Childhood overweight is currently a significant health challenge not only in Hong Kong but also globally. In 2013 and 2014, primary school children had an overweight prevalence of 20% while that of secondary school children was 19.5% (Chan & Wang, 2013). Eating habits that encourage the consumption of fast foods, which possess high calories and fats, poor nutritional values, and high sodium intake, entail a major trend that explains the increased prevalence of the problem among young children in Hong Kong’s pre-school setting. For example, Yoshinoya, Jollibee, KFC, and McDonald’s among other fast-food companies have stores across Hong Kong.
Other risk factors for overweight include physical inactivity, especially during school hours, highly demanding academic-based curriculum, family-specific factors, and general misconceptions. Risk factors for overweight among young children are modifiable by contextual and environmental factors, including availing healthy foods in their recommended proportions. This paper argues that communities, families, and schools have a major role to play in the management of overweight among Hong Kong’s school-going children.
Analysis of the Possible Causes
Overweight and obesity refer to a condition of extreme and anomalous accumulation of fats that threaten one’s health. Hong Kong’s Center for Health Protection (2017) informs that obesity arises from an imbalance between the calories that people take in and the amount that the body manages to burn. The use of reference charts entails one of the ways of determining whether a child is overweight or not. Published by the World Health Organization (2017), the charts compare weight and height in a manner that any weight that is 20% higher relative to the median or mean value implies that a child is overweight. As shown in Graphs 1 and 2, boys and girls have different charts for determining whether they are overweight or not. Alternatively, one can measure a child’s stature and weight to compute the Body Mass Index (BMI).
In this case, if the quotient of weight in kilograms and the measured height in square meters is two (2) standard deviations higher than the World Health Organization’s median for growth standards as shown in Graphs 3 and 4, the child is regarded as overweight. A value greater than three (3) standard deviations of the WHO median for standard growth indicates that a child is obese.
Graph 1: Weight-for–Height (Girls 2 to 5 years (Z-scores)) Graph 2: Weight-for–Height (Boys 2 to 5 years (Z-scores)) Graph 3: BMI-for-Age (Boys Birth to 5 years (Z-Scores) BMI-for-Age (Girls Birth to 5 years (Z-Scores)
Overweight and Obesity have different causes. Alongside the increased rates of overweight and obesity among school-going children in Hong Kong, there is a rising infiltration of western world’s fast food culture. Families in Hong Kong are exposing kids to more energy and starchy take-away foods from home and fast food eateries (Zhang, Zhai, Du, & Popkin, 2014). Such restaurants form an important source of food consumed by people between the age of 2 and 17 years. Zhang, Van der Lans, and Dagevos (2012) assert, “The percentage of total calories derived from food consumed at fast food restaurants rose from 2% in the 1977-1978 to 9% during the 1994–1996” (p. 89).
The quantity of calories consumed at fast-food restaurants is mostly taken in higher-than-recommended portions, owing to their alluring tastes, expediency, accessibility, and affordability. Zhang et al. (2014) report a higher frequency of the consumption of fatty foods among 9-19-year olds.
Various scholars have argued that fast foods are closely associated with higher calorific, fats, nutrients, and sodium intakes and hence the higher chances of children developing obesity and overweight issues in Hong Kong (Ogden, Carroll, Kit, & Flegal, 2012). However, Zhang et al. (2012) attribute the higher weight gain to the increased fast foods intake during the transition age from adolescence to adulthood. Reinforcing this position, Ogden et al. (2012) inform, “Obesity tracks from childhood to adulthood” (p. 486).
This finding substantiates the claim that school-going kids in Hong Kong are at risk of being obese or overweight. From the above arguments, poor eating habits and food choices among children result in overweight and obesity issues. For school-going children, parents play a critical role in shaping their (kids) food preferences and choices.
For instance, they limit the number of food options available to children. Choices that favor unhealthy food alternatives increase the risk of being overweight and obese among preschool children. Parents help in transferring cultural norms to children. Hong Kong people believe in the traditional Chinese culture that embraces the misconception that “fat and white” is healthier compared to an average weight or body size (Zhang et al., 2014). Transferring such beliefs to generations implies that the problem of obesity in Hong Kong continues to grow.
Hong Kong’s curriculum is academic-intensive to the extent that children spend most of their time doing home works ( Lo, Cheng, & Wong, 2017). This situation causes them to have insufficient sleep and anxiety. In case young children have inadequate sleep, their brains trigger a search of starchy and sugary foods, which cause overweight (Zhang et al., 2014). Parents in collaboration with teachers may arrange for tutorial classes in the effort to increase their children’s educational attainment, thereby denying them the opportunity to engage in play with their peers. When free from the usual academic work, some kids in Hong Kong engage in sedative behaviors such as using computers, playing video games, and/or watching televisions. They have no time for physical activities. Likewise, in school settings, teachers may have little emphasis on physical education. Therefore, children have inadequate opportunity to engage in physical and motor activities.
Genetic and non-genetic factors cause obesity and overweight among young children. Some children have a genetic predisposition to overweight. This risk worsens when they share unhealthy lifestyles, for instance, physical inactivity and poor eating habits, with their family members. Smoking among pregnant women constitutes a non-genetic factor that is linked to higher childhood BMI (Chan & Wang, 2013). It alters the neuroendocrine system and metabolic processes, thereby increasing the weight of the unborn (Chan & Wang, 2013). Therefore, in Hong Kong, any successful intervention that seeks to promote healthy eating habits and increased physical activity should involve a multifaceted approach that involves different players, including parents, teachers and educators, and communities.
How Being Overweight Affects Hong Kong’s Young Children’s Well-being
Overweight has a negative outcome on children’s well-being. Chan and Wang (2013) argue that it is associated with chronic ailments such as type-2 diabetes and hence the need for an effective program for addressing the problem. In 2010, about 22% of all children (including the school-going ones) in Hong Kong was overweight, although the figure went down to roughly 21% in 2012 (Chan & Wang, 2013). Unfortunately, this number exceeds the 16% recorded 15 years ago.
The 2012 drop, as evidenced in Graph 5, may be explained by the government’s “Eat-Healthy” wellbeing promotion campaign. Although only about 200 schools participated, with only about 69 of them being considered ‘eating smart’ (Chan & Wang, 2013), such a campaign can go a long way in addressing the problem of childhood overweight and obesity in Hong Kong. The health promotion strategy has a direct correlation with endocrine, digestive, cardiovascular, respiratory, and musculoskeletal system diseases among young children (Gage et al., 2012). Overweight also has psychological health implications. For example, overweight children may suffer from stigma in schools and other socio-environmental contexts (Chan & Wang, 2013). Such children may view themselves as abnormal compared to average weight children.
Graph 5: Hong Kong Overweight and Obesity Detection Rate Among Primary School Students by Sex from School Year 2006/2007 to 2015/2016
Ways of Improving Children’s Well-being
Preschool teachers, parents, and communities have important roles to play in improving overweight and obesity-related health outcomes, especially where these parties collaborate in a community-based intervention for childhood overweight management. First, they must have the capacity to identify positively the commonness of obesity and overweight issues among children. However, for a positive identification of the problem, some training, especially on overweight, is necessary.
For example, Gage et al. (2012) carried out a study in Southern England with the aim of comparing general practitioners’ views and those of parents on the causes, significance, and the mechanisms for managing obesity and overweight. They also aimed at assessing the degree to which the study groups could effectively identify the problem of overweight in their communities. Gage et al. (2012) found a response rate of 33% with differences existing between the views of health officers and those of parents regarding childhood weight management. For instance, “roughly 87% of parents felt that the practitioners should be involved compared to approximately 74% of the health officers” (p.146). The study concluded that general practitioners in the English context required more training on the problem of overweight.
It suggested that a community-based intervention should focus on creating consistent awareness and sharing information on the causes and mechanisms for addressing the problem of obesity among children.
Since reduced physical activity correlates positively with increased obesity and overweight, preschool teachers can inculcate the values and importance of physical activity among young children from an early age (McEachanm et al., 2016). They can accomplish this goal by availing an array of “fun” options and mechanisms for enhancing motor activities in a secure play environment within school settings. Indeed, teachers should advise school-going kids to avoid sedentary behaviors, including playing video games, extensive television watching, and spending more time on computers. More focus should be on physical activities.
In fact, the time spent in sedentary activities directly predicts the potential amount of time a child is likely to use in physical activities (McEachanm et al., 2016). Preschool teachers also need to influence children’s eating habits by ensuring that school diets consist of less sugary and starchy foods.
Parents play an important role in shaping their children’s cognition levels and influencing their choices, including eating habits. In fact, Kothandan (2014) observes, “Children acquire their preferences for foods very early in life, and changing these preferences becomes progressively more difficult” (p. 5). Mother’s food preferences and choices, influenced by cultural heritage, reduce the choices of food available to children. This situation exposes children to the risk of adopting poor eating habits right from an early age. Consequently, parents have the responsibility of seeking nutritional health education from health workers. Such information may help in the selection of good eating habits for their kids, hence effectively reducing the risk of childhood obesity and overweight cases in Hong Kong.
Addressing childhood obesity and overweight in Hong Kong calls for the need to extend beyond personal, schools, and familial boundaries to include the community. Communities may be comprised of people who share common cultural artifacts, beliefs and values, and/or ethnic backgrounds. Membership to any one particular community should emphasize the protection and observance of shared values. Hence, in the context of childhood overweight and obesity, such values may include enabling children to grow and develop healthy lifestyles to promote their good psychological and physical development outcomes (Kothandan, 2014).
Here, kids are taught the need to inculcate and adopt social norms that support healthy lifestyles. Consequently, institutions such as Yoshinoya, Jollibee, KFC, and McDonald’s, which form part of Hong Kong’s community, need to not only incorporate healthy food alternatives into their menus but also reduce unhealthy food alternatives significantly in the quest to promote and respect the common interest of promoting children’s health outcomes.
Just like any other place in the world where the fast-food culture has already grown to be the norm, Hong Kong faces the problem of overweight and obesity among its preschool children. Poor eating habits, inadequate physical activity, genetic and non-genetic aspects, and poor nutritional choices in schools and homes are important factors that explain the problem of childhood overweight and obesity in Hong Kong. Although statistical findings indicate that the problem is now reducing compared to the situation in 2010, Hong Kong needs to adopt policy frameworks and community-based interventions to ensure that the problem of being overweight and obese among school-going kids is reduced to the 1990s levels.
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Preventing Young Children Overweight