessment is carried out in future.
- Develop capacity of the workforce- There is an urgent need of building capacity of healthcare professionals who can address the increasing demand of country’s population regarding nutritional interventions. Involving nutritionists, dieticians, and allied healthcare professionals to educate individuals about the importance of proper nutrition would be a key approach. The contribution of the government in this regard would be to allocate funds for advanced training to be given to the professionals since current provisions are inadequate.
- Tailored approach for Aboriginals- A tailored approach is needed for adjusting the present nutritional strategies for the indigenous population. The underlying rationale is that this segment of the country’s population contributes majorly to the total poor nutrition burden. It has been repeatedly highlighted that the needs of this population are different from the non-indigenous population. The Dietetics Association of Australia (DAA) needs to advocate for the approaches that focus on remote service provision. In addition, the CALD population is also to be given tailor made interventions for improving the provision for better nutrition (Baum, 2016)
References
Adair, L. S., Gordon?Larsen, P., Du, S. F., Zhang, B., & Popkin, B. M. (2014). The emergence of cardiometabolic disease risk in Chinese children and adults: consequences of changes in diet, physical activity and obesity. obesity reviews, 15(S1), 49-59.
Australia’s food & nutrition. (2012). Retrieved from https://www.aihw.gov.au/getmedia/0c26b145-81fa-4a94-af38-d52515885a07/12504.pdf.aspx?inline=true
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.
Baum, F. (2016). The new public health (No. Ed. 4). Oxford University Press.
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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.
Tieleman, L. (2014). Health and Nutrition in Australia. Retrieved from https://futuredirections.org.au/wp-content/uploads/2014/06/FDI_Strategic_Analysis_Paper-_Health_and_Nutrition_in_Australia.pdf
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